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3002 > 14 Anatomy of oesophagus, stomach and duodenum > Flashcards

14 Anatomy of oesophagus, stomach and duodenum Flashcards

1
Q

What is the function of the oesophagus?

A

Transport food and fluid from pharynx → thorax and diaphragm → stomach (via peristaltic waves)

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2
Q

Where does oesophagus start?

A

Starts in midline as the continuation of the pharynx at C6 (cricopharyngeal sphincter)

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3
Q

How long and wide is the oesophagus?

A

25cm long

2 cm in diameter

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4
Q

What is the course and direction of the oesophagus in relation to other structures?

A

In superior mediastinum:
• Passes immediately posterior to trachea
• Antieror to vertberal column
• Arch of aorta to its left

Inferiorly:
• Swings forwards and to the left (anterior to aorta)
• Pierce diaphragm at T10

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5
Q

What type of muscles make up the oesophagus?

A

• Upper 1/3:
Striated muscle - swallowing is voluntary & rapid

• Lower 1/3:
Smooth muscle - involuntary

• Middle 1/3:
Mixed

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6
Q

Cricopharyngeal sphincter:
• What is it?
• Function?

A

• Indentation caused by the normal function of the cricopharyngeal sphincter between the pharynx and the oesophagus

• Function:
To prevent air being sucked into the stomach during inhalation

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7
Q 
Superior/cervical third of oesophagus:
• Begins at?
• Arterial supply?
• Venous drainage?
• Nerve supply?
• Lymphatics?
A
  1. Begins at C6
  2. Arterial supply:
    • Inferior thyroid arteries
  3. Venous drainage:
    • To brachiocephalic veins
  4. Nerve supply:
    • Branches of vagus nerves (recurrent laryngeal nerves)
  5. Lymphatics drain:
    • To deep cervical nodes
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8
Q 
Middle/thoracic third of oesophagus:
• Arterial supply?
• Venous drainage?
• Nerve supply?
• Lymphatics?
A
  1. Arterial supply:
    • Direct from thoracic aorta and bronchial arteries
  2. Venous drainage:
    • To azygos system (systemic)
  3. Nerve supply:
    • Oesophageal plexus (vagus and sympathetic)
  4. Lymphatics drain:
    • To tracheobronchial nodes
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9
Q 
Inferior/ abdominal third of oesophagus:
• Arterial supply?
• Venous drainage?
• Nerve supply?
• Lymphatics?
A
  1. Arterial supply:
    • Left gastric artery
  2. Venous drainage:
    • To left gastric veins and therefore to portal vein
  3. Nerve supply:
    • Branches of oesophageal plexus (vagus and sympathetic)
  4. Lymphatics drain:
    • To left gastric and coeliac nodes
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10
Q

What do arthritic osteophytes do?

A
  • Indent the oesophagus
  • May cause pain on swallowing
  • Associated thickening of the anterior longitudinal ligament
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11
Q

Where is the clinical measurement of length of oesophagus measured from?

A

From upper incisor teeth during endoscopy

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12
Q

What are the 5 oesophageal constrictions?

A
  1. Upper oesophageal sphincter (17cm) - C6
  2. Arch of aorta - T4
  3. Left main bronchus (28cm)
  4. Left atrium of heart indentation (rather than constriction)
  5. Diaphragm (lower oesophageal sphincter - 43 cm) - T10
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13
Q

Structures anterior to the oesophagus (5)

A
  • Trachea
  • Right pulmonary artery
  • Left main bronchus
  • Left atrium
  • Diaphragm
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14
Q

Structures posterior to the oesophagus (3)

A
  • Vertebral bodies (C6 – T12)
  • Thoracic duct (partly)
  • Thoracic aorta (inferiorly)
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15
Q

Structures lateral to the oesophagus (3)

A
  • Thoracic aorta lies to left
  • Azygos vein lies to right
  • Parietal pleura covers the right side
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16
Q

What is the epithelium and muscle type of the oesophagus?

A
  • Lined by stratified squamous epithelium (transport)
  • With submucosal mucous glands (lubrication)
  • Has smooth muscle walls (lower 1/3, middle 1/3 is mixed)
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17
Q 
Abdominal oesophagus:
• Where does it enter the abdomen?
• Arterial supply?
• Venous drainage?
• Lymph drainage?
• Nervous supply?
A
  1. Where it enters the abdomen:
    • Passes through the right crus of diaphragm at T10 (or 7th costal cartilage)
    • Just to the left of the midline
  2. Arterial supply:
    • Left gastric artery (and inferior phrenic)
  3. Venous drainage:
    • To portal vein
  4. Lymph drainage:
    • To nodes along the left gastric artery → coeliac nodes
  5. Nervous supply:
    • Oesophageal plexus - both vagal (p’symp and afferent) and sympathetic
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18
Q

Difference between anterior vagal trunk and posterior vagal trunk?

A
  • Anterior vagal trunk derived from left vagus

* Posterior vagal trunk derived from right vagus

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19
Q

What is the cardiac orifice? How far from incisor teeth?

