Esphagus Stomach Duodenum Gross Anatomy

1. Review the esophagus: commencement, commencement, termination, location, length, constrictions, relations, neurovascular neurovascular supply

Commencement: opposite the sixth cervical vertebra; it is continuous above with the laryngeal part of the pharynx begins at the inferior border of the cricoid cartilage y

y

Termination: end by entering the stomach (cardiac orifice) left 7th costal cartilage or opposite T11 y

Location: y

It

is between the trachea and the spine

Length: y

25-30

cm long in a normal adult

Constrictions: 1. at the beginning by the cricopharyngeus muscle 2. where the aortic arch and the left bronchus cross its anterior surface 3. where the esophagus passes through the diaphragm into the stomach at th the 10 thoracic vertebra Relations: y

Inferiorly

to the level of the roots of the lungs Left vagus lies anterior to it Right vagus lies posterior to it o At the opening in the diaphragm it is accompanied by two vagi o branches of the left gastric blood vessels o lymphatic vessels o In the neck o Posteriorly vertebral column Laterally o lobes of the thyroid gland Anteriorly o trachea recurrent laryngeal nerves In the thorax Anteriorly o Trachea left recurrent laryngeal nerve left principal bronchus pericardium Posteriorly o bodies of the thoracic vertebrae thoracic duct azygos veins right posterior intercostal arteries descending thoracic aorta at its lower end Right side o mediastinal pleura terminal part of the azygos vein Left side o left subclavian artery o

y

y





 

y

   

    

 



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  

y

aortic arch thoracic duct mediastinal pleura

In the abdomen o

Anteriorly

o

left lobe of the liver posteriorly left crus of the diaphragm 



NVS: y

y

y

The upper segment is innervated by the recurrent laryngeal nerves. The smooth fibers in the lower segment are innervated by sympathetic fibers from the 6th -10th thoracic ganglia; with para -sympathetic fibers from the vagus. The inferior thyroid arteries supply the cervical segment, while the thoracic aorta takes care of the thoracic part. The diaphragmatic and abdominal segments are supplied by branches from the esophageal branch of the left gastric artery. Veins draining the blood from the upper segments join tributaries to the superior vena cava; while those from the lower segments communicate with the veins that join the portal vein.

2. Discuss the

stomach as to its shape, location, parts, relation, peritoneal attachments, NVS

Shape: J-shaped Location: left upper quadrant, epigastric, and umbilical regions, and much of it lies under cover of the ribs; between the esophagus and the small intestine Parts: y

Fundus: dome-shaped projects upward and to the left of the cardiac orifice usually full of gas o Body/C orp orpus Vent ric ricul i i : level of the cardiac orifice to the level o of the incisuraangularis (a constant notch in the lower part of the lesser curvature) Pyl oric oric ant r rum: um: from the incisuraangularis to the o pylorus Pyl or or us: us: most tubular part o pyloric sphincter - thick muscular wall o pyloric canal - cavity of the pylorus o Cardia: o part surrounding the cardiac orifice Lesser curvature: shorter concave border o Greater curvature: convex border o o o

y

y

y

y

y

y

Relation:





four or five times longer starts from the left of the cardiac orifice over the dome of the fundus along the left border of the stomach to the pylorus gastrosplenicomentum (ligament) o from the upper part of the greater curvature to the spleen greater omentum o from the lower part of the greater curvature to the transverse colon a se se sect the lesser sac showi ng ng the T r ransve nsver io ion of of o io ion of arr angement angement the peri tt neum i n the for mat mat the lesser omentum, the gast ro rosplenicomentum, and the i igament. ament. Arrow i ic icates the posi io ion of splenicor enal enal l g nd nd tt the openi ng ng of the lesser sac. Anteriorly: anterior abdominal wall o left costal margin o left pleura and lung o o diaphragm left lobe of the liver o Posteriorly: lesser sac o diaphragm o spleen o o left suprarenal gland upper part of the left kidney o splenic artery o pancreas o transverse mesocolon o transverse colon o o o

  





y

y

St r ru ctur es es

h.

