Podcast
Questions and Answers
What is the clinical significance of the submucosal veins of the distal oesophagus?
What is the clinical significance of the submucosal veins of the distal oesophagus?
- They form a site of porto-systemic anastomosis where oesophageal varices develop in portal hypertension. (correct)
- They directly supply blood to the cardiac orifice of the stomach.
- They play a role in the pathogenesis of achalasia.
- They are crucial for maintaining the structural integrity of the oesophageal wall.
What is the primary role of the gastrosplenic ligament and greater omentum in relation to the stomach's greater curvature?
What is the primary role of the gastrosplenic ligament and greater omentum in relation to the stomach's greater curvature?
- They facilitate peristaltic movement along the greater curvature.
- They tether the stomach directly to the anterior abdominal wall.
- They provide attachment sites for the gastro-omental vessels. (correct)
- They contain the primary lymphatic drainage pathways for the stomach.
Injury to which structure during cardiomyotomy or fundoplication leads to gastroparesis?
Injury to which structure during cardiomyotomy or fundoplication leads to gastroparesis?
- The posterior gastric artery
- The phrenico-oesophageal ligament
- The cardia
- The anterior vagal trunk (correct)
How does the phrenico-oesophageal ligament contribute to the function of the gastroesophageal junction?
How does the phrenico-oesophageal ligament contribute to the function of the gastroesophageal junction?
How does the muscular wall composition differ between the abdominal oesophagus and the more proximal parts of the oesophagus?
How does the muscular wall composition differ between the abdominal oesophagus and the more proximal parts of the oesophagus?
What factor contributes to the increased risk of gastric volvulus in elderly individuals?
What factor contributes to the increased risk of gastric volvulus in elderly individuals?
Which arteries is MOST likely involved if ischemia occurs to the anterior aspect of the stomach?
Which arteries is MOST likely involved if ischemia occurs to the anterior aspect of the stomach?
What is the significance of the 'intermediate sulcus' in the context of the greater curvature of the stomach?
What is the significance of the 'intermediate sulcus' in the context of the greater curvature of the stomach?
Patients who undergo total gastrectomy are at risk of vitamin B12 deficiency, but which cell type is affected?
Patients who undergo total gastrectomy are at risk of vitamin B12 deficiency, but which cell type is affected?
What causes pyloric stenosis to primarily affect infants?
What causes pyloric stenosis to primarily affect infants?
What is the main function of mucus-secreting epithelium which covers the entire luminal surface, covering the gastric pits?
What is the main function of mucus-secreting epithelium which covers the entire luminal surface, covering the gastric pits?
Damage to the celiac branch is MOST likely to impact which structure?
Damage to the celiac branch is MOST likely to impact which structure?
Pyloroplasty can be fashioned that involved dividing the anterior pyloric wall during gastric mobilization and oesophagectomy, and reconstruction runs counter direction. Why?
Pyloroplasty can be fashioned that involved dividing the anterior pyloric wall during gastric mobilization and oesophagectomy, and reconstruction runs counter direction. Why?
What is the MOST likely finding in the region of the oesophageal hiatus?
What is the MOST likely finding in the region of the oesophageal hiatus?
What mechanism explains why clasp fibers rise with increasing gastric distention in stomach?
What mechanism explains why clasp fibers rise with increasing gastric distention in stomach?
During a hiatal hernia repair, a surgeon identifies the phrenico-oesophageal ligament on the thinner portion of the left side; this is the gateway to safe mobilization. From what is that thinner portion separated?
During a hiatal hernia repair, a surgeon identifies the phrenico-oesophageal ligament on the thinner portion of the left side; this is the gateway to safe mobilization. From what is that thinner portion separated?
How is the distal esophagus controlled from the intrinsic muscles?
How is the distal esophagus controlled from the intrinsic muscles?
What is directly impacted when pressure increases in HPZ from contraction of peri-oesophageal fibers of the right crus of the respiratory diaphragm?
What is directly impacted when pressure increases in HPZ from contraction of peri-oesophageal fibers of the right crus of the respiratory diaphragm?
If it can be avoided and is not a part of the procedure, what procedure should be avoided to fix the anterior surface of a stomach?
If it can be avoided and is not a part of the procedure, what procedure should be avoided to fix the anterior surface of a stomach?
What describes the location and purpose of the anterior nerve of the lesser curvature?
What describes the location and purpose of the anterior nerve of the lesser curvature?