A
  • The superior opening into the stomach from oesophagus

* 40 - 43 cm from incisor teeth

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20
Q

What forms the porto-systemic or portocaval anastomosis?

A
  • Submucosal veins in the oesophagus form an anastomosis between its middle and lower 1/3s
  • Middle 1/3 drains → azygos vein → the SVC (systemic)
  • Lower 1/3 drains →left gastric vein → portal vein
  • Therefore this anastomosis is between the portal and systemic circulations (porto-systemic or portocaval anastomosis)
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21
Q

Consequence of cirrhotic liver disease?

A
  • Cirrhotic liver disease raises the portal venous pressure (portal hypertension) and blood escapes via the submucosal veins in the oesophagus → systemic azygos vein
  • Consequently the veins become dilated and tortuous → oesophageal varices

=> May cause fatal haemorrhage

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22
Q

How is reflux prevented at the lower end of the oesophagus? (3)

A

• No anatomical sphincter, reflux is prevented by a “physiological” cardiac sphincter:

  1. Contraction of the right crus of the diaphragm
  2. The tonic contraction of the circular layer of smooth muscle in the lower oesophagus
  3. The “valvular” effect of the oblique entry of the oesophagus into the stomach, augmented by the oblique muscle layer

• Sphincter closure under vagal control

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23
Q

Closure of the lower oesophageal sphincter is under what control?

A
  • Vagal control
  • Augmented by gastrin
  • Reduced in response to secretin, cholecystokinin and glucagon
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24
Q

What does z-line in oesophagus show?

A

Transition from stratified squamous (oesophageal) to columnar (gastric) epithelium

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25
Q

Which regions does the stomach lie in?

A

Lies across the epigastric region extending to the umbilical & left hypogastric regions

26
Q

What are the anterior relations of the stomach?

A
  • Anterior abdominal wall
  • Left costal margin
  • Left pleura & lung
  • Diaphragm itself
  • Left lobe of the liver
27
Q

What are the posterior relations of the stomach?

A 
• Lesser sac
• Diaphragm
• Spleen
• Left suprarenal/ adrenal
gland
• Upper part of left kidney
• Splenic artery
• Pancreas
• Transverse mesocolon
• Transverse colon
28
Q

What are the 4 parts of the stomach?

A
  1. Cardia
  2. Fundus (usually full of gas)
  3. Body
  4. Pyloric part/region
    • Pyloric antrum
    • Pyloric canal

• Also has greater and lesser curvature

29
Q

What does the muscular wall of the stomach contain?

A

Longitudinal, circular and oblique fibres (contributing to cardiac “sphincter”)

30
Q

What are folds or rugae?

A

Mucous membrane (thick and vascular) which is thrown into numerous folds or rugae that flatten on distension

31
Q

What happens to the circular muscle in the pyloric region?

A

The circular muscle coat is thickened in the pyloric region to form the pyloric sphincter - controls outflow fo gastric contents into the duodenum

32
Q

Change to bolus in stomach?

A
  • The stomach receives and stores food and fluid
  • Adds more fluid, acid and enzymes

=> create chyme and start digestion

33
Q

List the blood supply to the stomach

A
  1. Left gastric artery - celiac trunk
  2. Right gastric artery - common hepatic artery
  3. Short gastric artery - from splenic artery
  4. Left gastroepiploic artery - splenic artery
  5. Right gastroepiploic artery - gastroduodenal branch of common hepatic artery
34
Q

Left gastric artery:
• Where does it arise from?
• Where does it pass?
• Supplies?

A
  1. Origin:
    • Arises from celiac trunk
  2. Pathway:
    • Passes upward and to the left to reach oesophagus
    • Then depends along lesser curvature of stomach
  3. Supplies:
    • Lower 1/3 of oesophagus
    • Proximal part of lesser curvature
    • Adjacent body of stomach
35
Q

Right gastric artery:
• Where does it arise from?
• Where does it pass?
• Supplies?

A
  1. Origin:
    • Arises from common hepatic artery
  2. Pathway:
    • Runs to the left along the lesser curvature
  3. Supplies:
    • Distal part of lesser curvature
    • Adjacent body of stomach
36
Q

Short gastric arteries:
• Where does it arise from?
• Where does it pass?
• Supplies?

A
  1. Origin:
    • Arise from splenic artery at the hilum of the spleen
  2. Pathway:
    • Hilum of the spleen
    • Pass forward in the gastrosplenic/ gastrolienal ligament
  3. Supplies:
    • Fundus of stomach
37
Q 
Left gastroepiploic (gastro-omental) artery:
• Where does it arise from?
• Where does it pass?
• Supplies?
A
  1. Origin:
    • Arise from splenic artery at hilum of the spleen
  2. Pathway:
    • Hilum of spleen
    • Passes forward in the astrosplenic/ gastrolienal ligament
  3. Supplies:
    • Stomach along the proximal part of the greater curvature
    • Adjacent body
38
Q 
Right gastroepiploic (gastro-omental) artery:
• Where does it arise from?
• Where does it pass?
• Supplies?
A
  • Arises from the gastroduodenal branch of the common hepatic artery
  • Passes to the left to supply the stomach along the distal part of the greater curvature & adjacent body
39
Q

Where does the gastroduodenal artery lie in relation to the duodenum?

