Anatomy

Dr. Gonzalez

Esophagus

Muscular tube lined with mucous membrane

About 10 inches long
Commences at the level of C6
Passes through the diaphragm at T10
In the neck it lies in front of the vertebral column
Laterally related to the lobes of the thyroid
Anteriorly in contact with trachea and recurrent laryngeal nerve

3 Constant Constrictions
1- level of cricoid cartilage
2- behind the bifurcation of trachea
3- at its passage through the esophageal hiatus in the diaphragm

Thoracic Part
Anteriorly- trachea and left recurrent laryngeal nerve, left bronchus, pericardium
Posteriorly- thoracic vertebrae, thoracic duct, azygos veins, posterior intercostal arteries,
descending aorta
Right side- mediastinal pleura, terminal azygos veins
Left side- left subclavian artery, aortic arch, thoracic duct, mediastinal pleura

Blood Supply
Upper third- inferior thyroid artery
Mid third- descending aorta
Lower third- branches from left gastric artery

Venous Drainage
Upper third- inferior thyroid veins
Mid third- azygos veins
Lower third- left gastric vein

Nerve Supply
Parasympathetic and sympathetic efferent and afferent fibers via the vagi and sympathetic
trunks
 Heartburn: An incompletely closed LES allows acidic stomach contents to back up (reflux) into
the esophagus. Reflux can cause heartburn, cough or hoarseness, or no symptoms at all

Gastroesophageal reflux disease (GERD): When reflux occurs frequently or is bothersome, its
called gastroesophageal reflux disease (GERD).

Barretts esophagus: Regular efflux of stomach acid irritates the esophagus, which may cause
the lower part to change its structure. Very infrequently, Barretts esophagus progresses to
esophageal cancer.

Esophageal stricture: A narrowing of the esophagus. Chronic irritation from reflux is the usual
cause of esophageal strictures.

Mallory- Weiss tear: Vomiting or retching creates a tear in the lining of the esophagus. The
esophagus bleeds into the stomach, often followed by vomiting blood.

Esophageal varices: In people with cirrhosis, veins in the esophagus may become engorged and
bulge. Called varices, these veins are vulnerable to life- threatening bleeding.

Esophageal caustic injuries

Tracheo-esophageal fistula
 Stomach

Functions
Storage of food-up to 1.5 L in adults
Mixes food with gastric secretions to form chime (semifluid)
Controls the delivery of food to the small intestines (for efficient digestion and absorption)
The stomach is situated at the left costal margin region extending to the epigastric and umbilical
regions
Under the cover of the lower ribs
J shaped
Fixed at both ends
Mobile in between
Shape depends on its contents, body position, phase of respiration

Two openings
Cardiac
Pyloric

Two curvatures
Greater curvature
Lesser curvature

Two surfaces
Anterior
Posterior

Parts
Cardia- surrounds the opening of the esophagus into the stomach
Fundus- dome- shaped, projects upward above the level of the cardiac orifice. Usually contains
gas (gastric bubble).
Body- from the level of cardiac orifice to cisura angularis (notch at the lesser curve)
Pylorus- tubular part of the stomach
Pyloric sphincter- muscular wall of pylorus
Pyloric canal- cavity of the pylorus

Lesser curvature
Forms the right border of the stomach
From cardiac orifice to the pylorus
Suspended from the liver by the lesser omentum

Greater curvature
Left of the cardiac orifice
 Over the dome of fundus
Longer than the lesser curvature
Gastrosplenic omentum
Greater omentum- lower part of greater curvature to transverse colon

Cardiac orifice
Where the abdominal part of esophagus enters the stomach
Physiological mechanism which prevents regurgitation of stomach contents to the esophagus

Pyloric orifice
Formed by the pyloric canal
Approximately 1 inch in length
Pyloric sphincter- thick circular muscle coat, controls the rate of stomach content discharge to
the duodenum
Mucous membrane- thick and vascular
Rugae- folds mainly longitudinal in direction

Muscular wall of the stomach

Longitudinal fibers- most superficial
Circular fibers-inner layer, greatly thickened at the pylorus to form the sphincter
Oblique fibers- innermost layer

Blood supply
Left gastric artery- from celiac artery, supplies the lower 3rd of esophagus and upper right part of
the stomach
Right gastric artery- from hepatic artery, supplies the lower right (lesser curvature)
Short gastric arteries- from the splenic artery, supplies the fundus area
Left gastroepiploic artery- from the splenic artery, supplies the upper portion (left) at the
greater curvature
Right gastroepiploic artery- from the gastroduodenal branch of hepatic artery, supplies the
lower part (right) of the greater curvature

Veins
Drain into the portal circulation
Left and right gastric veins drain directly into the portal vein
Short gastric veins and left gastroepiploic veins drain into the splenic vein
Right gastroepiploic vein joins the superior mesenteric vein

Lymph drainage
Nodes along the left gastric vessels drain into the celiac nodes
Nodes along the right gastric vessels drain to the hepatic artery nodes then to the celiac nodes
 Nodes along short gastric/ left gastroepiploic drain to splenic nodes then to the
pancreaticosplenic nodes then to the celiac nodes
Nodes from right gastroepiploic drain to the gastroduodenal then to the celiac nodes

Nerve supply
Derived from the celiac sympathetic plexus and form the right and left vagus nerves
Anterior vagal trunk (left)- enters the abdomen on the anterior surface of the esophagus
Posterior vagal trunk (right)- enters the diaphragm at the posterior surface of the esophagus