A patient presents with difficulty swallowing (dysphagia) due to achalasia. What is the underlying cause of their symptoms?
A patient presents with difficulty swallowing (dysphagia) due to achalasia. What is the underlying cause of their symptoms?
What is MOST likely the reason for not directly repairing a para-oesophageal hiatal hernia?
What is MOST likely the reason for not directly repairing a para-oesophageal hiatal hernia?
In addition to potential injury to structures of the body, what is another high-occurence result of improper handling during surgery?
In addition to potential injury to structures of the body, what is another high-occurence result of improper handling during surgery?
What result can result to the stomach as a whole in low-activity digestive situations?
What result can result to the stomach as a whole in low-activity digestive situations?
If a needle is required to be placed on a gastrostomy, which portion of the stomach MUST be avoided?
If a needle is required to be placed on a gastrostomy, which portion of the stomach MUST be avoided?
The description between the squamous epithelium (above) and the red columnar epithelium is an important marker that forms in a line. What is that marker?
The description between the squamous epithelium (above) and the red columnar epithelium is an important marker that forms in a line. What is that marker?
What should be performed in connection with hiatal repair and fundoplication in order to perform gastropexy?
What should be performed in connection with hiatal repair and fundoplication in order to perform gastropexy?
How does muscularis externa help with digestive movements in the stomach itself?
How does muscularis externa help with digestive movements in the stomach itself?
What will be likely impacted if an individual's lower and upper portion exhibits symptoms such as diarrhea after an operation?
What will be likely impacted if an individual's lower and upper portion exhibits symptoms such as diarrhea after an operation?
Under normal circumstances with NO outside factors, what has to happen to contents inside pyloric antrum?
Under normal circumstances with NO outside factors, what has to happen to contents inside pyloric antrum?
What is the role of the liver (proximal border) on drainage into the vein for gastric activity?
What is the role of the liver (proximal border) on drainage into the vein for gastric activity?
During total procedure, a region is activated to activate more action that impacts and stimulates gastric contraction and activity. What procedure is required?
During total procedure, a region is activated to activate more action that impacts and stimulates gastric contraction and activity. What procedure is required?
What cell directly releases what aids protective stomach layer?
What cell directly releases what aids protective stomach layer?
What happens to membrane increase in secretory state?
What happens to membrane increase in secretory state?
Cells that divide and create daughter/progeny new cells?
Cells that divide and create daughter/progeny new cells?
What layer primarily anchors the abdominal oesophagus to the margins of the oesophageal hiatus?
What layer primarily anchors the abdominal oesophagus to the margins of the oesophageal hiatus?
Where does the anterior vagal trunk typically lie in relation to the oesophagus?
Where does the anterior vagal trunk typically lie in relation to the oesophagus?
In cases of portal hypertension, where are oesophageal varices MOST likely to develop due to porto-systemic anastomosis?
In cases of portal hypertension, where are oesophageal varices MOST likely to develop due to porto-systemic anastomosis?
What anatomical feature is a reliable surgical marker for the gastro-oesophageal junction?
What anatomical feature is a reliable surgical marker for the gastro-oesophageal junction?
How does the phrenico-oesophageal ligament change with age?
How does the phrenico-oesophageal ligament change with age?
What histological feature defines Barrett's oesophagus?
What histological feature defines Barrett's oesophagus?
What is the clinical significance of the 'zigzag line' (Z line) in the oesophagus?
What is the clinical significance of the 'zigzag line' (Z line) in the oesophagus?
What is the primary mechanism by which the lower oesophageal sphincter (LES) maintains basal tone?
What is the primary mechanism by which the lower oesophageal sphincter (LES) maintains basal tone?
How does the arterial blood supply to the stomach contribute to its resistance to ischemia?
How does the arterial blood supply to the stomach contribute to its resistance to ischemia?
What is the MOST likely result of severing the vagal innervation to the pylorus during surgery?
What is the MOST likely result of severing the vagal innervation to the pylorus during surgery?
What anatomical relationship explains why pancreatic inflammation can lead to isolated gastric varices?
What anatomical relationship explains why pancreatic inflammation can lead to isolated gastric varices?
How does the location of referred pain typically present for pain originating from the gastro-oesophageal junction?
How does the location of referred pain typically present for pain originating from the gastro-oesophageal junction?
If a surgeon is performing a para-oesophageal hernia repair, where would the surgeon look to create a safe gateway for mobilization of the oesophagus?
