Podcast
Questions and Answers
A patient presents with a history of chronic heartburn and is diagnosed with Barrett's esophagus. Which of the following histological changes is characteristic of this condition?
A patient presents with a history of chronic heartburn and is diagnosed with Barrett's esophagus. Which of the following histological changes is characteristic of this condition?
- Replacement of squamous epithelium with stratified cuboidal epithelium.
- Replacement of stratified squamous epithelium with metaplastic columnar epithelium containing goblet cells. (correct)
- Atrophy of the gastric glands with increased mucus production.
- Hyperplasia of the muscularis mucosae.
During a surgical procedure involving the stomach, the surgeon needs to ligate the gastrosplenic ligament. Injury to what structure is most likely?
During a surgical procedure involving the stomach, the surgeon needs to ligate the gastrosplenic ligament. Injury to what structure is most likely?
- Common bile duct
- Splenic vessels and the tail of the pancreas (correct)
- Proper hepatic artery
- Left gastric artery
A surgeon is performing a highly selective vagotomy to treat a patient with chronic peptic ulcers. Which of the following is a primary goal of this procedure?
A surgeon is performing a highly selective vagotomy to treat a patient with chronic peptic ulcers. Which of the following is a primary goal of this procedure?
- Full denervation of the stomach.
- Division of the anterior and posterior vagal trunks close to the abdominal esophagus
- Denervation of the stomach to reduce acid secretion while preserving innervation to the pylorus. (correct)
- Denervation of the entire stomach while preserving the nerves of Latarjet.
A patient undergoes an esophagectomy, and during the surgery, the thoracic duct is inadvertently damaged. Which anatomical relationship would best explain how this occurred?
A patient undergoes an esophagectomy, and during the surgery, the thoracic duct is inadvertently damaged. Which anatomical relationship would best explain how this occurred?
A patient undergoing an upper endoscopy is found to have a Schatzki ring. At which anatomical location is this ring most likely to be found?
A patient undergoing an upper endoscopy is found to have a Schatzki ring. At which anatomical location is this ring most likely to be found?
A patient is diagnosed with a peptic ulcer on the posterior wall of the duodenal cap. If the ulcer perforates, which of the following structures is most immediately at risk of erosion?
A patient is diagnosed with a peptic ulcer on the posterior wall of the duodenal cap. If the ulcer perforates, which of the following structures is most immediately at risk of erosion?
Following a motor vehicle accident, a patient is diagnosed with a ruptured spleen. Significant bleeding is noted. Which peritoneal fold, if damaged, would most likely contribute to continuous bleeding from the splenic vessels?
Following a motor vehicle accident, a patient is diagnosed with a ruptured spleen. Significant bleeding is noted. Which peritoneal fold, if damaged, would most likely contribute to continuous bleeding from the splenic vessels?
A patient presents with dysphagia and is found to have esophageal varices. Increased pressure in which venous system directly contributes to the formation of these varices?
A patient presents with dysphagia and is found to have esophageal varices. Increased pressure in which venous system directly contributes to the formation of these varices?
A previously healthy 25-year-old male presents to the emergency department complaining of severe abdominal pain, nausea, and vomiting. Imaging reveals compression of the third part of the duodenum between the superior mesenteric artery and the abdominal aorta. Which condition is most likely causing these symptoms?
A previously healthy 25-year-old male presents to the emergency department complaining of severe abdominal pain, nausea, and vomiting. Imaging reveals compression of the third part of the duodenum between the superior mesenteric artery and the abdominal aorta. Which condition is most likely causing these symptoms?
During a laparoscopic cholecystectomy, the surgeon accidentally ligates the cystic artery too close to its origin. Which of the arteries is most likely to be inadvertently affected, potentially leading to liver ischemia?
During a laparoscopic cholecystectomy, the surgeon accidentally ligates the cystic artery too close to its origin. Which of the arteries is most likely to be inadvertently affected, potentially leading to liver ischemia?
