esophagus and stomach 2

8/3/2019 Esophagus and Stomach 2

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Faculty of medicineMED 2035

Dr. Ahmed Mohammed Saliem

Course Coordinator: Mr. Said

Al- Qurra

Esophagus and Stomach


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Objectives

By the end of this session you will be able to:

1. describe the esophagus,

2. describe the stomach,

3. describe the blood supply of the stomach,

4. describe the innervation of the stomach,

5. describe the lymphatic drainage of the stomach.


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The Esophagus


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Esophagus

The esophagus is a muscular tube 25 cm in long.

It starts as the continuation of the pharynx and ends by

joining the cardia of the stomach (T11 vertebra). it isattached at proximal end to the cricoid cartilage and at its

distal end to the diaphragm by the phrenicoesophegeal

ligament.


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Esophagus

the esophagus follows

the curves of the

vertebral column inthe neck and

mediastinum.


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Esophagus

It has an internal circular

muscular layer and

outerlongitudinal

muscular coat that is

composed of skeletal

muscle in the upper end,

and smooth muscle in the

lower end and mixed ofboth in the middle

portion.


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Esophagus

the esophagus crosses the diaphragm by passing

through the esophageal hiatus in the right crus, on

the left side of the median plan and at the level ofthe T10 vertebra.

the abdominal; trumpet part of the esophagus is

1.25 cm in long and ends by joining the cardiaof

the stomach.


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Esophagus

along the course of the esophagus, three

constriction will be noted, specially during a

barium fluoroscopy, these constrictionsare.


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Esophagus

Cervical constriction: At the beginning of the esophagus,15 cm from the incisor teeth, (pharyngoesophageal

junction), due to the cricopharyngeus muscle.

Thoracic (broncho-aortic) constriction: where it is firstcrossed by the arch of the aorta (22.5 cm from the incisorteeth) [AP view] and second by the left bronchus (27.5 cmfrom the incisor teeth) [lateral].

Diaphragmatic constriction: as it passes through theesophageal hiatus of the diaphragm 40 cm from the incisorteeth.


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Esophagus (blood supply)

The cervical portion inferior thyroid artery.

The thoracic portion bronchial arteries and

esophageal arteries.

75 percent of individuals having one right-sided and two

left-sided bronchial branches.

The abdominal portion ascending branch of the leftgastric artery from the celiac trunk and from inferior

phrenic arteries.


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Esophagus (blood supply)

Blood from the capillaries of the esophagus flows into a

submucosal venous plexus and then into a periesophageal

venous plexus from which the esophageal veins originate.

In the cervical region the inferior thyroid vein.

In the thoracic region the bronchial, azygos, or

hemiazygosveins.

In the abdominal region the coronary vein and to the

azygos vein.


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Esophagus (lymphatic drainage)

The lymphatics located in the submucosa of

the esophagus are so dense and

interconnected that they constitute a singleplexus.

In the upper two-third of the esophagus the

lymphatic flow is mostly proximally, and in

the lower third distally.


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Esophagus (lymphatic drainage)

The cervical esophagus paratracheal and inferior

deep cervical lymph nodes.

The upper thoracic esophagus the paratracheallymph nodes.

The lower thoracic esophagus the subcarinal nodes

and nodes in the inferior pulmonary ligaments.

The abdominal esophagus the left gastric lymph

nodes the celiac lymph nodes.


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Esophagus (nerve supply)

the cervical esophagus and The cricopharyngeal

sphincter receives somatic motor and sensory from

both recurrent laryngeal nerves, which originatefrom the vagus nerves the right recurrent nerve at

the lower margin of the subclavian artery, the left

at the lower margin of the aortic arch.


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Esophagus (nerve supply)

The parasympathetic innervation of the pharynx

and esophagus is provided mainly by the vagus

nerves.

the esophagus is innervated by the esophageal

plexuses by the anterior and the posterior gastric

nerves from the vagal trunk and by the thoracicsympathatic trunk which gives off the splanchnic

and the periarterial plexuses.


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The Stomach


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Stomach

The stomach is the dilated portion of the

gastrointestinal tract that receives the food

from the esophagus and deliver it later tothe small intestine.


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Stomach

The stomach has three main functions:

1. It stores food (in the adult it has a capacity of about 1.5L

and may expand to hold up to 3L),

2. It acts a blender that mixes the food with the gastric juice

and enzymes, digest the food to form a semifluidchyme,

3. And the stomach (pyloric sphincter controls) the rate ofdelivery of the chyme to the duodenum and small intestine

where efficient digestion and absorption can take place.