If a surgeon is performing a para-oesophageal hernia repair, where would the surgeon look to create a safe gateway for mobilization of the oesophagus?
What is the MOST accurate description of the gastric folds in the stomach?
What is the MOST accurate description of the gastric folds in the stomach?
Which of the following is a key function of the mucus-secreting epithelium that lines the stomach?
Which of the following is a key function of the mucus-secreting epithelium that lines the stomach?
What is the significance of interstitial cells of Cajal (ICCs) in the stomach?
What is the significance of interstitial cells of Cajal (ICCs) in the stomach?
After a surgeon completes a gastrectomy with D2 removal, what lymph nodes would have been removed?
After a surgeon completes a gastrectomy with D2 removal, what lymph nodes would have been removed?
When performing minimally invasive surgery of the stomach, what should be avoided when placing a needle for gastrostomy?
When performing minimally invasive surgery of the stomach, what should be avoided when placing a needle for gastrostomy?
To relieve distention in the stomach from excess contents, what procedure can be used?
To relieve distention in the stomach from excess contents, what procedure can be used?
What procedure that helps aid in fixing a recurrent hiatal hernia?
What procedure that helps aid in fixing a recurrent hiatal hernia?
The largest gastric branch comes from which structure?
The largest gastric branch comes from which structure?
What structure contributes most significantly to preventing gastro-oesophageal reflux under normal physiological conditions?
What structure contributes most significantly to preventing gastro-oesophageal reflux under normal physiological conditions?
Which cellular process is directly responsible for the increase in microvilli on parietal cells during the secretion of hydrochloric acid (HCl)?
Which cellular process is directly responsible for the increase in microvilli on parietal cells during the secretion of hydrochloric acid (HCl)?
Which of the following statements BEST describes the pattern of muscle arrangement at the gastro-oesophageal junction?
Which of the following statements BEST describes the pattern of muscle arrangement at the gastro-oesophageal junction?
Why might a surgeon choose to perform a pyloroplasty during or after extensive gastric mobilization or oesophagectomy?
Why might a surgeon choose to perform a pyloroplasty during or after extensive gastric mobilization or oesophagectomy?
How can the presence of a sliding hiatal hernia complicate the endoscopic diagnosis of Barrett's oesophagus?
How can the presence of a sliding hiatal hernia complicate the endoscopic diagnosis of Barrett's oesophagus?
Damage to what anatomical structure results in gastric stasis?
Damage to what anatomical structure results in gastric stasis?
What is the surgical significance of the fat pad often visible beneath the peritoneum over the anterior surface of the gastro-oesophageal junction?
What is the surgical significance of the fat pad often visible beneath the peritoneum over the anterior surface of the gastro-oesophageal junction?
A surgeon identifies an abnormally large artery penetrating the muscular coat of the stomach near the gastro-oesophageal junction. Which condition is MOST likely?
A surgeon identifies an abnormally large artery penetrating the muscular coat of the stomach near the gastro-oesophageal junction. Which condition is MOST likely?
What is the rationale behind performing a fundoplication during hiatal hernia repair?
What is the rationale behind performing a fundoplication during hiatal hernia repair?
What is the MOST likely consequence if a surgeon mistakenly severs the coeliac branch of the posterior vagal trunk during a gastrectomy?
What is the MOST likely consequence if a surgeon mistakenly severs the coeliac branch of the posterior vagal trunk during a gastrectomy?
How does nitric oxide (NO) contribute to the function of the lower oesophageal sphincter (LES)?
How does nitric oxide (NO) contribute to the function of the lower oesophageal sphincter (LES)?
Which anatomical characteristic predisposes a patient with splenic vein thrombosis to develop isolated gastric varices?
Which anatomical characteristic predisposes a patient with splenic vein thrombosis to develop isolated gastric varices?
A surgeon encounters a replaced left hepatic artery originating from the left gastric artery during a gastrectomy. What is the MOST appropriate course of action?
A surgeon encounters a replaced left hepatic artery originating from the left gastric artery during a gastrectomy. What is the MOST appropriate course of action?
In the context of gastric cancer surgery, what does 'D2 dissection' refer to?
In the context of gastric cancer surgery, what does 'D2 dissection' refer to?
How does the morphology of the gastric epithelium differ in its response to acid versus duodenal contents within the pyloric antrum?
How does the morphology of the gastric epithelium differ in its response to acid versus duodenal contents within the pyloric antrum?
What is the significance of the muscularis mucosae in the stomach's structural and functional organization?
