DEPARTMENT OF ANATOMY ABDOMEN. Esophagus The abdominal oesophagus The abdominal oesophagus measures...
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DEPARTMENT OF ANATOMY
ABDOMEN
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Esophagus
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The abdominal oesophagus
• The abdominal oesophagus measures approximately 1.25 cm in length.
• Phrenicoesophageal ligament• Esophagogastric junction: T11 vert,Z-line
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Barrett's esophagus
• The normal squamous epithelium lining of the esophagus is replaced by metaplastic columnar epithelium.
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Nerves of abdominal esophagus
• The right and left vagus nerves (CN X) divide into branches that form the esophageal plexus around the inferior esophagus.
• Anterior and posterior gastric branches of the plexus accompany the esophagus through the esophageal hiatus for distribution to the anterior and posterior aspects of the stomach.
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Esophageal Varices
• The lower third of the oesophagus is a site of porto-systemic venous anastomosis. This is formed between tributaries of the left gastric and azygos veins
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Esophagageal varices
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Stomach
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Stomach• The stomach is the most dilated part of the
gastrointestinal tract and has a J-like shape.• Positioned between the abdominal esophagus and
the small intestine, the stomach is in the epigastric, umbilical, and left hypochondrium regions of the abdomen.
• It stores food (in the adult it has a capacity of about 1500 mL), it mixes the food with gastric secretions to form a semifluid chyme, and it controls the rate of delivery of the chyme to the small intestine so that efficient digestion and absorption can take place.
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Surface anatomy of stomach parts
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Parts of the Stomach
• Has two openings: Cardiac and pyloric orifices • Two curvatures: Greater and lesser curvatures• Two surfaces: Anterior and a posterior surface
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The stomach is divided into four regions
• 1. Cardia• 2. Fundus of stomach• 3. Body of stomach• 4. Pyloric part: which is divided into the
pyloric antrum and pyloric canal and is the distal end of the stomach
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v
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Interior of the Stomach
• When contracted, the gastric mucosa is thrown into longitudinal ridges called gastric folds, or gastric rugae, they are most marked toward the pyloric part and along the greater curvature.
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Hiatal Hernia
• 1.Paraesophageal hiatal hernia:the cardia remains in its normal position, however, a pouch of peritoneum, often containing part of the fundus, extends through the esophageal hiatus
• 2.Sliding hiatal hernia:the abdominal part of the esophagus, the cardia, and parts of the fundus of the stomach slide superiorly through the esophageal hiatus into the thorax
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Blood supply• The arterial
supply to the stomach is
exclusively from branches of the celiac artery. Venous drainage is to the portal system
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Celiac trunk
• The celiac trunk is the anterior branch of the abdominal aorta supplying the foregut.
• It arises from the abdominal aorta immediately below the aortic hiatus of the diaphragm anterior to the upper part of vertebra LI.
• It immediately divides into the left gastric, splenic, and common hepatic arteries.
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Veins of stomach and duodenum
• Venous drainage from the stomach and duodenum is into the portal vein, either directly or indirectly via the splenic or superior mesenteric vein (SMV).
• The splenic vein usually receives the inferior mesenteric vein and then unites with the SMV to form the portal vein.
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• The right and left gastric veins drain into the portal vein.
• short gastric veins and left gastro-omental veins drain into the splenic vein.
• The right gastro-omental vein empties in the SMV.
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Nerve supply• Parasympathetic
• The anterior and posterior vagal trunks arise from the oesophageal plexuses and enter the abdomen through the oesophageal hiatus.
• The hepatic branches of the anterior vagus pass to the liver.
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• The coeliac branch of the posterior vagus passes to the coeliac ganglion from where it proceeds to supply the intestine down to the distal transverse colon.
• The anterior and posterior vagal trunks descend along the lesser curve as the anterior and posterior nerves of Latarjet from which terminal branches arise to supply the stomach,
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• The sympathetic nerve supply of the stomach from the T5 through T9 segments of the spinal cord passes to the celiac plexus through the greater splanchnic nerve.
Sympathetic
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Peptic Ulcer
• A peptic ulcer is a hole in the gut lining of the stomach, duodenum, or esophagus. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer.
• An ulcer occurs when the lining of these organs is corroded by the acidic digestive juices which are secreted by the stomach cells.
• >80% involve Helicobacter pylori
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Complications of Peptic ulcer
• 1.Gastro intestinal bleeding• 2. Perforation• 3. Cancer• Perforation• Lesser curvature :Erosion of gastric artery (R & L)
• Posterior Surface of stomach: Splenic artery• Posterior wall of 1st part of duodenum: Gastroduodenal artery
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Vagotomy(surgical section of the vagus nerves) is performed in some people
with chronic or recurring ulcers to reduce the production of acid
• A truncal vagotomy (surgical section of the vagal trunks) is rarely performed because the innervation of other abdominal structures is also sacrificed
• A selective proximal vagotomy :attempts to denervate even more specifically the area in which the parietal cells are located
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Selective vagotomy and truncal vagotomy
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Antrectomy and truncal vagotomy for duodenal ulcer with
Billroth I anastomosis.
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Gastrectomy
• Total gastrectomy • Partial gastrectomy
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Stomach cancer
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Partial gastrectomy with gastrojejunostomy (Billroth II)
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Total gastrectomy