Esophagus & Stomach (GNT Block) PDF

to Ana 4my 43 Esophagus & Stomach G N T Block Color Index Main Text Female Slides Male Slides Drs' Notes Important Extra info The Editing File Objectives Describe the anatomical view of the Esophagus; extent & length, parts, constrictions, relations, blood & nerve supply and lymphatic. Descri...

to Ana 4my 43 Esophagus & Stomach G N T Block Color Index Main Text Female Slides Male Slides Drs' Notes Important Extra info The Editing File Objectives Describe the anatomical view of the Esophagus; extent & length, parts, constrictions, relations, blood & nerve supply and lymphatic. Describe the anatomical view of the Stomach; location, shape, parts, relations, blood & nerve supply and lymphatic. This lecture was presented by : Dr. Zahid Kaimkhani Dr. Amal Al-Rabiah You can find more quizzes by Clicking HERE! Special Thanks to Saleh Aljanah and Abdulaziz Alqarni! You can find Atlas by Clicking HERE! Esophagus The Esophagus is a tubular structure about 25 cm long. The esophagus begins as the continuation of the pharynx at the level of the 6th cervical vertebra. At the level of the 10th thoracic vertebrae the esophagus pierces the diaphragm to join the stomach. It then ends at the level of the 11th thoracic vertebrae. Divided into three parts: 1 2 Cervical Abdominal 3 Thoracic Cervical relations Posteriorly: – Vertebral column. Laterally: – lobes of the thyroid gland. Anteriorly: – Trachea – Recurrent laryngeal nerves. Abdominal relations Fibers from the right crus of the diaphragm form a sling around the esophagus. At the opening of the diaphragm, the esophagus is accompanied by: - The Two Vagi - Branches of the Left Gastric Vessels - Lymphatic Vessels. In the abdomen, the esophagus descends for 1.3 cm and joins the stomach. Anteriorly it is related to: •left lobe of the liver. Posteriorly it is related to: •the left crus of the diaphragm. Thoracic Esophagus MCQ In the thorax,it passes downward and to the left through superior & posterior mediastinum. At the level of the sternal angle, the aortic arch pushes the esophagus again to the midline. Anterior Relations Trachea Left Atrium Pericardium Left principal bronchus Left recurrent laryngeal nerve Posterior Relations Bodies of the thoracic vertebrae Thoracic duct Azygos vein Right posterior intercostal arteries Descending thoracic aorta (at the lower end) Lateral Relations On the Right side: • Mediastinal pleura. • Terminal part of the azygos vein. On the Left side: • Mediastinal pleura. • Left subclavian artery. • Aortic arch. • Thoracic duct. Esophagus Constrictions The esophagus has 3 anatomic constrictions: The first (Narrowest)is at the junction with the pharynx (15 cm from incisor teeth). The second is at the crossing with the aortic arch and the left main bronchus. ( 27 cm) The third is at the junction with the stomach. (38 cm) They have a considerable clinical importance. Why? Also when crossed by arch of aorta 22 cm. Clinical importance: They may cause difficulties in passing an esophagoscope. In case of swallowing of caustic liquids (mostly in children),this is where the burning is the worst and strictures develop. The esophageal strictures are a common place of the development of the esophageal carcinoma. Oesophagus and left atrium: There is a close relationship between the left atrium of the heart and the esophagus. What is the clinical application? • A barium swallow in the esophagus will help the physician to assess the size of the left atrium (Dilation) as in case of a heart failure. In this picture what is the importance of the scale? So we know whether the constriction is physiological or pathological (stricture) Oesophagus Supply • Upper third is supplied by the inferior thyroid Arterial Supply artery. • The middle third by the thoracic aorta. • The lower third by the left gastric artery. Venous Drainage The upper third drains in into the inferior thyroid veins. • The middle third into the azygos veins. • The lower third into the left gastric vein, which is a tributary of the portal vein. • The upper third is drained in the deep cervical nodes. Lymphatic • The middle third is drained into the superior drainage and inferior mediastinal nodes. • The lower third is drained in the celiac lymph nodes in the abdomen. Nerve supply • It is supplied by sympathetic fibers from the sympathetic trunks. • The parasympathetic supply comes form the vagus nerves. • Inferior to the roots of the lungs, the vagus nerves join the sympathetic nerves to form the esophageal plexus. • The left vagus lies anterior to the esophagus. • The right vagus lies posterior to it. Stomach Location: It is the most dilated part of the alimentary canal and roughly resembles the letter “J”. It is located in the upper part of the abdomen. It extends from beneath the left costal region into the epigastric and umbilical regions. Much of the stomach is protected by the lower ribs. Relations: Posterior (Stomach bed) 1. 2. 3. 4. 5. 6. 7. 8. 