What is the significance of the muscularis mucosae in the stomach's structural and functional organization?
During a laparoscopic gastrectomy, what anatomical landmark helps a surgeon avoid injuring the recurrent laryngeal nerve?
During a laparoscopic gastrectomy, what anatomical landmark helps a surgeon avoid injuring the recurrent laryngeal nerve?
What is the MOST likely reason for a clinician to perform an endoscopic submucosal dissection (ESD) instead of endoscopic mucosal resection (EMR) for a gastric lesion?
What is the MOST likely reason for a clinician to perform an endoscopic submucosal dissection (ESD) instead of endoscopic mucosal resection (EMR) for a gastric lesion?
A patient with chronic gastritis develops metaplasia in the gastric mucosa. What cellular change would confirm this diagnosis?
A patient with chronic gastritis develops metaplasia in the gastric mucosa. What cellular change would confirm this diagnosis?
What is the significance of identifying interstitial cells of Cajal (ICCs) during histological examination of a gastric resection specimen?
What is the significance of identifying interstitial cells of Cajal (ICCs) during histological examination of a gastric resection specimen?
What is the MOST likely reason for performing roux-en-Y when an individual has issues in the pyloric antrum?
What is the MOST likely reason for performing roux-en-Y when an individual has issues in the pyloric antrum?
What is a key characteristic of a para-oesophageal hiatal hernia?
What is a key characteristic of a para-oesophageal hiatal hernia?
Which one of these is FALSE regarding the arterial supply to the stomach and in relation to the celiac trunk supply?
Which one of these is FALSE regarding the arterial supply to the stomach and in relation to the celiac trunk supply?
In performing an EMR (endoscopic mucosal resection), what is the MOST important factor that decides if it is appropriate and what are the limitations?
In performing an EMR (endoscopic mucosal resection), what is the MOST important factor that decides if it is appropriate and what are the limitations?
A distinct posterior gastric branch can be present, but if it is originating from the coeliac branch, then what is that implication MOST likely for the surgery?
A distinct posterior gastric branch can be present, but if it is originating from the coeliac branch, then what is that implication MOST likely for the surgery?
Where does the prepyloric drain?
Where does the prepyloric drain?
During inspiration, increased negative intrathoracic pressure increases gastro-oesophageal pressure. What counteraction from the body balances the lower oesphageal sphincter (LES)?
During inspiration, increased negative intrathoracic pressure increases gastro-oesophageal pressure. What counteraction from the body balances the lower oesphageal sphincter (LES)?
The anterior wall of the abdominal oesophagus is shorter than its posterior wall due to the obliquity of the diaphragmatic crura
The anterior wall of the abdominal oesophagus is shorter than its posterior wall due to the obliquity of the diaphragmatic crura
Within the abdominal part of the oesophagus, the muscular wall is composed of both smooth and skeletal muscle.
Within the abdominal part of the oesophagus, the muscular wall is composed of both smooth and skeletal muscle.
The phrenico-oesophageal ligament limits movement of the oesophagus within the oesophageal hiatus, acting as an anchor.
The phrenico-oesophageal ligament limits movement of the oesophagus within the oesophageal hiatus, acting as an anchor.
The proximal layer of the phrenico-oesophageal ligament is an extension of the transversalis fascia inferior to the respiratory diaphragm.
The proximal layer of the phrenico-oesophageal ligament is an extension of the transversalis fascia inferior to the respiratory diaphragm.
In elderly individuals, the phrenico-oesophageal ligament gains collagen fibers and contains less adipose tissue compared to younger individuals.
In elderly individuals, the phrenico-oesophageal ligament gains collagen fibers and contains less adipose tissue compared to younger individuals.
The distal oesophagus is not a site of porto-systemic anastomosis where oesophageal varices can develop in portal hypertension.
The distal oesophagus is not a site of porto-systemic anastomosis where oesophageal varices can develop in portal hypertension.
The lymphatics of the distal third of the oesophagus communicate with nodes in the adventitia, para-oesophageal nodes, or the thoracic duct directly.
The lymphatics of the distal third of the oesophagus communicate with nodes in the adventitia, para-oesophageal nodes, or the thoracic duct directly.
The abdominal part of the oesophagus receives parasympathetic innervation directly from the oesophageal plexus and anterior and posterior vagal trunks.
The abdominal part of the oesophagus receives parasympathetic innervation directly from the oesophageal plexus and anterior and posterior vagal trunks.
