Transcript Esophagus and stomach

DEPARTMENT OF ANATOMY
ABDOMEN
Esophagus
The abdominal oesophagus
• The abdominal oesophagus measures
approximately 1.25 cm in length.
• Phrenicoesophageal ligament
• Esophagogastric junction: T11 vert,Z-line
Barrett's esophagus
• The
normal squamous
epithelium lining
of the esophagus
is replaced by
metaplastic colum
nar epithelium.
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
Esophagageal varices
Stomach
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.
Surface anatomy of stomach parts
Parts of the Stomach
• Has two openings: Cardiac and pyloric orifices
• Two curvatures: Greater and lesser curvatures
• Two surfaces: Anterior and a posterior surface
The stomach is divided into four
regions
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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
v
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.
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
Blood supply
• The arterial
supply to the
stomach is
exclusively from
branches of the
celiac artery.
Venous drainage
is to the portal
system
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.
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.
• 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.
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.
• 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,
Sympathetic
• 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.
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
Complications of Peptic ulcer
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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
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
Selective vagotomy and truncal
vagotomy
Antrectomy and truncal vagotomy for duodenal ulcer with
Billroth I anastomosis.
Gastrectomy
• Total gastrectomy
• Partial gastrectomy
Stomach cancer
Partial gastrectomy with gastrojejunostomy
(Billroth II)
Total gastrectomy