What is TRUE regarding the oesophagus?
What is TRUE regarding the oesophagus?
Which of the following lymphatic drainage pathways is specific to the abdominal part of the oesophagus?
Which of the following lymphatic drainage pathways is specific to the abdominal part of the oesophagus?
A patient is diagnosed with adenocarcinoma at the gastroesophageal junction and requires surgical resection. What is the significance of the Z-line?
A patient is diagnosed with adenocarcinoma at the gastroesophageal junction and requires surgical resection. What is the significance of the Z-line?
After a motor vehicle accident, a patient is found to have a complete transection of the esophagus at the level of the fourth thoracic vertebra (T4). Which structure would most likely be compressed?
After a motor vehicle accident, a patient is found to have a complete transection of the esophagus at the level of the fourth thoracic vertebra (T4). Which structure would most likely be compressed?
Following an incident, a patient is found to have damage to the anterior vagal trunk near the esophageal hiatus. From which vagus nerve does the anterior vagal trunk primarily originate?
Following an incident, a patient is found to have damage to the anterior vagal trunk near the esophageal hiatus. From which vagus nerve does the anterior vagal trunk primarily originate?
Why is it clinically relevant to understand the four constriction areas of the esophagus?
Why is it clinically relevant to understand the four constriction areas of the esophagus?
A medical student studying the anterior relations of the stomach is asked to identify the structures that are related to the anterior surface. Which of the following is correct?
A medical student studying the anterior relations of the stomach is asked to identify the structures that are related to the anterior surface. Which of the following is correct?
A patient presents with a rare type of gastric volvulus where the stomach rotates around its longitudinal axis. Which ligaments are most critical in preventing this type of volvulus?
A patient presents with a rare type of gastric volvulus where the stomach rotates around its longitudinal axis. Which ligaments are most critical in preventing this type of volvulus?
A researcher is studying the structure of the stomach and notes the presence of rugae. What is the primary function of these gastric folds?
A researcher is studying the structure of the stomach and notes the presence of rugae. What is the primary function of these gastric folds?
During a surgical exploration, a surgeon needs access to the lesser sac. Through which anatomical structure can the surgeon gain entry to the lesser sac?
During a surgical exploration, a surgeon needs access to the lesser sac. Through which anatomical structure can the surgeon gain entry to the lesser sac?
A patient is diagnosed with a paraesophageal hiatal hernia. Which anatomical characteristic differentiates this condition from a sliding hiatal hernia?
A patient is diagnosed with a paraesophageal hiatal hernia. Which anatomical characteristic differentiates this condition from a sliding hiatal hernia?
A patient who had a peptic ulcer perforate to the posterior wall would put what vessel at risk?
A patient who had a peptic ulcer perforate to the posterior wall would put what vessel at risk?
A patient with a history of alcohol abuse presents with sudden, severe epigastric pain radiating to the back. Imaging reveals inflammation of the pancreas and compression of the third portion of the duodenum. Which vessel might be compressed?
A patient with a history of alcohol abuse presents with sudden, severe epigastric pain radiating to the back. Imaging reveals inflammation of the pancreas and compression of the third portion of the duodenum. Which vessel might be compressed?
What is the function of gastrosplenic ligament?
What is the function of gastrosplenic ligament?
What are the structures contained in the splenorenal ligament?
What are the structures contained in the splenorenal ligament?
A patient has had damage to their celiac nodes. What would this impact?
A patient has had damage to their celiac nodes. What would this impact?
Stimulation of what nerve stimulates parasympathetic innervation of the stomach:?
Stimulation of what nerve stimulates parasympathetic innervation of the stomach:?
Which arteries anastomose at the lesser curvature of the stomach?
Which arteries anastomose at the lesser curvature of the stomach?
What would be least risk tissue if there was damage to the blood supply of the stomach?
What would be least risk tissue if there was damage to the blood supply of the stomach?
What artery branches off the Common Hepatic artery?