The sympathetic supply to the distal oesophagus originates from the first to fourth thoracic spinal segments.
The sympathetic supply to the distal oesophagus originates from the first to fourth thoracic spinal segments.
The stomach's capacity typically decreases from approximately 50-60ml at birth to approximately 800-1000ml in adults.
The stomach's capacity typically decreases from approximately 50-60ml at birth to approximately 800-1000ml in adults.
The lesser omentum attaches to the lesser curvature and contains the right and left colic vessels.
The lesser omentum attaches to the lesser curvature and contains the right and left colic vessels.
The greatest convexity of the greater curvature, the apex of the fundus, is approximately level with the left tenth rib anteriorly.
The greatest convexity of the greater curvature, the apex of the fundus, is approximately level with the left tenth rib anteriorly.
The anterior surface of the stomach lies posterior to the right costal arch in contact with the respiratory diaphragm.
The anterior surface of the stomach lies posterior to the right costal arch in contact with the respiratory diaphragm.
The transverse mesocolon separates the stomach from the duodenojejunal flexure and proximal jejunum.
The transverse mesocolon separates the stomach from the duodenojejunal flexure and proximal jejunum.
The 'Z line' is located at the proximal extent of the lymphatic mucosal folds.
The 'Z line' is located at the proximal extent of the lymphatic mucosal folds.
The pyloric sphincter is formed by a circumferential thickening of longitudinal muscle integrated with some connecting tissue.
The pyloric sphincter is formed by a circumferential thickening of longitudinal muscle integrated with some connecting tissue.
The gastric folds represent variations in the thickness of the mucosa, and they are accentuated when the stomach is distended.
The gastric folds represent variations in the thickness of the mucosa, and they are accentuated when the stomach is distended.
The diameter of each gastric pit is approximately 700 µm and depth of about 2 mm.
The diameter of each gastric pit is approximately 700 µm and depth of about 2 mm.
Chief cells are the source of the digestive enzymes pepsin and trypsin.
Chief cells are the source of the digestive enzymes pepsin and trypsin.
The anterior vagal trunk gives off hepatic branches that ramify and supply the pancreas, duodenum, pylorus.
The anterior vagal trunk gives off hepatic branches that ramify and supply the pancreas, duodenum, pylorus.
Match the gastric cell type with its primary secretion:
Match the gastric cell type with its primary secretion:
Match each blood vessel to the structure it primarily supplies:
Match each blood vessel to the structure it primarily supplies:
Match the type of gastric gland with its primary location within the stomach:
Match the type of gastric gland with its primary location within the stomach:
Match the type of hiatal hernia with its description:
Match the type of hiatal hernia with its description:
Match the nerve to the structure for which it provides innervation:
Match the nerve to the structure for which it provides innervation:
Match the surgical procedure with its primary purpose:
Match the surgical procedure with its primary purpose:
Match each layer of the gastric wall with its distinguishing characteristic:
Match each layer of the gastric wall with its distinguishing characteristic:
Match each type of cell with its function associated in the stomach:
Match each type of cell with its function associated in the stomach:
Match esophageal varices with underlying cause of the condition:
Match esophageal varices with underlying cause of the condition:
Match each portion of vagal trunk with one of it's primary branches mentioned in the article:
Match each portion of vagal trunk with one of it's primary branches mentioned in the article:
Flashcards
Abdominal Oesophagus
Abdominal Oesophagus
1-2.5 cm long, left of midline, broader at cardiac orifice. Lies posterior to the left lobe of the liver and anterior to the left crus of the respiratory diaphragm.
Phrenico-oesophageal Ligament
Phrenico-oesophageal Ligament
Two layers of elastin and collagen-rich connective tissue with smooth muscle fibers. Tethers the oesophagus to the esophageal hiatus.
Arterial Supply to Abdominal Oesophagus
Arterial Supply to Abdominal Oesophagus
Supplied by numerous esophageal branches of the left gastric artery ascending beneath the visceral peritoneum.