9. Left crus of diaphragm. Left suprarenal gland. Part of left kidney. Spleen. Splenic artery. Pancreas. Transverse mesocolon. Transverse colon. Lesser sac. (AKA Omental bursa) Anterior 1. Anterior abdominal wall 2. Left costal margin 3. Left pleura & left lung 4. Diaphragm 5. Left lobe of the liver All structures on the posterior aspect are separated from the stomach by the peritoneum of lesser sac EXCEPT the spleen which is separated by the greater sac. MCQ Stomach Parts Esophagus Parts of Stomach Fundus Orifices Cardiac Orifice border border Lesser curvature Greater curvature Orifices Pyloric Orifice Parts of Stomach Body of stomach (Corpus) Duodenum Pylorus Formation Pylorus Formation Pyloric Antrum Pyloric Canal Parts of Stomach Pylorus (Divided into: Pyloric Antrum & Pyloric Canal) Stomach Parts A) Cardiac Orifice 2 Orifices 1- It is the site of the Gastroesophageal sphincter (It’s a physiological rather than an anatomical Sphincter). 2- Consist of circular smooth muscles (under vagal and hormonal control). 3- Lies opposite to the left seventh costal cartilage 2.5 cm from the sternum (T10). 4- Function: prevents esophageal regurgitation (reflux). B) Pyloric Orifice A) Lesser curvature 1- Forms the Right border of the stomach 2- Extends from the cardiac orifice to the pylorus(Opening of stomach to Duodenum). 3- Attached to the liver by lesser omentum (gastrohepatic ligament) 2 Borders B) Greater curvature 1- Forms the Left border of the stomach 2- Extends from the cardiac orifice to the pylorus. 3- Its upper part attached to the spleen by gastrosplenic ligament. 4- Its lower part attached to the transverse colon by greater omentum. A) Fundus 3 Parts 1- Dome shaped, usually full of gases 2- Located to the left of the cardiac orifice. It reaches the left 5th intercostal space just below the apex of the heart B) Body 1- Extends from the level of the Fundus to the level of incisura angularis 2- Incisura angularis is a constant notch on the lesser curvature C) Pylorus Pylorus The pylorus is a tubular part of the stomach. It lies in the transpyloric plane L1 (1 cm) to the right of the midline made of: A) Pyloric Antrum Extends from incisura angularis to the pylorus B) Pyloric canal cavity of the pylorus C) Pyloric Sphincter Thick muscular End Surfaces 1) Anterior surface 2) Posterior surface Stomach Supply 5 arteries, runs on: ● Lesser curvature: - Right gastric: from hepatic artery of celiac (to the left Along the lesser curvature). Arterial Supply Venous Drainage - Left gastric: a branch of celiac artery. ● Greater curvature: - Right gastroepiploic: from gastroduodenal artery of hepatic (to the left Along the greater curvature). Gastrosplenic ligament: - Short gastric Arteries - Left gastroepiploic (Both arise from splenic artery). ● Corresponds to the arteries and all of them drain in the portal circulation • Right and left gastric veins drain directly into the portal vein. • Right gastroepiploic vein drain in the superior mesenteric vein. • Short gastric and left gastroepiploic veins join the splenic vein. • Pre-pyloric vein of mayo It a an indicator of the site of the pyloric sphincter (which is an anatomical sphincter). 1- The lymph vessels Follow the arteries and drains first into: Lymphatic - Left and right gastric nodes drainage - Left and right gastroepiploic nodes - Short gastric nodes 2-Ultimately, all lymph nodes of the stomach is collected at the celiac nodes. ● Sympathetic: Nerve supply derived from celiac plexus ● Parasympathetic: from both vagi. A- Anterior vagal trunk: - Formed from the left vagus. - Supplies the anterior surface of the stomach. - Gives off a hepatic branch, and from it a branch to the pylorus. B- Posterior vagal trunk: -Formed from the right vagus. -Supplies the posterior surface of the stomach. -Gives off a large branch to the celiac and superior mesenteric plexuses. Blood supply of the Stomach Thanks to Aroub Almahmoud for this diagram. EXTRA MCQs Q1. The greater omentum connects the stomach to which structures? A. Spleen B. Transverse colon C. Liver D. All of the above Q2. Which of the following is NOT an anterior relation of the oesophagus? A. Trachea B. Azygos vein D. Left recurrent laryngeal N. C. Left atrium Q3. Which one of these statement is true regarding the anterior vagal trunk? A. Formed from the B. Supply the posterior right vagus surface of the stomach C. Gives off a hepatic branch and from it - a branch to the pylorus D. Gives off a branch to the celiac mesenteric plexus Q4. The bolus enters into the stomach from the esophagus to the stomach through? A. Pyloric sphincter B. Fundic orifice C. Angular notch D. Cardiac orifice Q5. At which level does the oesophagus pierce the diaphragm? A. T10 B. T11 C. C6 D. T8 Q6. Which one of the following posterior relations is NOT separated from stomach by peritoneum of lesser sac? A. Spleen B. Splenic artery C. Pancreas D. Left kidney A1. B A2. B A3. C A4. D A5. A A6. A FOR ANKI FLASHCARDS OR CLICK HERE Team Leaders Faris Alzahrani Salman Althunayan Norah Almohaimeed Raseel Almutairi Team Members Khalid Alsobei Lama Alsuliman Mohammed Alarfaj Wafa Alakeel Faisal Alhejji Mohammed Alqutub Aban Basfar Faisal Alshowier Sultan Albaqami Moath Alhudaif Aljoharah Alkhalifah Sarah Alshahrani Fatimah Alghamdi Shahad Alzaid Reuf Alahmari Lama Alotaibi Reem Alomair Haya Alajmi Norah Alhazzani Renad M Alshehri Special Thanks to Moath Alhudaif & Aleen Alkulyah for the Design and to Norah Almania for the Logo! [email protected]