What artery branches off the Common Hepatic artery?
Which of the following accurately describes the usual anatomical position of the esophagus in relation to the aorta?
Which of the following accurately describes the usual anatomical position of the esophagus in relation to the aorta?
A patient is diagnosed with a condition affecting the junction between the esophagus and the pharynx. At which vertebral level is this junction typically located?
A patient is diagnosed with a condition affecting the junction between the esophagus and the pharynx. At which vertebral level is this junction typically located?
After undergoing a medical procedure, a patient develops esophageal dysfunction. What anatomical structure is most likely to be responsible for this condition?
After undergoing a medical procedure, a patient develops esophageal dysfunction. What anatomical structure is most likely to be responsible for this condition?
A patient presents with difficulty swallowing due to a lesion at the T10 vertebral level, potentially affecting the abdominal esophagus. Which anatomical structure is at the highest risk of direct compression?
A patient presents with difficulty swallowing due to a lesion at the T10 vertebral level, potentially affecting the abdominal esophagus. Which anatomical structure is at the highest risk of direct compression?
During a surgical procedure, the anterior vagal trunk is inadvertently severed near the esophageal hiatus. Which of the following is the most likely consequence of this injury?
During a surgical procedure, the anterior vagal trunk is inadvertently severed near the esophageal hiatus. Which of the following is the most likely consequence of this injury?
A patient presents with symptoms indicative of Barrett's esophagus. Which of the following best describes the cellular change associated with this condition?
A patient presents with symptoms indicative of Barrett's esophagus. Which of the following best describes the cellular change associated with this condition?
What change occurs in the squamocolumnar junction in Barret's esophagus?
What change occurs in the squamocolumnar junction in Barret's esophagus?
A patient's barium swallow study shows a hiatal hernia where the gastroesophageal junction and part of the stomach have moved into the thorax. This type of hernia is best described as:
A patient's barium swallow study shows a hiatal hernia where the gastroesophageal junction and part of the stomach have moved into the thorax. This type of hernia is best described as:
A patient undergoes a diagnostic procedure revealing a paraesophageal hernia. How does this hernia differ anatomically from a sliding hiatal hernia?
A patient undergoes a diagnostic procedure revealing a paraesophageal hernia. How does this hernia differ anatomically from a sliding hiatal hernia?
Considering the anatomical relations of the stomach, which of the following structures is in direct contact with the anterior surface?
Considering the anatomical relations of the stomach, which of the following structures is in direct contact with the anterior surface?
A surgeon needs access to the lesser sac (omental bursa) during a complex abdominal surgery. What is the correct route of entry into this space?
A surgeon needs access to the lesser sac (omental bursa) during a complex abdominal surgery. What is the correct route of entry into this space?
A patient is diagnosed with a gastric ulcer that perforates the posterior wall of the stomach. Which of the following structures is most immediately at risk of erosion?
A patient is diagnosed with a gastric ulcer that perforates the posterior wall of the stomach. Which of the following structures is most immediately at risk of erosion?
A patient undergoing an upper endoscopy is found to have inflammation in the first part of the duodenum. What specific anatomical region is most likely affected?
A patient undergoing an upper endoscopy is found to have inflammation in the first part of the duodenum. What specific anatomical region is most likely affected?
A 25-year-old male is diagnosed with Superior Mesenteric Artery (SMA) syndrome following rapid weight loss. Which part of the duodenum is most likely compressed in this patient?
A 25-year-old male is diagnosed with Superior Mesenteric Artery (SMA) syndrome following rapid weight loss. Which part of the duodenum is most likely compressed in this patient?
A patient presents with a rare condition in which the third part of the duodenum is compressed. An angiogram reveals a decreased angle between the superior mesenteric artery and the aorta. What is the anatomical name for this condition?
A patient presents with a rare condition in which the third part of the duodenum is compressed. An angiogram reveals a decreased angle between the superior mesenteric artery and the aorta. What is the anatomical name for this condition?