Lymphatic Drainage of Oesophagus
Lymphatic Drainage of Oesophagus
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Innervation of the Oesophagus
Innervation of the Oesophagus
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Stomach
Stomach
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Stomach Functions
Stomach Functions
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Fundus
Fundus
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Body of the Stomach
Body of the Stomach
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Cardia
Cardia
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Pyloric Antrum
Pyloric Antrum
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Pyloric Canal
Pyloric Canal
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Lesser Curvature
Lesser Curvature
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Greater Curvature
Greater Curvature
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Achalasia
Achalasia
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Gastropexy
Gastropexy
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Barrett's Oesophagus
Barrett's Oesophagus
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Endoscopic Mucosal Resection
Endoscopic Mucosal Resection
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Short Gastric arteries
Short Gastric arteries
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Lymphatic Drainage of Stomach
Lymphatic Drainage of Stomach
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Hiatal Hernia
Hiatal Hernia
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Oesophagus function
Oesophagus function
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Gastric Volvulus Definition
Gastric Volvulus Definition
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Hiatal Hernia Types
Hiatal Hernia Types
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Purpose of Gastropexy
Purpose of Gastropexy
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Gastric ligaments
Gastric ligaments
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Anterior surface (stomach)
Anterior surface (stomach)
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What is Pyloric Sphincter, composed of?
What is Pyloric Sphincter, composed of?
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Course of left gastric artery
Course of left gastric artery
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What and where is origin of right gastric artery
What and where is origin of right gastric artery
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Origin of both Arteries of stomach
Origin of both Arteries of stomach
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What does Left Gastric Vein do?
What does Left Gastric Vein do?
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How do Varices start?
How do Varices start?
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How are stomach signals triggered to parasympathetic system?
How are stomach signals triggered to parasympathetic system?
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Muscularis Externa- layers Stomach
Muscularis Externa- layers Stomach
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What are Gastric Folds for?
What are Gastric Folds for?
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What doe Surface Mucous Cells do?
What doe Surface Mucous Cells do?
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Function of the Phrenico-oesophageal Ligament
Function of the Phrenico-oesophageal Ligament
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Anterior Vagal Trunk
Anterior Vagal Trunk
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Posterior Vagal Trunk
Posterior Vagal Trunk
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Gastro-phrenic Ligament
Gastro-phrenic Ligament
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Gastric Mucosa
Gastric Mucosa
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Zigzag (Z) Line
Zigzag (Z) Line
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Gastric Volvulus
Gastric Volvulus
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Anterior Surface
Anterior Surface
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Posterior Stomach Surface
Posterior Stomach Surface
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The name of one of the rare lesions in stomach
The name of one of the rare lesions in stomach
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Pyloric Canal Junction
Pyloric Canal Junction
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Venous System - Variations
Venous System - Variations
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Anterior surface
Anterior surface
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Limitations of phrenico-oesophageal ligament
Limitations of phrenico-oesophageal ligament
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Intrinsic Nervous System
Intrinsic Nervous System
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Esophageal sphincter's
Esophageal sphincter's
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Gastric mucosal rosette
Gastric mucosal rosette
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Lower oesophageal sphincter and Gastro-Oesophageal Junction
Lower oesophageal sphincter and Gastro-Oesophageal Junction
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What causes Transient LES.
What causes Transient LES.
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The gastric canalis
The gastric canalis
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Mucus neck cells in Gastric pits
Mucus neck cells in Gastric pits
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Chief Cell
Chief Cell
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ECL Cells
ECL Cells
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Gastrin G
Gastrin G
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Left Gastric Artery
Left Gastric Artery
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Right Gastro-omental Artery
Right Gastro-omental Artery
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Arterial anastomoses
Arterial anastomoses
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Varices creation
Varices creation
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EMR procedure
EMR procedure
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Location of The Stomach
Location of The Stomach
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What helps gastrectomy and Lymphs
What helps gastrectomy and Lymphs
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Vagus Nerves of Stomach
Vagus Nerves of Stomach
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Pyloric Stenosis Cause
Pyloric Stenosis Cause
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Proximal Stomach Function
Proximal Stomach Function
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Distal Stomach Function
Distal Stomach Function
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Organs of the Gastric System
Organs of the Gastric System
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Cells in Gastric Pits
Cells in Gastric Pits
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Study Notes
Abdominal Oesophagus
- Lying left of the midline, 1-2.5 cm long, is slightly broader at the cardiac orifice than at the oesophageal hiatus (T11).
- It runs obliquely to the left and slightly posteriorly ending at the gastro-oesophageal junction and is continuous with the cardiac orifice.
- Covered by connective tissue and visceral peritoneum with anterior/posterior vagus nerves plus oesophageal branches.
- The anterior wall is effectively longer than its posterior wall because of the diaphragmatic crura's obliquity and lies posterior to the left liver lobe and anterior to the respiratory diaphragm, the left inferior phrenic vessels and left thoracic splanchnic nerves.
