Fig. 2.1
1 heart, 2 aorta, 3 esophagus, 4 inferior vena cava
Fig. 2.2
1 aorta, 2 GE junction, 3 stomach, 4 spleen, 5 descending colon
Fibromuscular tube that allows passage of food from the pharynx to the stomach
About 25 cm long and has a star-shaped lumen with a 2–3 cm diameter
Begins at the lower border of the C6 [1]
Cranially enters the thorax at about T1 and occupies the posterior mediastinum [2]
Caudally enters the abdomen through esophageal hiatus in the diaphragm through the right crus at about T10 [2]
Has a slight deviation from right to left with three curves: one on the sagittal and two on the frontal plane [1]
Divided into cervical, thoracic, diaphragmatic, and abdominal [3]
No serosal covering [4]
Esophageal wall consists of four layers: mucosa, submucosa, muscularis propria, and adventitia [4]
2.1.2 Physiologic Points of Constriction/Narrowing [2]
At the origin of the esophagus at the cricopharyngeus muscle (upper esophageal sphincter)
By the aortic arch, left anterolateral esophageal surface
By the left main bronchus
By the diaphragm at the esophageal hiatus
2.1.3 Esophageal Portions [3]
Cervical esophagus starts at about 16 cm from the incisors
Upper thoracic esophagus begins around 20–21 cm from the incisors
Mid-thoracic esophagus begins at around 24 cm from the incisors, at the level of the carina
Lower thoracic esophagus begins around 32 cm from the incisors with the lower esophageal sphincter starting at 37–39 cm from the incisors
2.1.4 Cervical Portion [1]
About 4–5 cm long, begins at the lower border of the C6 and extends to the upper border of T2
Anteriorly, connected to the trachea by soft connective tissues and tracheoesophageal muscular tissues
Posteriorly, connected to the deep cervical fascia and spinal column through the retroesophageal space
Laterally, connected to the right and left common carotid arteries and recurrent laryngeal nerve on the right
2.1.5 Thoracic Portion [1]
About 16 cm long, extends from T2 to the diaphragm and is located in the posterior mediastinum
Upper thoracic esophagus, above the level of the mainstem bronchi
Anteriorly connected to the trachea and attached to the initial part of the left main bronchus by the bronchoesophageal muscle
Connected posteriorly to the vertebral column, up to T4
Laterally on right side, attached to mediastinal pleura forming the azygoesophageal recess. On the left side, connected to the mediastinal pleura, the aortic arch, and the initial part of the descending aorta
Lower thoracic esophagus, below level of bronchi
Connected anteriorly to the posterior part of the pericardium covering the left atrium and the lymph nodes at the tracheobronchial bifurcation
Laterally connected to the vagus nerve
2.1.6 Diaphragmatic Portion [1]
About 1–2 cm long, connected to the esophageal hiatus
Anterior to the aortic orifice, attached by the phrenicoesophageal muscle
The phrenicoesophageal ligament attaches the esophagus to the diaphragm
2.1.7 Abdominal Portion [1]
About 3 cm in length, begins as it transits the diaphragmatic hiatus and ends into the cardia of the stomach along the lesser curvature forming an acute angle with the gastric wall (the angle of His)
Anteriorly, related to the posterior surface of the left hepatic lobe
Posteriorly, the abdominal aorta and the medial diaphragmatic pillars
Right, hepatic caudate lobe
Left, bottom of the stomach
2.1.8 Lymphatic Drainage [4, 5]
Cervical and thoracic esophagus – extensive submucosal lymphatic system, continuous longitudinally
Cervical – efferent vessels drain directly or through the paratracheal nodes into the deep cervical nodes
Thoracic-posterior mediastinal nodes
Abdominal – left gastric nodes, celiac nodes, and left and right paracardial nodes. Posterior surface – uppermost aortic nodes
Direct drainage into the thoracic duct
2.1.9 Blood Supply [2, 5]
2.1.9.1 Arterial Supply
Cervical: inferior thyroid arteries
Thoracic: bronchial and esophageal branches of the aorta
Diaphragmatic and abdominal: esophageal branches of the aorta, left gastric, and phrenic arteries
2.1.9.2 Venous Drainage
Drains into the submucosa and then into the tributary of the paraesophageal plexus
Thoracic esophagus drains into the azygos vein. Some drainage into hemiazygos and accessory azygos veins into the anterior and posterior intercostal veins
Cervical: veins merge into the inferior thyroid vein
Abdominal: veins drain into the left gastric vein and to the portal vein
2.2 Stomach
2.2.1 Gross Anatomy [1]
Figs. 2.2, 2.3, 2.4, and 2.12
Fig. 2.3
1 aorta, 2 kidney, 3 pancreas, 4 colon, 5 small bowel, 6 stomach, 7 inferior vena cava, 8 portal vein, 9 celiac axis, 10 superior mesenteric artery, 11 splenic vein
Fig. 2.4
1 aorta, 2 kidney, 3 pancreas, 4 colon, 5 small bowel, (jejunum) 6 stomach, 7 inferior vena cava, 8 portal vein/superior mesenteric vein, 9 superior mesenteric artery, 10 splenic vein, 11 duodenum, 12 gallbladder
Muscular J-shaped, highly vascular organ, in the left upper quadrant of the abdomen