A patient develops a peptic ulcer in the superior part of the duodenum. Which of the following anatomical structures is most immediately posterior to this location?
A patient develops a peptic ulcer in the superior part of the duodenum. Which of the following anatomical structures is most immediately posterior to this location?
During a surgical procedure, a surgeon identifies the ligament of Treitz. Which portion of the duodenum does this ligament support?
During a surgical procedure, a surgeon identifies the ligament of Treitz. Which portion of the duodenum does this ligament support?
A patient has impaired function of major duodenal papilla. What does this impact?
A patient has impaired function of major duodenal papilla. What does this impact?
Which of the following characteristics is typical of the spleen's anatomical location?
Which of the following characteristics is typical of the spleen's anatomical location?
A trauma patient is diagnosed with a splenic rupture following a motor vehicle accident. Which ligament, if damaged, would most likely contribute to significant bleeding from the splenic vessels?
A trauma patient is diagnosed with a splenic rupture following a motor vehicle accident. Which ligament, if damaged, would most likely contribute to significant bleeding from the splenic vessels?
A patient undergoes a splenectomy due to traumatic injury. Which of the following anatomical relationships is most important for the surgeon to consider to avoid injury to adjacent structures?
A patient undergoes a splenectomy due to traumatic injury. Which of the following anatomical relationships is most important for the surgeon to consider to avoid injury to adjacent structures?
A patient is diagnosed with a splenic infarction due to occlusion of a major arterial supply. Which of the following arteries is most likely involved?
A patient is diagnosed with a splenic infarction due to occlusion of a major arterial supply. Which of the following arteries is most likely involved?
A patient presents with abdominal pain suggestive of splenic pathology. Which anatomical landmark can be used to locate the spleen during physical examination or imaging?
A patient presents with abdominal pain suggestive of splenic pathology. Which anatomical landmark can be used to locate the spleen during physical examination or imaging?
During an upper endoscopy, a bleeding blood vessel is viewed. It is determined that it originated from the celiac trunk. Which vessel is the blood most likely coming from?
During an upper endoscopy, a bleeding blood vessel is viewed. It is determined that it originated from the celiac trunk. Which vessel is the blood most likely coming from?
During a surgical operation, a surgeon isolates the celiac trunk to control bleeding. Which of the following arteries does NOT directly branch from the celiac trunk?
During a surgical operation, a surgeon isolates the celiac trunk to control bleeding. Which of the following arteries does NOT directly branch from the celiac trunk?
A patient has problems receiving blood supply from the Celiac trunk, impacting several organs. What organ is not impacted by this?
A patient has problems receiving blood supply from the Celiac trunk, impacting several organs. What organ is not impacted by this?
A patient presents with symptoms of impaired gastric motility and acid secretion following a surgical procedure. What nerve was potentially severed?
A patient presents with symptoms of impaired gastric motility and acid secretion following a surgical procedure. What nerve was potentially severed?
Which arteries form an anastomosis along the lesser curvature of the stomach, providing collateral circulation?
Which arteries form an anastomosis along the lesser curvature of the stomach, providing collateral circulation?
A surgeon performs a highly selective vagotomy to reduce acid secretion in a patient with chronic peptic ulcers. What is the primary goal of this procedure?
A surgeon performs a highly selective vagotomy to reduce acid secretion in a patient with chronic peptic ulcers. What is the primary goal of this procedure?
During the truncal vagotomies, what trunks are involved?
During the truncal vagotomies, what trunks are involved?
A patient is experiencing complications after a surgical procedure that involved the celiac nodes. Which of the following is most likely to be affected?
A patient is experiencing complications after a surgical procedure that involved the celiac nodes. Which of the following is most likely to be affected?
A patient has had a splenectomy procedure that impacted a peritoneal fold . Which of the following structures does the gastrosplenic ligament contain?
A patient has had a splenectomy procedure that impacted a peritoneal fold . Which of the following structures does the gastrosplenic ligament contain?