- Anterior vagal trunk is closely applied to the anterior outer surface in the 2 o'clock position and the thread-like nerve is hard to visualize: surgeon appreciation to avoid injury is vital.
- Posterior vagal trunk is substantial and lies within loose connective tissue immediately posterior/to the right of the oesophagus and then identify the nerve at fundoplication to avoid injury or incorporation into the wrap.
- Unlike the more proximal oesophagus, its muscular wall consists entirely of smooth muscle.
- Phrenico-oesophageal ligament tethers to the margins of the oesophageal hiatus to limit mobility inside the oesophageal hiatus and formed by circumferential elastin and collagen-rich connective tissue containing smooth muscle fibres.
- The anchor location limits upward/downward oesophagus mobility inside the oesohpageal hiatus
- Distal layer extends the transversalis fascia that joins the respiratory diaphragm, and is thin and loosely attached.
- Proximal layer continues with the endothoracic fascia, thicker than the distal layer and cranially oblique, fused firmly with the oesophagus.
- In elderly people the ligament tends to attenuate becoming more composed of adipose tissue and losing collagen.
- Phrenico-oesophageal ligament is denser anteriorly and bridges between outer layer of the oesophageal wall and arcing crura fibres.
- Identifying it on the thinner left segment mobilizes the oesophagus/aorta.
- Reconstructing it with sutures between the left lateral oesophagus and the left crus during fundoplication
- Peritoneal reflection is short posterior to it, continuing directly on to the stomach fundus, sometimes called the gastro-phrenic ligament and encloses oesophageal branches and coeliac branches.
- A fat pad is sometimes visible beneath the peritoneum over the anterior surface of the gastro-oesophageal junction and is a helpful surgical marker
- Mucosal squamocolumnar transition forms a Z line at the gastro-oesophageal junction.
Arterial Supply
- Supplied by oesophageal branches of the left gastric artery beneath visceral peritoneum.
- The posterior surface receives an additional blood supply via branches of the upper short gastric arteries, reinforced by terminal arteries, oesophageal branches of the descending thoracic aorta and occasional ascending branches of posterior gastric artery.
Veins
- Submucosal veins drain via plexuses to the left gastric and shorter gastric veins in the abdomen and to the azygos/hemiazygos system of veins in the thorax.
- Distal oesophagus serves as an important site of porto-systemic anastomosis where oesophageal varices develop in portal hypertension.
Lymphatic Drainage
- Lymphatics are concentrated into submucosal/intermuscular plexuses and receive lymph from all oesophageal wall layers.
- Lymphatic drainage from the gastroesophageal junction communicates with nodes in the adventitia, para-oesophageal nodes or the thoracic duct itself
- The distal third of the oesophagus communicates with left gastric nodes, nodes around the cardia, and then goes to coeliac nodes
Innervation
- Oesophagus has an intrinsic nervous system with a ganglioneted myenteric plexus & a submucosal plexus, modulated by extrinsic autonomic nerves.
- Parasympathetic innervation of abdominal part is directly from the oesophageal plexus and, to a lesser extent, from the anterior and posterior vagal trunks.
- These nerves are motor to the distal oesophagus and both stimulatory and inhibitory to the lower oesophageal sphincter.
- Sympathetic supply originates from the fifth to twelfth thoracic spinal segments via the greater/lesser thoracic splanchnic nerves and then the coeliac plexus.
Hiatal Hernia
- This condition involves expansion of the oesophageal hiatus and herniation of the stomach through the respiratory diaphragm into the thorax, which is more common in elderly and obese individuals.
- Sliding hiatal hernia accounts for 90% while para-oesophageal or mixed types account for the other 10%.
- Sliding hiatal hernia is when the abdominal part of the oesophagus and cardia of the stomach project above the oesophageal hiatus.
- Para-oesophageal hiatal hernia, the abdominal part of the oesophagus and pylorus lie beneath the diaphragm, and a portion of the stomach passes through the hiatus.
- The Entire stomach can rotate, forming an upside-down stomach
- Treatment for a symptomatic sliding hiatal hernia is directed at managing gastro-oesophageal reflux, and anti-reflux surgery if medication fails.
- Anti-reflux surgery traditionally involves fundoplication, but new methods use a band of interlinked titanium beads and magnetic cores around the lower oesophageal sphincter
Stomach
- Functions include temporary storage of ingested nutrients, breakdown of solid food, chemical digestion of proteins, regulation of chyme passage, secretion of intrinsic factor, secretion of gut hormones and secretion of acid to aid digestion (including absorption of iron).
