Chapter 4 - Oesophagus and Stomach

Question 1

Features of abdominal part of oesophagus

Answer 1

1. 1.25 cm long
2. enters abdomen through oesophageal opening of diaphragm at level of T10
3. Veins drain partly into systemic and partly into portal circulation. Veins with left gastric V drain into portal V. Others into hemiazygos
4. Opens into cardiac end of stomach at level of T11.
5. Right border continuous with lesser curvature. Left border separated by cardiac notch.
6. Covered by peritoneum anteriorly and on left side.

Question 2

Oesophageal varices

Answer 2

• lower end of oesophagus is site of portosystemic anastamoses
• anastamoses open up in portal hypertension
• form venous dilatations - oesophageal varices
• rupture causes severe haematemesis

Question 3

Commonest site of oesophageal carcinoma

Answer 3

1st - lower end of oesophagus

2nd - middle 1/3 of oesophagus

Question 4

Barrett’s oesophagus

Answer 4

Squamous epithelium of lower oesophagus replaced by columnar epithelium

Question 5

Tracheo-oesophageal fistula

Answer 5

• separation of trachea and oesophagus is not complete
• proximal segment ends in blind pouch
• distal segment communicates with trachea

Question 6

General properties of stomach

Answer 6

• muscular bag
• widest, most distensible part of GIT
• lies obliquely in left upper abdomen
• occupies epigastric, umbilical, left hypochondriac region
• normally J shaped. In strong people, active people, it’s horizontal
• 1.5-2 litres capacity

Question 7

Orifices of stomach

Answer 7

CARDIAC

• behind 7th costal cartilage
• at level of T11
• sphincter cannot be demonstrated anatomically

PYLORIC

• at level of L1 in transpyloric plane
• indicated by circular groove on surface
• indicated by prepyloric V of Mayo which lies in front of constriction

Question 8

Curvatures of stomach

Answer 8

LESSER

• concave
• forms right border
• provides attachment for lesser omentum
• marked by angular notch

GREATER

• convex
• forms left border
• provides attachment for greater omentum
• attachment for gastrosplenic, gastrophrenic ligament
• shows cardiac notch in upper end
• 5 times longer than lesser curvature

Question 9

Surfaces of stomach

Answer 9

Anterior - faces forward and upwards

Posterior - faces backwards and downwards

Question 10

Cardiac part of stomach

Answer 10

FUNDUS

• upper, convex, dome shaped
• situated above horizontal line at level of cardiac orifice

BODY

• b/w fundus and pyloric antrum
• has gastric glands - mucous, chief, parietal

Question 11

Pyloric part of stomach

Answer 11

• pyloric antrum is separated from pyloric canal by sulcus intermedius
• richest in mucous cells
• pyloric canal is narrow and tubular

Question 12

Peritoneal relations of stomach

Answer 12

Lined by peritoneum on both surfaces

• lesser curvature, anterior and posterior layers meet to form lesser omentum
• greater curvature, they meet to form greater omentum
• fundus end, they form gastrospleic ligament
• cardiac end, peritoneum is reflected to form gastrophrenic ligament
• Cranial to the ligament, stomach in direct contact with diaphragm - bare area of stomach

Question 13

Anterior visceral relations of stomach

Answer 13

Liver
Diaphragm
Transverse colon
Anterior abdominal wall

• diaphragm separates stomach from pleura, pericardium
• transversus abdominis separates stomach from costal cartilages

Question 14

Traube’s space

Answer 14

• space b/w left costal margin and lower edge of left lung
• Resonant note heard on percussion normally
• Dull note heard in splenomegaly/ pleural effusion

Question 15

Posterior visceral relations of diaphragm

Answer 15

Diaphragm
Left kidney
Left suprarenal gland
Pancrea
Transverse mesocolon
Splenic flexure of colon
Splenic A

Question 16

Arterial supply of stomach

Answer 16

Lesser curvature

• Gastric A left and right
• Coeliac trunk branches
• Proper hepatic A branches

Greater curvature

• Right and left gastroepiploic
• Gastroduodenal
• Splenic

Fundus - short gastric A

Question 17

Venous drainage of stomach

Answer 17

• Right and left gastric V into portal V
• Right gastroepiploic V into superior mesenteric V
• Left gastroepiploic, short gastric into splenic V

Question 18

Lymphatic drainage of stomach

Answer 18

AREA 1

• upper part of left 1/3
• into pancreatosplenic nodes
• finally into coeliac nodes

AREA 2

• right 2/3
• into left gastric nodes
• also drain abdominal part of oesophagus
• finally into coeliac nodes

AREA 3

• lower part of left 2/3
• into right gastroepiploic nodes
• then into subpyloric -> hepatic -> coeliac

AREA 4

• pyloric part
• pyloric, hepatic, left gastric, coeliac

From coeliac to intestinal lymph trunk to cisterna chyli

Question 19

Nerve supply of stomach

Answer 19

Sympathetic

• T6-T10 segments
• via greater splanchnic N, coeliac and hepatic plexuses

Parasympathetic
- from vagi
- through oesophageal, gastric N
Ant. gastric N: Left vagal fibres. Gastric and 2 pyloric branches(pylorus, antrum)
Post. gastric N: Right vagal fibres. Gastric and coeliac branches for coeliac plexus

Question 20

Functions of stomach

Answer 20

1. Reservoir for food
2. Mixing of food
3. Softens and mixes food with gastric juice
4. Produces enzymes for digestion
5. Produces HCl which destroys microorganisms
6. Produces mucous to prevent corrosive action
7. Absorbs alcohol, salt, water, certain drugs
8. Produces intrinsic factor for absorption of Vit B12

Question 21

Peculiarities of lesser curvature

Answer 21

1. Homologous with gastric trough of ruminants
2. Mucosa is not freely movable over muscle
3. Thin epithelium
4. Lesser blood supply, fewer anastamoses
5. More abundant nerve supply
6. Receives most effect of drinks due to gastric canal
7. Wave of constriction stays longer
   - cause of more incidence of gastric ulcers

Question 22

Gastric carcinoma

Answer 22

• common along greater curvature
• Metastasis occurs through thoracic duct into left supraclavicular lymph node
• common in blood group ‘A’