on the posterior omi w si tuated tuated abd nal nal all all behi nd nd the





Peritoneal y

y

attachments: parietal peritoneum anterior abdominal wall surfaces o o lateral abdominal wall surfaces posterior abdominal wall surfaces o inferior surface of diaphragm and pelvis o visceral peritoneum surfaces of intraperitoneal organs (i.e., stomach, jejunum, ileum, transverse colon, liver, spleen) o anterior aspect of retroperitoneal organs (i.e., duodenum, L & R colon, pancreas, kidneys, adrenal glands) o

Peri oneal tt

i i io ions i l gaments and mesenteric r gaments ef le lect n the adult. attachments par tt tt nt nt ne ne potent a i i io i on the abd omen i o ni i ial l ic ic, spaces: ri ght ght and lef t subphr en enic, subhepat supr amesente amesente ric and nfr amesente amesenteric spaces, ri ght ght and lef tt i par ic ic gutter i is, omental bur acol s, s, pelv s , and sa sa (sh ow n i n i nset nset on ri ght). ght).

hese hese T

y

peritoneal cavity  divided into 2 parts greater sac o main compartment and extends from the diaphragm down into the pelvis lesser sac o smaller and lies behind the stomach in free communication with one another through an oval window called the opening of the lesser sac, or the epiploic foramen intraperitoneal - almost totally covered with visceral peritoneum Retroperitoneal - lie behind the peritoneum and are only partially covered with visceral peritoneum Peritoneal ligaments - two-layered folds of peritoneum that connect solid viscera to the abdominal walls Liver is connected to the diaphragm by o falciform ligament coronary ligament right and left triangular ligaments 



y

y y y

  

NVS: y

all arteries derived from branches of the celiac artery left gastric artery o from the celiac artery supplies the lower third of the esophagus and the upper right part of the stomach. right gastric artery o from the hepatic artery supplies the lower right part of the stomach short gastric arteries o from the splenic artery supply the fundus  

 

 





 

y

from the gastroduodenal branch of the hepatic artery supplies the stomach along the lower part of the greater curvature

veins drain into the portal circulation left and right gastric veins o drain directly into the portal vein short gastric veins and the left gastroepiploic veins o join the splenic vein o right gastroepiploic vein joins the superior mesenteric vein 





y

y

y

Nerve Supply sympathetic fibers derived from the celiac plexus o parasympathetic fibers from the right and left vagus nerves o

anterior vagal trunk formed in the thorax mainly from the left o vagus nerve divides into branches that supply the o anterior surface of the stomach hepatic branch o pyloric branch o posterior vagal trunk o formed in the thorax mainly from the right vagus nerve divides into branches that supply mainly the o posterior surface of the stomach celiac and superior mesenteric plexuses and o is distributed to the intestine as far as the splenic flexure and to the pancreas





sympathetic innervation of the stomach carries a proportion of pain -transmitting nerve fibers parasympathetic vagal fibers are secretomotor to the gastric glands and motor to the muscular wall of the stomach pyloric sphincter receives motor fibers from the sympathetic system and inhibitory fibers from the vagi

y y y

3. Discuss the duodenum as to its shape, length, location, parts, relations, NVS

Shape:C -shaped tube Length:( 25 cm) long Location:lies mostly in the upper retroperitoneum; situated in the epigastric and umbilical regions; commences @ duodeno nd pyloric junction; ends @ 2 lumber vertebra

-

Relations: 1st Part y

y

y

y

y

nd

2

pylorus and runs upward and backward on the transpyloric plane at the level of the first lumbar vertebra Anteriorly: The quadrate lobe of the liver and the gallbladder Posteriorly: The lesser sac (first inch only), the gastroduodenal artery, the bile duct and portal vein, and the inferior vena cava Superiorly: The entrance into the lesser sac (the epiploic foramen) Inferiorly: The head of the pancreas (Fig. 5-26)

Part y

y

y

y

y

y

y

y

Runs vertically downward in front of the hilum of the right kidney on the right side of the second and third lumbar vertebrae halfway down its medial border, the bile duct and the main pancreatic duct pierce the duodenal wall They unite to form the ampulla that opens on the summit of the major duodenal papilla accessory pancreatic duct, if present, opens into the duodenum a little higher up on the minor duodenal papilla Anteriorly: The fundus of the gallbladder and the right lobe of the liver, the transverse colon, and the coils of the small intestine Posteriorly: The hilum of the right kidney and the right ureter Laterally: The ascending colon, the right colic flexure, and the right lobe of the liver Medially: The head of the pancreas, the bile duct, and the main pancreatic duct

