Esophagus Anatomy

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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?

  • 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?

  • 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?

  • 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?

<p>The thoracic duct is located posterior to the esophagus throughout its thoracic course. (D)</p> Signup and view all the answers

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?

<p>At the junction of the esophagus and the stomach. (B)</p> Signup and view all the answers

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?

<p>Gastroduodenal artery (C)</p> Signup and view all the answers

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?

<p>Splenorenal ligament (B)</p> Signup and view all the answers

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?

<p>Portal venous system (D)</p> Signup and view all the answers

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?

<p>Superior mesenteric artery syndrome (B)</p> Signup and view all the answers

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?

<p>Right hepatic artery (A)</p> Signup and view all the answers

What is TRUE regarding the oesophagus?

<p>The oesophagus is anterior to the thoracic vertebrae, then moves anterior to the aorta as it descends. (C)</p> Signup and view all the answers

Which of the following lymphatic drainage pathways is specific to the abdominal part of the oesophagus?

<p>To the celiac nodes. (B)</p> Signup and view all the answers

A patient is diagnosed with adenocarcinoma at the gastroesophageal junction and requires surgical resection. What is the significance of the Z-line?

<p>It marks the transition from stratified squamous epithelium to columnar epithelium. (D)</p> Signup and view all the answers

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?

<p>Aortic Arch (C)</p> Signup and view all the answers

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?

<p>Left vagus nerve (B)</p> Signup and view all the answers

Why is it clinically relevant to understand the four constriction areas of the esophagus?

<p>They are common sights of oesophageal cancer for bolus of food to get lodged (C)</p> Signup and view all the answers

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?

<p>Diaphragm and left lobe of the liver (C)</p> Signup and view all the answers

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?

<p>Gastrocolic and gastrophrenic ligaments (A)</p> Signup and view all the answers

A researcher is studying the structure of the stomach and notes the presence of rugae. What is the primary function of these gastric folds?

<p>To increase surface area for expansion (D)</p> Signup and view all the answers

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?

<p>Foramen of Winslow (Epiploic foramen) (D)</p> Signup and view all the answers

A patient is diagnosed with a paraesophageal hiatal hernia. Which anatomical characteristic differentiates this condition from a sliding hiatal hernia?

<p>The gastroesophageal junction remains in its normal position, but a part of the stomach herniates into the thorax. (A)</p> Signup and view all the answers

A patient who had a peptic ulcer perforate to the posterior wall would put what vessel at risk?

<p>The Splenic artery (C)</p> Signup and view all the answers

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?

<p>Superior mesenteric artery, causing Superior Mesenteric Artery syndrome (B)</p> Signup and view all the answers

What is the function of gastrosplenic ligament?

<p>Contains short gastric vessels and left gastro-omental vessels (D)</p> Signup and view all the answers

What are the structures contained in the splenorenal ligament?

<p>Contains the splenic vessels and the tail of the pancreas (C)</p> Signup and view all the answers

A patient has had damage to their celiac nodes. What would this impact?

<p>Draining lymphatic of nodes before draining to the celiac nodes (B)</p> Signup and view all the answers

Stimulation of what nerve stimulates parasympathetic innervation of the stomach:?

<p>Vagus nerve (B)</p> Signup and view all the answers

Which arteries anastomose at the lesser curvature of the stomach?

<p>Right gastric and left gastric (C)</p> Signup and view all the answers

What would be least risk tissue if there was damage to the blood supply of the stomach?

<p>Omentum (D)</p> Signup and view all the answers

What artery branches off the Common Hepatic artery?

<p>Right hepatic artery (B)</p> Signup and view all the answers

Which of the following accurately describes the usual anatomical position of the esophagus in relation to the aorta?

<p>The esophagus is anterior to the aorta in the upper thorax and posterior in the lower thorax. (A)</p> Signup and view all the answers

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?

<p>C6 (B)</p> Signup and view all the answers

After undergoing a medical procedure, a patient develops esophageal dysfunction. What anatomical structure is most likely to be responsible for this condition?

<p>Impaired function of the 4 constriction areas. (A)</p> Signup and view all the answers

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?

<p>Esophageal hiatus of the diaphragm. (A)</p> Signup and view all the answers

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?

<p>Reduced parasympathetic tone to the stomach. (B)</p> Signup and view all the answers

A patient presents with symptoms indicative of Barrett's esophagus. Which of the following best describes the cellular change associated with this condition?