If the peptic ulcer eroded the greater curvature of the wall, the it could affect which structure?
If the peptic ulcer eroded the greater curvature of the wall, the it could affect which structure?
Which of the regions is the most acidic?
Which of the regions is the most acidic?
What structure is contained in the hepatoduodenal
What structure is contained in the hepatoduodenal
Flashcards
Oesophagus location
Oesophagus location
From the cricoid cartilage (C6) to the cardiac opening of the stomach.
Oesophagus relationships
Oesophagus relationships
Thoracic duct (posterior), Aorta (to the left, then posterior), Right pulmonary artery, Left main bronchus, Left atrium-anterior, Vagal trunks.
Thoracic oesophagus blood supply
Thoracic oesophagus blood supply
Oesophageal arteries & Bronchial arteries.
Thoracic oesophagus venous drainage
Thoracic oesophagus venous drainage
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Thoracic oesophagus, lymphatic drainage
Thoracic oesophagus, lymphatic drainage
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Abdominal oesophagus
Abdominal oesophagus
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Abdominal oesophagus blood supply
Abdominal oesophagus blood supply
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Abdominal oesophagus circulation
Abdominal oesophagus circulation
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Barrett's esophagus
Barrett's esophagus
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Stomach anterior surface relation
Stomach anterior surface relation
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Stomach inferior relation
Stomach inferior relation
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Stomach function
Stomach function
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Posterior relations of the stomach
Posterior relations of the stomach
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Stomach bed
Stomach bed
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Greater omentum function
Greater omentum function
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Lesser omentum function
Lesser omentum function
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Gastrophrenic Ligament
Gastrophrenic Ligament
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Gastrosplenic Ligament
Gastrosplenic Ligament
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Stomach absorption
Stomach absorption
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Food in the stomach
Food in the stomach
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Epiploic foramen
Epiploic foramen
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Hiatus hernia
Hiatus hernia
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Sliding (axial) hiatal hernia
Sliding (axial) hiatal hernia
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Paraesophageal (nonaxial) hiatal hernia
Paraesophageal (nonaxial) hiatal hernia
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Duodenum
Duodenum
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Superior part of the duodenum
Superior part of the duodenum
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Descending part of the duodenum
Descending part of the duodenum
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Ascending part of the duodenum
Ascending part of the duodenum
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Superior mesenteric artery syndrome
Superior mesenteric artery syndrome
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Superior mesenteric artery compression
Superior mesenteric artery compression
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Spleen size
Spleen size
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Spleen relations
Spleen relations
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Spleen vascularity
Spleen vascularity
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Spleen blood supply
Spleen blood supply
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Regional lymph nodes
Regional lymph nodes
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Oesophageal hiatus
Oesophageal hiatus
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Z-line
Z-line
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Stomach variability
Stomach variability
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Gastric folds
Gastric folds
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Anterior epiploic foramen
Anterior epiploic foramen
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Superior part of duodenum
Superior part of duodenum
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Descending duodenum
Descending duodenum
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Splenic capsule
