ABDOMINAL PART OF
OESOPHAGUS AND STOMACH
Prof. Dr. Selda Önderoğlu
OESOPHAGUS From pharynx to stomach;C6-T11
has 3 parts:
- Cervical - Thoracic
:sup+post mediastinum - Abdominal
Shortest part
It has 4 constrictions:
1- Beginning
2- Where it is crossed by the arch of the
aorta
3- Where it is crossed by the left main
bronchus
4- Where it passes from the diaphragm
4 Constrictions
of oesophagus
ABDOMINAL OESOPHAGUS
-Begins from T10 vertebra - Lenght is 1.25 cm.
-Covered by peritoneum on its front and left side
-no peritoneum on post. side- here L crus of diaphragm is located
Oesophageal impression
Left lobe of liver
Cardiac notch
-
gastrophrenic
ligament.(peritoneum)
-Phrenico-oesophageal lig.(not periton.)
Bw R crus of diaph-oesoph:Prevents upward
movement of oesophagus during swallowing &respiration
- In the ligament:
Oesophageal branches of the left gastric vessels
STRUCTURE
-Adventitia: outermost layer ,connective tissue -Muscular layer:
Outer longitudinal, Inner circular
-Submucous layer: Vessels, nerves, mucous glands
- Mucous layer: Longitudinal folds
Muscular layer
Skeletal muscle fibres are limited to the upper 1/3
Middle 1/3 is made up both types
Lower 1/3 contains smooth muscle fibres
OESOPHAGO-GASTRIC JUNCTION and SPHINCTERIC MECHANISM
1- Circular muscle fibers in both diaphragm and oesophagus near the junction
2- Right crus encircles around the oesophagus
3- Obliquity of the junction
4- Mucosal folds acts as a valvular mechanism
physiological sphincteric Prevents reflux
Arteries: Oesophageal branches of; - Left gastric a.
- Left inferior phrenic a.
VEINS
Left gastric vein to portal venous system Oesophageal veins to axygos vein—then to systemic venous system
So here there is:
PORTACAVAL ANASTOMOSIS
Lymph vessels:
Left gastric lymph nodes
Then to :
Celiac lymph nodes
Nerves:
Psymp.:Vagus n(R+L)
Left vagus n. is anterior to oesophagus)
Sympathetic:
- Thoracic:
- Greater splanchnic n.
- Plexus around left gastric and inferior phrenic arteries
symp+parasymp.fib ers form 2 plexuses 1-Myenteric =
auerbach plexus;
located between two layers of the muscular layer 2- Meissner = Submucous plexus
STOMACH
Location: epigastric, umbilical,
left hypocondriac
stomach
• Shape: letter “J”
• Capacity: newborn:30 ml.
adult: 1500ml.
STOMACH
• Cardiac orifice
• Pyloric orifice
• Lesser Curvature
• Greater Curvature
• anterosuperior surf.
(anterior)
• posteroinferior surf.
(posterior)
PARTS OF STOMACH
- Cardia(entrance) - Fundus
(transverse line From cardiac notch-some air)
- Body
(up to angular notch)
- Pyloric part
(pyloric antrum+
Pyloric canal)
-Pylorus (gatekeeper)
Gastric orifices:
1- Cardiac orifice
located 2.5 cm. left to the junction of the
sternum and 7 th costal cartilage
2- Pyloric orifice: In supine position and empty stomach it is located 1.2 cm. right of the midline in
transpyloric plane.
Gastric curvatures- lesser&greater
LESSER: bw.cardiac&pyloric orifices
Concave
Right border of stomach Angular notch
Lesser omentum-hepatogastric lig.
Within:R&L gastric a.v.
GREATER:cardiac notch-pylorus L1 vertebra level
Gastrosplenic(gastrolienal) lig.
Within:Lgastroepiploic av +short gastric aa&vv.
Gastrophrenic lig:fundus-diaphragm
Lesser Omentum
Greater Omentum
Peritoneal ligaments from greater curvature:
1- Gastrophrenic lig.
2- Greater omentum 3-Gastrosplenic lig.
(Beginning of
L gastroepiploic av
&short gastric aa+vv.
FUNDUS: Junction between 5th intercostal space and
mid-clavicular line.
PYLORUS : 1st L vertebra
L1
Gastric Surfaces -Anterosuperior - Posteroinferior
ANTEROSUPERIOR SURFACE
- Covered by peritoneum
- If stomach is full –related to anterior abdominal wall
- Triangle:left costal arch;
Anterior margin of liver; Line between right and left 10th rib
- If stomach is empty:transverse colon
POSTEROINFERIOR SURFACE
=STOMACH BED
Covered by peritoneum except a triangular area on the posterior surface near the cardiac orifice contacts directly the left diaphragmatic crus.
Omental bursa is related to this surface
Relations of stomach bed:
Diaphragm
- Left suprarenal gland
-ant. Surf. Of L kidney
- Splenic artery - Ant. pancreatic surface
- Left colic flexure
- Transvers mesocolon
GASTRIC STRUCTURE
Serous+muscular+mucous layers
-Serous Layer: Peritoneum Peritoneum covers the entire surface except:
-Attachments of greater and lesser curvatures
(greater&lesser omentum) - A small posterior area near the cardiac orifice
-Muscular Layer:
Longitudinal Circular
Oblique fibres
Mucous Layer:
If stomach is empty
mucosa has gastric folds.
-Most marked along the pylorus and greater
curvature.
-Gastrıc canal(Waldeyer street): No folds along the lesser curvature.liquids
pass from here.
- Numerous gastric glands
Arteries of stomach
• Left gastric a.
• right gastric a.
• Right gastroomental a.
• Left gastroomental a.
• short gastric aa
Veins of stomach
• splenic v.
• superior
mesenteric v.
• portal vein
• Prepyloric vein drains into R gastric vein: used to identify
pyloris
LYMPHATIC DRAINAGE
1- Left gastric
2- Hepatic & pyloric
3- Right
gastroepiploic&right gastric
4-Pancreaticosplenic lymph nodes
NERVES
-symp.:Greater splanchnic n.
(T6-9 semp. nn.)
- psymp: Anterior (L vagus) & posterior (R vagus) vagal Trunks Coeliac plexus
Gastric plexus