- It is also important in microbial defence.
Location
- Situated in the upper abdomen, extending from the left upper quadrant to the right, while lying in the left hypochondriac, epigastric, and umbilical regions and occupies a space beneath the diaphragm and the anterior abdominal wall.
- Is bounded by the upper abdominal viscera on either side.
- Mean capacity increases from ~20-30 ml at birth to ~1000-1500 ml in adults.
- Peritoneal surface interrupted by attachments of the greater/lesser omenta to define the curvatures and separate the anterior/posterior surfaces.
Parts of the Stomach
- Stomach divided into the fundus, body, pyloric antrum and pylorus using artificial lines.
- Fundus is dome-shaped and projects above/to the left of the oesophageal opening to lie in contact with the left respiratory diaphragm above a horizontal line from the cardiac notch to the greater curvature.
- Body extends from the fundus to the angular incisure (an external notch at the lower end of the lesser curvature).
- Lower boundary of the body is a line from the angular incisure to an inconstant indentation on the greater curvature.
- Cardia is the stomach region adjacent to the oesophageal opening.
- Pyloric antrum: extends from the line extending between the angular incisure/an indentation on the greater curvature towards the pylorus as the stomach narrows to become the pyloric canal that terminates at the pyloric orifice.
Greater curvature
- The curvature, two to three times longer than the lesser curvature, starts from the cardiac notch and arches upwards, posterolaterally/to the left, and slightly convex till it terminates medially at the pylorus: on the transpyloric plane at Lower border L1.
- Frequently has intermediate sulcus in the curvature close to the pyloric canal.
- The part of the greater curvature is covered by peritoneum, which continues over the anterior stomach surface.
- Laterally, the greater curvature gives attachment to the gastrosplenic ligament and, below this, to the greater omentum, which contains the gastro-omental (gastro-epiploic) vessels.
- The gastrosplenic ligament and the greater omentum, together with the gastrophrenic and splenorenal ligaments, are continuous derivatives of the original dorsal mesogastrium
Gastric Surfaces
- The Stomach, when empty/contracted, has its anterior/posterior surfaces that tend to face superiorly and inferiorly; but as it distends, they face progressively more anteriorly and posteriorly.
- The entire anterior surface of the stomach is covered by peritoneum.
- The lateral part of the anterior surface lies under the left costal arch in contact with the respiratory diaphragm that separates it from the left parietal pleura, the base of the left lung, the pericardium and the left seventh to ninth ribs and costal cartilages.
- Transversus abdominis also lies posterior to the costal attachments of the proximal fibers
- However, the transverse colon can lie adjacent when the stomach is empty.
- The Spleen lies posterior and superior to the left part of the anterior surface
- The Right part of the anterior stomach surface is related superiorly to the left liver lobe and inferiorly to the anterior abdominal wall
Lesser curvature
- The lesser curvature extends Cardiac/Pyloric orifices while forming the medial border of the stomach.
- Descending from the oesophagus medial side in front of the respiratory diaphragm then curving downwards/to the right, anterior to the pancreas' superior border.
- Ends at the pylorus, right of the midline.
- Dependent part=notch (angular incisure)
- Incisure position appearance varies with distention with the contained right left vessels.
Vessels
- Arterial supply provided by coeliac trunk (short arteries), also the (left gastro-omental) that run off .
- A smaller branch off the . Right artery) off (proper hepatic artery, also the off gastroduodenal artery respectively.
- the veins that run out out, distribution variability.
Gastric Volvulus
- The abnormal stomach rotation into either organoaxial or axial.
- The anatomy of the gastroesophageal pylorus is highly mobile .
- Managing, surgical fixation by gastropexy.
- Surgery combining is also needed for those with type plus and.
Dieulafoy Lesions
Dieuafoy lesions is a rare cause of acute upper gastrointestinal haemorrhage whereby a large artery penetrates the muscular coating. runs submucosa and protrudes small mucosal defect, but is typically managed by fixation of the anterior surface of the stomach to the anterior abdominal wall (gastropexy)
- An alternative, such as gastric volvulus, is the insertion of one or more percutaneous endoscopic gastrostomy (PEG) tubes to fix the stomach to the anterior abdominal wall maneuver.
- The pyloroplasty can still counter this possibility,
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