anatomy of the esophagus and stomach

1. 1
ESOPHAGUS& STOMACH

2. OBJECTIVES
• By the end of this lecture the student
should be able to:
• Describe the anatomy of the esophagus: extent,
length, parts, strictures, relations, blood supply,
innervation and lymphatics.
• Describe the anatomy of the stomach: location,
shape, parts, relations, blood supply, innervation
and lymphatics.
2

3. ESOPHAGUS
• It is a tubular structure
about 25 cm long.
• It begins as the
continuation of the
pharynx at the level of the
6th cervical vertebra.
• It pierces the diaphragm at
the level of the 10th
thoracic vertebra to join
the stomach.
• It is divided into 3 parts:
• 1- Cervical.
• 2- Thoracic.
• 3- Abdominal.
Abdominal
thoracic
Cervical
3

4. 4
CERVICAL PART
• Posteriorly:
• Vertebral column.
• Laterally:
• Lobes of the thyroid
gland.
• Anteriorly:
• Trachea and the
recurrent laryngeal
nerves.
RELATIONS

5. 5
THORACIC PART
• In the thorax, it passes
downward and to the left
through superior then to
posterior mediastinum
• At the level of the sternal
angle, the aortic arch
pushes the esophagus again
to the midline.

6. 6
ANTERIOR
RELATIONS
• Trachea
• Left recurrent
laryngeal
nerve
• Left principal
bronchus
• Pericardium
• Left atrium
Thoracic part

7. 7
POSTERIOR
RELATIONS
• Bodies of the
thoracic
vertebrae
• Thoracic duct
• Azygos vein
• Right posterior
intercostal
arteries
• Descending
thoracic aorta
(at the lower
end)
Thoracic part

8. LATERAL
RELATION
• On the Right
side:
• Right mediastinal
pleura
• Terminal part of
the azygos vein.
• On the Left side:
• Left mediastinal
pleura
• Left subclavian
artery
• Aortic arch
• Thoracic duct
8

9. ESOPHAGUS AND LEFT ATRIUM
• There is a close
relationship between
the left atrium of the
heart and esophagus.
• What is the clinical
application?
• A barium swallow in
the esophagus will help
the physician to assess
the size of the left
atrium (dilation) as in
case of long standing
mitral stenosis or heart
failure.

10. 10
RELATIONS IN THE ABDOMEN
• In the Abdomen, the esophagus
descends for 1.3 cm and joins the
stomach.
• Anteriorly, left lobe of the liver.
• Posteriorly, left crus of the
diaphragm.
• Fibers from the right crus of the diaphragm
form a sling around the esophagus.
• At the opening of the diaphragm, the
esophagus is accompanied by:
– The two vagi
– Branches of the left gastric vessels
– Lymphatic vessels.

11. ESOPHAGEAL
CONSTRICTIONS
• The esophagus has 3 anatomic
constrictions.
• The first is at the junction with the
pharynx(pharyngeoesophageal
junction).
• The second is at the crossing with
the aortic arch and the left main
bronchus.
• The third is at the junction with
the stomach.
• They have a considerable clinical
importance.
• Why?

12. 1. They may cause difficulties in
passing an esophagoscope.
2. In case of swallowing of caustic
liquids (mostly in children), this
is where the burning is the
worst and strictures develop.
3. The esophageal strictures are a
common sites of the
development of esophageal
carcinoma.
4. In this picture what is the
importance of the scale?

13. 13
ARTERIAL
SUPPLY
• Upper third by the
inferior thyroid
artery.
• The middle third by
the thoracic aorta.
• The lower third by
the left gastric
artery.

14. VENOUS
DRAINAGE
• The upper third
drains in into the
inferior thyroid
veins.
• The middle third
into the azygos
veins.
• The lower third into
the left gastric
vein, which is a
tributary of the
portal vein.
• NB. Esophageal
varices.
14

15. 15
LYMPH
DRAINAGE
• The upper third
is drained into
the deep
cervical nodes.
• The middle third
is drained into
the superior
and inferior
mediastinal
nodes.
• The lower third
is drained in the
celiac lymph
nodes in the
abdomen.

16. 16
NERVE SUPPLY
• It is supplied by
sympathetic fibers
from the sympathetic
trunks.
• The parasympathetic
supply comes form
the vagus nerves.
• Inferior to the roots of
the lungs, the vagus
nerves join the
sympathetic nerves to
form the esophageal
plexus.
• The left vagus lies
anterior to the
esophagus.
• The right vagus lies
posterior to it.

17. 17
The abdominal
cavity is divided
into 9
compartments:
by:
2 vertical and 2
horizontal planes
Vertical planes:
2 Midclavicular lines.
Horizontal planes:
Subcostal and
Intertubercular lines.
8th
costal L
1

18. 18
LOCATION
• The stomach is most
dilated part of the
alimentary canal.
• It is located in the
upper part of the
abdomen.
• It extends from
beneath the left
costal margin into
the epigastric and
umbilical regions.
• Most of the stomach is
protected by the lower
ribs.
• It is roughly J-shaped.
STOMAC
H

19. Capacity:
• In new-born- 30-50 ml
• Puberty:- 750-1000ml
• In adult:- 1000-1500 ml
• Volume of fundic air: 50ml in adult
19

20. Shape:
• In cadaver: sickle –shaped
• In the living: J shaped
• Clinically stomach presents 3 types:-
• A) Sthenic or normal type: longer limb of J
is slightly oblique
• B) Hypersthenic: J is very oblique( steer-
horn), prone to suffer from DU
• C) Hyposthenic or asthenic: J is vertical,
prone to suffer from GU
20