<p>Replacement of stratified squamous epithelium with metaplastic columnar epithelium. (A)</p> Signup and view all the answers

What change occurs in the squamocolumnar junction in Barret's esophagus?

<p>Columnar epithelium replaces stratified squamous epithelium. (B)</p> Signup and view all the answers

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:

<p>Sliding hernia. (D)</p> Signup and view all the answers

A patient undergoes a diagnostic procedure revealing a paraesophageal hernia. How does this hernia differ anatomically from a sliding hiatal hernia?

<p>The stomach herniates alongside the esophagus but the gastroesophageal junction stays in place. (C)</p> Signup and view all the answers

Considering the anatomical relations of the stomach, which of the following structures is in direct contact with the anterior surface?

<p>Diaphragm. (A)</p> Signup and view all the answers

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?

<p>Through the epiploic foramen (of Winslow). (B)</p> Signup and view all the answers

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?

<p>Omental bursa. (A)</p> Signup and view all the answers

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?

<p>Duodenal cap (A)</p> Signup and view all the answers

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?

<p>The inferior part (B)</p> Signup and view all the answers

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?

<p>Superior mesenteric artery syndrome. (B)</p> Signup and view all the answers

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?

<p>Gastroduodenal artery (A)</p> Signup and view all the answers

During a surgical procedure, a surgeon identifies the ligament of Treitz. Which portion of the duodenum does this ligament support?

<p>Ascending part (B)</p> Signup and view all the answers

A patient has impaired function of major duodenal papilla. What does this impact?

<p>Contains the major and minor duodenal papillae. (D)</p> Signup and view all the answers

Which of the following characteristics is typical of the spleen's anatomical location?

<p>It is located intraperitoneally except the hilum. (C)</p> Signup and view all the answers

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?

<p>Splenorenal ligament. (C)</p> Signup and view all the answers

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?

<p>The posterior relation to the 9th-10th ribs. (A), The medial relation to the left kidney. (B), The inferior relation to the left colic flexure. (C), The anterior relation to the stomach. (D)</p> Signup and view all the answers

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?

<p>Splenic artery. (D)</p> Signup and view all the answers

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?

<p>Left 9th-10th ribs. (C)</p> Signup and view all the answers

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?

<p>Left gastric a. (A)</p> Signup and view all the answers

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?

<p>Right gastric artery. (D)</p> Signup and view all the answers

A patient has problems receiving blood supply from the Celiac trunk, impacting several organs. What organ is not impacted by this?

<p>Kidney (B)</p> Signup and view all the answers

A patient presents with symptoms of impaired gastric motility and acid secretion following a surgical procedure. What nerve was potentially severed?

<p>Vagus nerve. (A)</p> Signup and view all the answers

Which arteries form an anastomosis along the lesser curvature of the stomach, providing collateral circulation?

<p>Right gastric and left gastric arteries. (D)</p> Signup and view all the answers

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?

<p>To preserve the nerves of Latarjet. (A)</p> Signup and view all the answers

During the truncal vagotomies, what trunks are involved?

<p>dividing the anterior and posterior vagal trunks close to the abdominal oesophagus (D)</p> Signup and view all the answers

A patient is experiencing complications after a surgical procedure that involved the celiac nodes. Which of the following is most likely to be affected?

<p>Lymphatic drainage from the stomach. (B)</p> Signup and view all the answers

A patient has had a splenectomy procedure that impacted a peritoneal fold . Which of the following structures does the gastrosplenic ligament contain?

<p>Contains the short gastric vessels. (C)</p> Signup and view all the answers

If the peptic ulcer eroded the greater curvature of the wall, the it could affect which structure?

<p>gastro-omental arteries (B)</p> Signup and view all the answers

Which of the regions is the most acidic?

<p>Fundus (C)</p> Signup and view all the answers

What structure is contained in the hepatoduodenal

<p>portal triad (B)</p> Signup and view all the answers

Flashcards

Oesophagus location

From the cricoid cartilage (C6) to the cardiac opening of the stomach.

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

Oesophageal arteries & Bronchial arteries.

Thoracic oesophagus venous drainage

Azygos venous system.

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Thoracic oesophagus, lymphatic drainage

Posterior mediastinal nodes.

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Abdominal oesophagus

Passes through the diaphragm at T10 through the oesophageal hiatus.

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Abdominal oesophagus blood supply

Oesophageal branches from the left gastric artery and the left inferior phrenic artery.