elat elat Posterior r io ions

the duodenum and of the pancr eas. eas. T he he number s r epr esent esent the ts ts of the duodenum. four par







rd

3

Part y

y

y

y y

th

4

runs horizontally to the left on the subcostal plane, passing in front of the vertebral column and following the lower margin of the head of the pancreas Anteriorly: The root of the mesentery of the small intestine, the superior mesenteric vessels contained within it, and coils of jejunum Posteriorly: The right ureter, the right psoas muscle, the inferior vena cava, and the aorta Superiorly: The head of the pancreas Inferiorly: Coils of jejunum

Part y

y

y

y

runs upward and to the left to the duodenojejunal flexure Flexure is held in position by a peritoneal fold, the ligament of Treitz, which is attached to the right crus of the diaphragm Anteriorly: The beginning of the root of the mesentery and coils of jejunum Posteriorly: The left margin of the aorta and the medial border of the left psoas muscle

Pancr eas eas

and anterior elat elat the k dneys. dneys. r io ions of i i

Ent a the bi le le duct and the mai n and r ran nce of accessor yy eat eat nt nt t t pancr ic ic ducts i o the second par of the duodenum. Note the smooth l ni ng ng of the fir st st i i t t the duodenum, the pl es es of the par of ic icaecircular second t, t, and the maj duodenal lla. lla. par or or papi

Attachment the root the mesenter yy the small of of of ntest ntest ne ne t abd nal nal all. all. Note that i i i o the posterior omi w t extends from the duodenojejunal lexu lexur e on lef t t i f of the aor ta, ta, d nw ar d and t ght ght t ow ow o the ri o the





NVS: Arteries y

y

superior pancreaticoduodenal artery a branch of the gastroduodenal artery o supplies upper half o inferior pancreaticoduodenal artery a branch of the superior mesenteric artery o supplies lower half o

Veins y

y

superior pancreaticoduodenal vein drains into the portal vein o inferior vein joins superior mesenteric vein o

Nerve derived from sympathetic and parasympathetic (vagus) nerves from the celiac and superior mesenteric plexuses Lymph Drainage follow the arteries and drain upward via pancreaticoduodenal nodes to the gastroduodenal nodes and then to the celiac nodes and downward via pancreaticoduodenal nodes to the superior mesenteric nodes around the origin of the superior mesenteric artery. y

y

4.

Discuss the mucosal lining and muscular walls of the esophagus, stomach, duodenum.

Esophagus upper 1/3 striated muscle 2/3 smooth muscle 2 layers of fibers o Inner circular Outer longitudinal o Thinner layer anteriorly due to posterior fibro -muscular wall of trachea Stomach mucosa is a thick layer with a soft, smooth surface that is mostly reddish brown in life but pink in the pyloric region. In the contracted stomach the mucosa is folded into numerous folds or rugae, most of which are longitudinal. They are most marked towards the pyloric end and along the greater curvature. The rugae represent large folds in the submucosal connective tissue rather than variations in the thickness of the mucosa covering them, and they are obliterated when the stomach is distended submucosa is a variable layer of loose connective tissue. It contains thick bundles of collagen, numerous elastin fibres, blood vessels and nervous plexuses, including the ganglionatedsubmucosal ( Meissner's) plexus. muscularisexterna is a thick muscle coat immediately under the serosa, with which it is closely connected by subserous loose connective tissue. From innermost outwards, it contains oblique, circular and longitudinal layers of y y y

y

y y

y

y

y





5.

Map out the topography of the stomach and duodenum in the abdomen of a live individual using the regions and quadrants as reference.

Stomach The stomach lies in a curve within the left hypochondrium and epigastrium although, when distended and pendulous, it may lie as far down as the central or hypogastric regions. The epigastrium is the usual place to auscultate for a succussion splash' caused by chronic gastric stasis in upper intestinal obstruction. Duodenum The first part of the duodenum sometimes lies just above the trans -pyloric plane, depending on its mobility and length. The second part usually lies in the transpyloric plane just to the right of the midline, and the third part usually lies in the subcostal plane across the midline. The fourth part often lies in the transpyloric plane to the left of the midline, although its position varies according to the length of its mesentery.

Esphagus Stomach Duodenum Gross Anatomy

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