Gastric wall is made up of four layers: mucosa, submucosa, muscularis propria, and serosa
Concave right margin: the lesser curvature and a convex left margin, the greater curvature
2.2.1.1 Anterior Surface
Completely covered with peritoneum and adjacent to the diaphragm
Related to the left lobe of the liver (segments II, III, and IV) and the distal transverse colon
2.2.1.2 Posterior Surface
Covered with peritoneum except at the part closer to the cardia where it touches the diaphragm
Related to the left adrenal gland, the body and tail of the pancreas, aorta, splenic and hepatic arteries, and portal vein
2.2.1.3 Lesser Curvature
Posterosuperior margin of the stomach
Starts at the right of the cardia and continues at the right border of the abdominal esophagus and runs a short distance along the right border of the body of the stomach where it turns upward horizontally and descends again to terminate at the level of the pylorus
The junction of the vertical and horizontal parts of the lesser curvature is called incisura angularis – point of insertion of the hepatogastric ligament connecting the liver and the stomach
Lesser omentum suspends the stomach from the abdominal wall
2.2.1.4 Greater Curvature
Starts at the cardiac notch and turns upward to form the dome-shaped margin of the fundus and subsequently goes down and medially up to the intermediate sulcus which separates the antrum and the pyloric canal
Covered by the peritoneum
Laterally, the anterior and posterior peritoneal visceral sheets merge to form the gastrosplenic ligament, which connects it to the splenic hilum
Posteriorly, related to the body and tail of the pancreas and a portion of the left hepatic lobe
The gastrocolic ligament attaches it to the transverse colon, the right colic flexure, and the duodenum and coincides with the anterior root of the greater omentum
The greater omentum attaches the stomach to the transverse colon, spleen, and diaphragm
The omental bursa also known as the lesser sac lies behind the stomach and in front of the pancreas; it communicates with the greater sac (main peritoneal cavity) via the epiploic foramen of Winslow behind the hepatoduodenal ligament (the free edge of the lesser omentum)
2.2.2 Portions of the Stomach
Divided into four parts: the cardia, fundus, body, and pylorus
2.2.2.1 Cardia
Connects the esophagus to the stomach
It is the region following the Z-line of the gastroesophageal junction at which the epithelium changes from stratified squamous to columnar epithelium
The lower esophageal sphincter is located near the cardia
2.2.2.2 Fundus
Part of the stomach above an imaginary horizontal line drawn from the cardiac notch
Radiologically, coincides with the gastric bubble (the air-filled part of the stomach which is radiolucent)
Touches the left hemidiaphragm
2.2.2.3 Body
The central part of the stomach, main site of acid production
2.2.2.4 Pylorus
Connects the stomach to the duodenum
Antrum: prepyloric vestibule, opening into the body of the stomach. May be demarcated from the pyloric canal by a slight groove
Pylorus: opens into the duodenum through the pyloric orifice which is surrounded by the pyloric sphincter
2.2.3 Blood Supply [6, 13]
2.2.3.1 Arterial Supply
Highly vascular with a rich anastomotic network
Celiac trunk arises from the abdominal aorta at the level of L1, about 1 cm in length, and divides into the left gastric artery, the common hepatic artery, and the splenic artery
Left gastric artery runs along the lesser curvature and divides into ascending and descending branches supplying the abdominal esophagus and the lesser curvature, respectively
Common hepatic artery runs along the superior border of the pancreas to the right and gives rise to the gastroduodenal artery (runs behind the first part of the duodenum) and then continues as the hepatic artery proper
The left gastric artery anastomoses with the right gastric artery (branch of the common hepatic or hepatic artery proper) along the lesser curvature forming an arcade which gives rise to multiple small arteries supplying the body of the stomach
The gastroduodenal artery gives rise to posterior superior pancreaticoduodenal artery and then divides into right gastroepiploic artery (runs from right to left along the greater curvature) and anterior superior pancreaticoduodenal artery
The splenic artery runs to the left along the superior border of the body and tail of the pancreas and gives rise to left gastroepiploic artery (runs from left to right along the greater curvature) which anastomoses with the right gastroepiploic forming an arcade from which multiple small arteries supply the body of the stomach
2.2.3.2 Venous Drainage
Into the portal vein from the left gastric vein which is formed by the union of superior mesenteric and splenic veins. Also the right gastric and right gastroepiploic drain into the portal vein
Into splenic vein from the left gastroepiploic and short gastric veinsRelated posts:
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