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Abdominal oesophagus circulation

A site where portal and systemic circulation meet.

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Barrett's esophagus

Replacement of stratified squamous epithelium by metaplastic columnar epithelium with goblet cells.

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Stomach anterior surface relation

Diaphragm, Left lobe of the liver, Anterior abdominal wall.

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Stomach inferior relation

Transverse colon.

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Stomach function

Stomach breaks down food mechanically and chemically via HCL.

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Posterior relations of the stomach

Posteriorly the stomach is related to the omental bursa and the spleen.

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Stomach bed

Left dome of the diaphragm, Spleen and splenic artery, Left kidney and supra renal gland, Pancreas, Transverse mesocolon.

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Greater omentum function

Attaches to the greater curvature, contains fat and lymph nodes.

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Lesser omentum function

Attaches to the lesser curvature, contains hepatic vessels.

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Gastrophrenic Ligament

Gastrophrenic ligament: inferior surface of the diaphragm.

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Gastrosplenic Ligament

Gastrosplenic ligament: to the spleen.

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Stomach absorption

Very little absorption takes place.

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Food in the stomach

May remain here for up to 4 hours, released via pylorus intermittently into the duodenum.

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Epiploic foramen

Opening in the lesser omentum; entrance to the lesser sac.

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Hiatus hernia

Weakening of diaphragm that results in stomach pushing up through oesophageal hiatus.

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Sliding (axial) hiatal hernia

Whole gastro-oesophageal junction moves into the thoracic space.

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Paraesophageal (nonaxial) hiatal hernia

Portion of stomach trapped to one side of the gastro-oesophageal junction.

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Duodenum

Retroperitoneal except for its beginning (hepatoduodenal ligament)

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Superior part of the duodenum

From the pyloric orifice to the neck of the gallbladder.

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Descending part of the duodenum

From the neck of the gallbladder to the L3.

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Ascending part of the duodenum

Terminates at the duodenojejunal flexure.

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Superior mesenteric artery syndrome

Rare form of proximal small bowel obstruction.

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Superior mesenteric artery compression

Resulting from compression of the third portion of the duodenum between the superior mesenteric artery, anteriorly, and the abdominal aorta, posteriorly.

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Spleen size

12x7x2.5cm.

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Spleen relations

Posteriorly with left 9th-10th ribs & diaphragm, Anteriorly with the stomach, Medially with left kidney, Inferiorly with the left colic flexure.

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Spleen vascularity

Extremely vascular.

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Spleen blood supply

Supplied by splenic artery (runs on top of the pancreas body and tail in the splenorenal ligament).

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Regional lymph nodes

Gastric nodes, Gastro-omental nodes, Pancreatoduodenal, Pyloric.

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Oesophageal hiatus

Where the abdominal and thoracic esophagus meet, at the diaphragm.

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Z-line

The junction between the esophagus and the stomach, where the mucosa changes.

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Stomach variability

The size, shape, and position varies depending on fullness and body position.

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Gastric folds

Folds or rugae increase surface area during digestion.

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Anterior epiploic foramen

Contains hepatic portal vein, common bile duct, and hepatic artery.

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Superior part of duodenum

Bile duct, gastroduodenal a. portal vein, IVC.

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Descending duodenum

From the neck of the gallbladder to the L3.

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Splenic capsule

An extremely thin capsule and is highly vascular, when ruptured, it bleeds profusely into the peritoneal cavity.

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Lymphatic drainage

Regional lymph nodes drain to celiac nodes, Gastric nodes, Gastro-omental nodes, Pancreatoduodenal and Pyloric.

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Descending duodenum

Contains the major and minor duodenal papillae.

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Descending duodenum

Posterior to the transverse colon, anterior to the right kidney, medial to the head of the pancreas

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Inferior part of the duodenum

Anterior to the IVC, aorta, posterior to the superior mesenteric vessels

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Sympathetic innervation

Originates at T6-T9 from the greater splanchnic nerves and synapses at the celiac ganglia.

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Parasympathetic innervation

Parasympathetic innervation is vagus nerve.

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Truncal Vagotomy

The truncal divides the anterior and posterior vagal trunks close to the abdominal oesophagus.

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Truncal vagotomies

The operation is effective in promoting ulcer healing but paralyses gastric motility and slows pyloric emptying.

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SMA syndrome

Rare. Resulting from compression of the third portion of the duodenum between the superior mesenteric artery. (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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