Splenic capsule
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Lymphatic drainage
Lymphatic drainage
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Descending duodenum
Descending duodenum
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Descending duodenum
Descending duodenum
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Inferior part of the duodenum
Inferior part of the duodenum
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Sympathetic innervation
Sympathetic innervation
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Parasympathetic innervation
Parasympathetic innervation
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Truncal Vagotomy
Truncal Vagotomy
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Truncal vagotomies
Truncal vagotomies
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SMA syndrome
SMA syndrome
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Study Notes
Oesophagus
- Starts from the cricoid cartilage (C6) and extends to the cardiac opening of the stomach
- Runs anterior to the thoracic vertebrae, then shifts anteriorly toward the aorta
- Has relationships with the thoracic duct (posterior), aorta (to the left, then posterior), right pulmonary artery (right below the tracheal bifurcation), left main bronchus (left and right below tracheal bifurcation), left atrium (anterior), and vagal trunks (right and left)
- Features four constriction areas marked in red in the image
Thoracic Oesophagus
- Receives blood supply from oesophageal and bronchial arteries
- Venous drainage is via the azygos venous system
- Lymphatic drainage occurs through posterior mediastinal nodes
Abdominal Oesophagus
- Passes through the diaphragm at T10 via the oesophageal hiatus
- The Z-line marks the transition in the mucosa
- Associated with the anterior vagal trunk (mostly from the left vagus nerve) and posterior vagal trunk (mostly from the right vagus nerve)
- Supplied by oesophageal branches from the left gastric and left inferior phrenic arteries
- Acts as a site where portal and systemic circulation meet
Barrett's Oesophagus
- Replacement of stratified squamous epithelium by metaplastic columnar epithelium with goblet cells
- Presents with velvety, pink islands of mucosa in the lower third of the oesophagus
- The squamocolumnar junction includes the oesophagus (Stratified squamous epithelium)
- The lower oesophagus (Columnar epithelium)
Stomach
- Breaks down food mechanically with an oblique muscle layer and chemically via HCL
- The anterior surface is related to the diaphragm, left lobe of the liver, and anterior abdominal wall
- The transverse colon is inferior to it
- Size, shape, and position are subject to change
- Includes the Duodenal cap (1st part of the duodenum) and Pyloric sphincter
Posterior Relations of the Stomach
- Related to the omental bursa and the spleen
- The stomach bed consists of the left dome of the diaphragm, spleen and splenic artery, left kidney and supra renal gland, pancreas, and transverse mesocolon
Peritoneal Folds
- Greater omentum attaches to the greater curvature
- Includes the gastrocolic ligament
- Lesser omentum attaches to the lesser curvature
- Includes the hepatogastric ligament and hepatoduodenal ligament
- Attaches to the inferior surface of the diaphragm by the gastrophernic ligament
- Attaches to the spleen by the gastrosplenic ligament
Structure
- Little absorption takes place
- Except for a few highly lipid-soluble substances like alcohol
- Food is churned into liquid "chyme"
- May stay for up to 4 hours
- Released via pylorus intermittently into the duodenum (few millilitres at a time)
- There is a very strong pyloric sphincter here
- Thickening of the inner circular muscle layer
- The layers are
- Outer longitudinal
- Inner circular
- Innermost Oblique
- Lining consists of columnar epithelium
- Consisting of folds -rugae- increase surface area
- Including glands / secretion
Epiploic Foramen (of Winslow)
- Serves as an entrance to the lesser sac
- Posterior to the Inferior Vena Cava
- Superior to the Caudate lobe of the liver
- Inferior to the duodenum part 1
- Anterior to : free edge of lesser omentum, which contains: Hepatic portal vein (posterior), Common bile duct (on right, anterior), Hepatic artery (on left, anterior)
Hiatus Hernia
- Weakening of the diaphragm during aging or congenital leading to the stomach pushing up through the oesophageal hiatus
- Two types of hernias exist
- Sliding (axial) hernias: the whole gastro-oesophageal junctional moves into the thoracic space
- Paraesophageal (nonaxial) hernias: a portion of the stomach gets trapped to one side of the gastro-oesophageal junction
- Symptoms: heartburn and regurgitation of gastric contents and subsequent reflux oesophagitis.