A

Gastroduodenal artery lies posterior to the 1st part of the duodenum

40
Q

What do the left and right gastric veins drain into?

A

Portal vein

41
Q

What do the short gastric and left gastro-epiploic (gastro-omental) veins drain into?

A

Splenic vein

42
Q

What does the right gastro-epiploic (gastro-mental) vein drain into?

A

Superior mesenteric vein

43
Q

List the venous drainage of the stomach

A
  1. Left gastric v.
  2. Right gastric v.
  3. Short gastric v.
  4. Left gastroepiploic v.
  5. Right gastroepiploic v.
44
Q

Lymphatic drainage of the stomach?

A
  • Lymph passes to nodes that lie along the arteries that supply the stomach
  • All lymph from the stomach eventually passes to celiac nodes - located around the root of the celiac trunk on the posterior abdominal wall
45
Q

Nerve supply of stomach?

A

• Sympathetic fibres (pain and vasomotor)
-derived from T5- T9 (via greater splanchnic nerves and celiac plexus)
• Parasympathetic fibres - from right and left vagus nerves (secretion and motility; plus efferents for emesis)

46
Q

Where does referred pain of stomach go?

A

Lower chest and epigastrium

47
Q

What is vagotomy?

A
  • Operations are performed to cut the vagal trunks to reduce gastric acidity & prevent ulcers
  • Unfortunately motility is also affected causing patients to suffer incredible fullness
  • Consequently the vagal branches were found & sectioned selectively & highly selectively, after the hepatic branches & after those going to the pyloric sphincter (nerve of Latarjet) so that sphincteric function is maintained
48
Q

Stomach bed:
• Formed by?
• Superiorly?
• Inferiorly?

A
  1. Formed by:
    • Posterior wall of the lesser sac (omental bursa) & retroperitoneal structures between this & the posterior abdominal wall
2. Superiorly:
• Part of the diaphragm (left
crus)
• Spleen
• Left suprarenal/adrenal gland
• Upper pole of the left kidney
  1. Inferiorly:
    • Body & tail of pancreas
    • Transverse mesocolon
    • Left colic (splenic) flexure • Splenic artery
49
Q

Describe the small intestine

A
  • Small intestine is the longest part of the alimentary canal
  • Extending from the pylorus of the stomach to the ileocaecal junction
  • ~ 6-7m long

• The greater part of digestion & food absorption takes place in the small intestine
• Divided into the following 3 parts:
- 1. duodenum 2. jejunum 3. ileum

50
Q 
Duodenum:
• Shape?
• Relations?
• Position in peritoneum?
• Functions?
A

• C shaped structure
• ~ 20-25cm long
• Divided into 4 parts
• Adjacent to the head of the pancreas
• Mainly retroperitoneal (not proximal first part that is intraperitoneal)
• Receives the openings of the common bile & pancreatic ducts
• Functions are:
- Continues digestion especially of fats
- Absorption

51
Q

Where does the 1st part (superior) of duodenum lie?

A

Anterolateral to the right of the upper border of L1

52
Q

Where does the 2nd part (descending) of duodenum lie?

A

Descends just to the right of the midline from L2 to L3

53
Q

Where does the 3rd part (inferior) of duodenum lie?

A

Crosses the midline anterior of L3

54
Q

Where does the 4th part (ascending) of duodenum lie?

A

Ascends from L3 to the left of L2 almost reaching the transpyloric plane at L1

55
Q

Where does the duodenojejunal flexure lie?

A

Level of L1 in the transpyloric plane

56
Q

What occurs at the major papilla?

A
  • Opening of the common bile duct and pancreatic duct into the duodenum
  • Secretion of bile and other enzymes
  • Also called papilla of Water
57
Q

Duodenum blood supply? Upper/lower halves

A
  1. Upper half:
    • Supraduodenal a.
    • Gastroduodenal a.
  • from common hepatic artery (celiac trunk, foregut)
  1. Lower half:
    • Inferior pancreaticoduodenal a.

-from superior mesenteric artery (midgut)

58
Q

What does the superior and inferior pancreaticoduodenal arteries divide to form?

A

Anterior and posterior anastomotic arcades

59
Q

What is the gastroduodenal artery at risk of at the 1st part of the duodenum?

A

Posterior ulcers

60
Q

Duodenum venous drainage?

A

• Superior pancreaticoduodenal vein drains → portal vein

• Inferior pancreaticoduodenal vein drains → superior
mesenteric vein

61
Q

Duodenum lymph drainage?

A
  • Celiac

* Superior mesenteric nodes

62
Q

Duodenum nerve supply?

A

Nerves are derived from:
• Sympathetic greater (T5-T9) and lesser
splanchnic (T10 & T11) nerves
• Parasympathetic (vagus) nerves via the celiac & superior mesenteric plexuses

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