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Esophagus and Stomach Esophagus And Stomach Gastrointestinal block-Anatomy-Lecture 3 Editing file Objectives Color guide : Only in boys slides in Green Only in girls slides in Purple important in Red At the end of the lecture, students should be able to: Notes in Grey ● Describe the anatomy of the esophagus; extent, length, parts, strictures, relations, blood & nerve supply and lymphatic. ● Describe the anatomy of the stomach; location, shape, parts, relations, blood & nerve supply and lymphatic. Esophagus ● It is a tubular structure about 25 cm long and is divided into three parts ● Extends from C6 (end of pharynx) → In the thoracic part it bends to the left but at the level of the sternal angle, aortic arch and left main bronchus push it again to the midline → Until it pierces diaphragm at T10 → Crosses the diaphragm for 1.3 cm to join the stomach in the abdomen = (end in the level of T11) 1 2 3 Cervical Thoracic Abdominal Relations Relations Relations Anterior: Anterior: Anterior: ● Trachea ● ● Left lobe of the liver ● Trachea Left principal bronchus ● Left Recurrent laryngeal nerve ● Recurrent laryngeal ● Left atrium and pericardium Posterior: Posterior: nerves ● Left crus of the diaphragm ● Bodies of Thoracic Vertebrae ● Thoracic Duct ● Azygos vein ● Descending Thoracic aorta Posterior: •Fibers from the right crus form a (end only) ● Vertebral column sling around the esophagus ● Right posterior intercostal arteries •At the opening of the diaphragm Lateral: Lateral: it’s accompanied by: ● Lobes of Thyroid gland - Right: - Left: ● Two vagi ● Left Mediastinum pleura ● Left gastric vessels ● Right Mediastinum pleura ● Aortic arch ● Lymphatic vessels ● Terminal end of azygos vein ● Left subclavian artery ● Thoracic duct 3 Clinical Aspects: Esophagus ● There’s a close relationship between the esophagus and left atrium. ● A barium swallow will help physicians assess the size of the left atrium (Dilation) in case of heart failure or long standing mitral stenosis 1. They might cause difficulties in The esophagus has 3 anatomic passing a gastroscope constrictions: Clinical Importance 2. In case of swallowing of caustic First one (16 cm): liquids (mostly in children), this is ● Located at the junction with where the burning is the worst and the pharynx strictures develop. Second one (23 cm): 3. Esophageal strictures are common ● Located at the crossing with place for esophageal carcinoma the aortic arch and left main bronchus The importance of this scale is that when a doctor inserts the Third one (38 cm) Constrictions gastroscope, they can know where ● Located at the junction with the levels of constriction is so they the stomach can move the gastroscope with caution 4 Esophagus Supply Arterial Supply Venous Drainage ● Upper third: inferior thyroid veins.(drains ● Upper third: inferior thyroid artery. into IJV) ● Middle third: thoracic aorta. ● Middle third: azygos veins. (drains into SVC) ● Lower third: left gastric artery. ● The lower third: left gastric vein (portal vein tributary) Nerve Supply Lymph Drainage ● Sympathetic: sympathetic trunks ● Parasympathetic: Vagus nerves - Left vagus becomes anterior to the ● Upper third: Deep cervical nodes esophagus. ● Middle third: Superior and inferior - Right vagus becomes posterior to the mediastinal nodes esophagus. ● Lower third: Celiac nodes ● Below the inferior root of the lungs the vagus nerve joins the sympathetic trunk to form the esophageal plexus 5 Stomach ● It is the most dilated part of the alimentary canal and roughly resembles the letter “J”. ● It is located in the upper part of the abdomen. ● It extends from beneath the left coastal region into the epigastric and umbilical regions ● Much of the stomach is protected by the lower ribs Relations Anterior Posterior (Stomach bed) 1. Left crus of diaphragm 1. Anterior abdominal wall 2. Left suprarenal gland 2. Left costal margin 3. Part of left kidney 3. Base of the left pleura 4. Spleen 4. Base of the left lung 5. Splenic artery 5. Diaphragm 6. Pancreas 6. Left lobe of the liver 7. Transverse colon and mesocolon 8. Lesser sac ● All structures on the posterior aspect are separated from the stomach by the peritoneum of lesser sac except the spleen which is separated by the greater sac 6 Stomach Parts Pylorus 2 Orifices 2 Borders 2 Surfaces 3 Parts Formation 1) Lesser curvature 1) Fundus 1) Cardiac Orifice 1) Anterior surface Tubular part of stomach lies ● Right border ● Dome shaped part that ● Gastro-esophageal (anterosuperior) in the transpyloric plane L1 ● Extends from the cardiac is full of gases sphincter 2) Posterior surface (1 cm) to the right of the orifice to the pylorus. ● Located to the left of (physiological) (posteroinferior) midline ● Attached to the liver by the cardiac orifice at ● Consist of circular lesser omentum the left 5th intercostal Made of: smooth muscles (gastrohepatic ligament) space just below the 1) Pyloric Antrum under vagal and apex of the heart 2) Greater curvature ● Extends from incisura hormonal control ● Left border angularis to the pylorus ● lies opposite to the 2) Body ● Extends from the cardiac ● Extends from Fundus 2) Pyloric canal left seventh costal orifice to the pylorus. to incisura angularis ● cavity of the pylorus cartilage 2.5 cm from ● At upper part it’s attached ● Incisura angularis is a the sternum to the spleen by 3) Pyloric Sphincter constant notch on the ● Prevents esophageal gastrosplenic ligament ● Thick muscular End lesser curvature ● At lower part it’s reflux (regurgitation) attached to the 3) Pylorus 2) Pyloric Orifice transverse colon by greater omentum 7 Stomach Supply (5) Arterial Supply (5) Venous Drainage (5) Runs on: Corresponds to the arteries and all of them drain in the portal ● Lesser curvature: vein Right gastric (hepatic artery of celiac) ● Right and left gastric drain directly into the portal vein Left gastric (a branch of celiac artery) ● ● Greater curvature: Short gastric and left gastroepiploic veins drain into the Right gastroepiploic (from gastroduodenal artery of hepatic) splenic vein ● Gastrosplenic ligament: ● Right gastroepiploic vein drain into the superior Short gastric arteries and Left gastroepiploic (from splenic artery) mesenteric vein 8 Stomach Supply Nerve supply Lymphatic drainage ● Sympathetic: derived from celiac plexus ● Parasympathetic: from both Vagus nerves ○ Anterior vagal trunk: Formed from the left vagus, ● The lymph vessels Follow the arteries and drain first supplies the anterior surface of the stomach and into: gives a hepatic branch that gives a branch to ○ Left and right gastric nodes pyloric ○ Left and right gastroepiploic nodes ○ Posterior vagal trunk :Formed from the right ○ Short gastric nodes vagus supplies the posterior surface of the ● Ultimately they drain into the celiac nodes stomach and gives a branch to the celiac and superior mesenteric plexuses 9 Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 QUIZ C C A B C A B A Q1: At which level does the esophagus ends ? Q5: Which one is from the posterior relations of the stomach : A. T8 A. Anterior abdominal wall B. T10 B. Diaphragm C. T11 C. Left crus of diaphragm D. C6 D. Base of the left pleura Q2: Which of the following is a lateral relation of the cervical Esophagus? Q6: The Lesser curvature is attached to which of the following? A. Trachea A. liver by gastrohepatic ligament B. Aortic arch B. liver by gastrosplenic ligament C. Lobes of thyroid gland C. Colon by lesser omentum D. Pericardium D. Colon by gastrosplenic ligament Q3: Which of the following is a direct branch of the celiac artery? Q7: The Fundus of the stomach is located at which level? A. Left gastric artery A.4th intercostal space just below the apex of the heart B. Right gastric artery B. 5th intercostal space just below the apex of the heart C. Short gastric artery C. 5th intercostal space just above the apex of the heart D. Right gastroepiploic artery D. 6th intercostal space just above the apex of the heart Q4: barium swallow will help to assess which of the following? Q8: Second esophageal constriction is located at which of the following? A. left ventricle dilation A. at the crossing with the aortic arch and left main bronchus B. left atrial dilation B. at the junction with the stomach C. RIght atrial dilation C. at the junction with the pharynx D. Right ventricle dilation D. at the junction with the Larynx 10 Members board Team leaders ● Abdulrahman Shadid ● Ateen Almutairi Boys team: Girls team : ● Mohammed Al-huqbani ● Ajeed Al Rashoud ● Salman Alagla ● Taif Alotaibi ● Ziyad Al-jofan ● Noura Al Turki ● Ali Aldawood ● Amirah Al-Zahrani ● Khalid Nagshabandi ● Alhanouf Al-haluli ● Sameh nuser ● Sara Al-Abdulkarem ● Abdullah Basamh ● Renad Al Haqbani ● Alwaleed Alsaleh ● Nouf Al Humaidhi ● Mohaned Makkawi ● Jude Al Khalifah ● Abdullah Alghamdi ● Nouf Al Hussaini ● Danah Al Halees ● Rema Al Mutawa ● Maha Al Nahdi ● Razan Al zohaifi ● Ghalia Alnufaei Contact us: Editing file .
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