Duodenum
- Retroperitoneal except for its beginning (hepatoduodenal ligamentpeptic)
- Divided into four parts
- Superior part: (L1) from the pyloric orifice to the neck of the gallbladder
- Most common site for peptic ulcers
- Passes anterior to the bile duct, gastroduodenal a. portal vein, IVC
- Descending part: (L2) from the neck of the gallbladder to the L3
- Posterior to the transverse colon, anterior to the right kidney, medial to the head of the pancreas. Contains the major and minor duodenal papillae
- Inferior part: (L3)
- Anterior to the IVC, aorta, posterior to the superior mesenteric vessels
- Ascending part: (L2) Terminates at the duodenojejunal flexure
Superior Mesenteric Artery Syndrome
- A rare form of proximal small bowel obstruction resulting from compression of the third portion of the duodenum between the superior mesenteric artery (anteriorly) and the abdominal aorta (posteriorly)
The Spleen
- Dimensions approximately 12x7x2.5cm (1x3x5 Inches)
- Seldom palpable (except in splenomegaly)
- Mostly intraperitoneal except the hilum
- Peritoneal folds:
- Gastrosplenic ligament : contains the short gastric vessels and left gastro-omental vessels
- Splenorenal ligament contains the splenic vessels and the tail of the pancreas
- Associated with left 9th-10th ribs and diaphragm on the posterior side, and is adjacent to the stomach on the anterior side
- Located medially relative to the left kidney
- Inferior to the left colic flexure
Splenic Rupture
- The spleen is extremely vascular
- The splenic gets supply by artery runs on top of the pancreas body and tail in the splenorenal ligament’
- Trauma is the most common mechanism of injury
- Suspect a rupture if left lower rib fractures are identified
- The capsule is extremely thin and highly vascular, when ruptured, it bleeds profusely into the peritoneal cavity
Blood Supply
- Common hepatic a.
- Rt. Hepatic a.
- Hepatic artery proper
- Supradudenal a.
- Gastrodudenal a.
- Rt. Gastro-omental a.
Anastomotic Connecions
- Right gastric and left gastric anastomose at the lesser curvature of the stomach
- Anterior superior pancreaticoduodenal artery anastomose with anterior Inferior pancreaticoduodenal artery
- Posterior superior pancreaticoduodenal artery anastomose with posterior inferior pancreaticoduodenal artery
Venous Drainage
- Superior Mesenteric & splenic veins join at L1-behind neck of the pancreas to form the hepatic portal vein
- Left gastric and right gastric drain to the hepatic portal vein
- Short gastric and left gastro-omental veins drain to the splenic vein
- Right gastro-omental vein drain to SMV
- Pancreaticoduodenal veins drain to SMV
Lymphatics
- Regional lymph nodes ultimately drain to celiac nodes
- Includes: Gastric nodes, Gastro-omental nodes, Pancreatoduodenal, Pyloric
Innervation
- Parasympathetic innervation: vagus nerve
- Sympathetic innervation: T6-T9 from the greater splanchnic nerves, synapse at the celiac ganglia, distributed by the celiac plexus
Vagotomies
- Used to treat chronic peptic ulcers
- It targets the parasympathetic innervation to the stomach, which increases the acid secretion from the stomach mucosa
- The truncal vagotomies involved dividing the anterior and posterior vagal trunks close to the abdominal oesophagus
- The operation is effective in promoting ulcer healing but paralyses gastric motility and slows pyloric emptying
- Highly selective vagotomy preserves the innervation of the distal antrum and pylorus, whilst denervating the proximal acid-secreting portion of the stomach
- It preserved the nerves of Latarjet and avoided the need for a gastric drainage procedure
- Early postoperative side effects were fewer but ulcer recurrence rates were higher than for truncal vagotomy
Peptic Ulcers
- GI lesions that erode into the layers of the stomach or the duodenum
- Most common, the first part of the duodenum (duodenal cap). Complications: perforation and haemorrhage
- Posterior wall ulcer may cause a lesser sac abscess, or erode into the pancreas or splenic artery
- Duodenal ulcer: epigastric pain may be eased by eating
- Stomach ulcer: epigastric pain may be worse after eating
Risk Assessment
- Greater curvature errosion: damage to the gastro-omental arteries at risk
- Lesser curvature errosion: damage to the gastric arteries
- Erosion of the posterior wall endangers the structures in the stomach bed
- Posterior wall of the duodenal cap errosion endangers the gastroduodenal artery
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