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Stomach

The position of the stomach varies according tothe shape of the body, posture and to the intraabdominal pressure.

In the supine position; the stomach is situated in

the upper part of the abdomen, extending fromthe left hypochondium region into the epigastricand umbilical regions.


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Stomach

The stomach is high and transversely arranged in

the short, obese person.

The stomach moves inferiorly and become

elongated and assume a vertical position in the

tall, thin person in the erect position and in thin

people.

The majority of the stomach is covered by the

lower ribs.


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Stomach

The stomach has

two openings,

1. The cardiac and

2. pyloric orifices.


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Stomach

Two curvatures,

1. The greater and

2. Lesser curvatures.

And two surfaces,

1. An anterior and a

2. Posterior surface.


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Stomach

The stomach is

divided into four

parts.1. Cardia.

2. Fundus.

3. Body.4. Pylorus.


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Stomach

Cardia: which is the part surrounding the cardiac

orifice (2-4cm left to the midline), behind the 6th

costal cartilage.

Fundus: dome-shaped and projects upward and to

the left of the cardiac orifice, and it is related to

the left dome of the diaphragm. It is separatedfrom the cardiac orifice by the cardiac notch and

is full of gas usually.


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Stomach

Body: extends from the plane below the

cardiac orifice to the level of the

incisuraangularis, a constant notch in thelower part of the lesser curvature.


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Stomach

Pylorus: which is composed of two parts,

the wide funnel shaped pyloric antrum that

extends from the incisuraangularis to thepyloric canal (second part) which is the

tubular part of the stomach that is

characterized by the thick circular layer ofthe muscular wall to form pyloric sphincter.


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Stomach (blood supply)

The arteries are derived from the branches of the celiac

artery.

The left (celiac artery) and right gastric(hepatic artery)

arteries lesser curvature.

(the RGA will supply the duodenum and the pylorus)


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The left gastroepiploic artery (splenic artery) and the right

gastroepiploic artery (gastroduodenal branch of the

hepatic artery) greater curvature,the antrum and the

lower portion of the fundus.

The short gastric arteries (splenic artery) will also supply

the fundus and the upper potion of the body.


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The veins drain into the portal circulation.

The left and right gastric veins the portal vein.

The short gastric vein and the left gastroepiploic vein

splenic vein superior mesenteric vein to form the

hepatic portal vein.

The right gastroepiploic vein superior mesenteric vein.

the prepyloric vein right gastric vein.


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Stomach (lymphatic drainage)

The lymph vessels follow the arteries into

the left and right gastric nodes, the left and

right gastroepiploic nodes, and the shortgastric nodes. All lymph from the stomach

eventually passes to the celiac nodes located

around the root of the celiac artery on theposterior abdominal wall.


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The upper 2/3rds of the stomach gastric lymph

nodes (along the right and left gastric vessels).

The fundus and the upper part of the body

pancreaticosplenic nodes (along the short gastric and

gastro-omental vessels).


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the right 2/3rd of the lower part of the body pyloric

lymph nodes (along the right gastro-omental vessels).

the left 1/3rd of the lower part of the stomach

pancreaticoduodenal lymph node (along the short gastric

and splenic vessels).


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Stomach (nerve supply)

The nerve supply includes sympathetic

fibers derived from the celiac plexus and

parasympathetic fibers from the right andleft vagus nerves.


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The anterior vagal trunk,

Which is formed in the thorax mainly from the left vagus

nerve, enters the abdomen on the anterior surface of theesophagus. The trunk, which may be single or multiple,

then divides into branches that supply the anterior surface

of the stomach. A large hepatic branch passes up to the

liver, and from this a pyloric branch passesdown to thepylorus .


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The posterior vagal trunk,

which is formed in the thorax mainly from the right vagus

nerve, enters the abdomen on the posterior surface of theesophagus. The trunk then divides into branches that

supply mainly the posterior surface of the stomach. A large

branch passes to the celiac and superior mesenteric

plexuses and is distributed to the intestine as far as thesplenic flexure and to the pancreas.


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The sympathetic innervation of the stomach carries a

proportion of pain-transmitting nerve fibers, whereas the

parasympathetic vagal fibers are secretomotor to the

gastric glands and motor to the muscular wall of the

stomach. The pyloric sphincter receives motor fibers from

the sympathetic system and inhibitory fibers from the

vagus nerve.


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esophagus and stomach 2

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