21. 21
PARTS
2 Orifices:
• Cardiac orifice
• Pyloric orifice
2 Borders:
• Greater curvature
• Lesser curvature
2 Surfaces:
• Antero- superior
• Postero-inferior
3 Parts:
• Fundus
• Body
• Pylorus:
The pylorus is formed
of 3 parts
• Pyloric antrum
• Pyloric canal
• Pyloric sphincter

22. • 2 ends: cardiac & pyloric
• 2 incisura: cardiac & angularis
• 2 omenta attached: greater & lesser
• 2 gastric nerves: anterior & posterior
• 2 sphincters: cardiac & pyloric
• 2 canals: gastric & pyloric
• 2 pints: average weight.
22

23. 23
CARDIAC ORIFICE
• It is the site of the
gastro- esophageal
sphincter.
• It is a physiological
rather than an
anatomical, sphincter.
• Consists of a circular
layer of smooth muscle
(under vagal and
hormonal control).
• Function:
• Prevents (GER)
regurgitation (reflux)
• NB. Notice the abrupt
mucosal transition from
esophagus to stomach
(Z- line)

24. Orifices
Cardiac
• 2.5 cm to the left of
median plane, behind 7th
costal cartilage, opposite
T11 vertebrae, 10cm
deep to AAW
Pyloric
• 1.25cm to the right of
middle line at lower border
of L1.
• Thicker, more superficial,
more movable than cardiac
end.
• Identified in the living by
pre-pyloric vein of Mayo.
• Sometimes it is bile
stained after death
• Remains open in empty
stomach
24

25. 25
FUNDUS
• Dome-shaped
• Located to the left of
the cardiac orifice
• Usually full of gas.
• In X-Ray film it appears
black

26. 26
BODY
• Extends from:
– The level of the
fundus
– to
– The level of
Incisura
Angularis:
• A constant notch
on the lesser
curvature

27. 27
LESSER
CURVATURE
• Forms the
right border
of the
stomach.
• Extends from
the cardiac
orifice to the
pylorus.
• Attached to
the liver by the
lesser
omentum.

28. 28
GREATER CURVATURE • Forms the left
border of the
stomach.
• Extends from
the cardiac
orifice to the
pylorus.
• Its upper part is
attached to the
spleen by
gastrosplenic
ligament
• Its lower part is
attached to the
transverse
colon by the
greater
omentum.

29. PYLORIC ANTRUM AND
PYLORUS
• The pyloric antrum
extends from Incisura
angularis to the pylorus
• The pylorus is a tubular
part of the stomach
• It lies in the
transpyloric plane
• It has a thick muscular
end called pyloric
sphincter.
• The cavity of the pylorus
is the pyloric canal.
29

30. 30
ANTERIOR
RELATIONS
• Anterior abdominal
wall
• Left costal margin
• Left pleura & lung
• Diaphragm
• Left lobe of the
liver

31. 31
POSTERIOR RELATIONS • Stomach Bed:
• Peritoneum
(Lesser sac)
• Left crus of
diaphragm
• Left suprarenal
gland
• Part of left kidney
• Spleen
• Splenic artery
• Pancreas
• Transverse
mesocolon
• They are separated
from the stomach
by Peritoneum
(Lesser sac except
the spleen)

32. 32
Cardiac orifice lies opposite the
left seventh costal cartilage 2.5
cm. from the sternum ,(T10).
Pyloric orifice lies on transpyloric
plane1 cm. to the right of the middle
line, at the level of L1.
Lesser curvature a curved line,
concave to the right joining these 2
points.
The fundus : reaches to the left
fifth intercostal space a little below
the apex of the heart.
Greater curvature is a curved line
drawn from the cardiac orifice to
the summit of the fundus, then
downward and to the left, finally
turning medial toward the pyloric
orifice, passing through the
intersection of the left lateral with
the transpyloric line.
SURFAC ANATOMY OF
THE STOMACH

33. 33
ARTERIES
• 5 arteries:
• As it is derived
from the foregut
all are branches
of the celiac
trunk
• 1- Left gastric
artery:
• It is a branch of
celiac artery.
– Runs along the
lesser curvature.
• 2- Right gastric
artery:
From the hepatic of
celiac.
– Runs to the left
along the lesser
curvature.

34. 34
ARTERIES
• 3-Short gastric arteries
– arise from the splenic
artery.
– Pass in the
gastrosplenic
ligament.
• 4- Left gastroepiploic
artery:
from splenic artery
– Pass in the
gastrosplenic
ligament, along the
greater curvature
• 5- Right gastroepiploic
artery:
• from the gastroduodenal
artery of hepatic .
– Passes to the left
along the greater
curvature.

35. 35
VEINS
• All of them drain into the portal circulation.
• The right and left gastric veins drain directly into the portal vein.
• The short gastric veins and the left gastroepiploic vein join the
splenic vein.
• The right gastroepiploic vein drain in the superior mesenteric vein.

36. 36
LYMPH DRAINAGE
• The lymph vessels
follow the arteries.
• They first drain to
the:
– Left and right
gastric nodes
– Left and right
gastroepiploic
nodes and the
– Short gastric
nodes
• Ultimately, all the
lymph from the
stomach is
collected at the
celiac nodes.

37. 37
NERVE
SUPPL
Y
• Sympathetic fibers are vasoconstrictors, antiperistaltic and carry pain
sensation. It is derived from the celiac plexus.
• Parasympathetic fibers from both vagi are for motility & secretory
Anterior vagal trunk:
– Formed from the left vagus
– Supply the anterior surface of the stomach
– Gives off a hepatic branch and from it - a branch to the pylorus.
• Posterior vagal trunk:
– Formed from the right vagus
– Supply the posterior surface of the stomach
– Gives off a large branch to the celiac and the superior mesenteric
plexuses.