Transcript 24 - oesophagus, stomach and spleen.ppt
ESOPHAGUS
It is a muscular tube ( 25 cm ).
It is the narrowest except for the part of the alimentary tract vermiform appendix.
It begins at the caudal border of pharynx.
(C6) where it is continuous with the
ESOPHAGUS
It is divided into three parts : Cervical .
Thoracic.
Abdominal .
ABDOMINAL ESOPHAGUS
It is the shortest part It pierces the right at the level of (T10)
crus of the diaphragm It passes for (1.25) cm .
½ inch
It ends at the right side of the stomach ( cardiac orifice
) at the level of (T11).
RELATIONS
1. Anterior :
Left lobe of the liver.
2. Posterior :
Left crus of the diaphragm.
ARTERIAL SUPPLY
Left gastric trunk).
(celiac Inferior phrenic
(abdominal aorta).
VENOUS DRAINAGE
It drains into the left gastric vein .
The esophagus is a site of portosystemic anastomosis.
ESOPHAGEAL PLEXUSES
They are formed from both vagi and the sympathetic plexus.
The descends anterior to the esophagus and forms the Left vagus nerve .
anterior gastric
ESOPHAGEAL PLEXUSES
The right vagus descends posterior to the esophagus and forms the posterior gastric nerve.
STOMACH
It is the most tube.
dilated part of the digestive It lies in the following regions:
Epigastric.
Umbilical.
Left hypochondrium.
It can has an oblique position when the intestine is empty.
SHAPE
It varies according to and the surrounding viscera.
changes both within itself It can be high and ( steer horn) obese subjects or
transversely located in short when it is contracted. It is J shaped thin persons.
in tall &
GASTRIC CURVATURES
1. Lesser curvature : It forms the stomach.
right (posterosuperior ) border of the
It is the continuation of the right border of the esophagus .
It forms a constant ( incisura angularis ).
notch at its lower part
GASTRIC CURVATURES
2. Greater curvature : It is directed antero inferiorly.
It is (4-5) times longer
than the lesser curvature.
It starts from the cardiac
orifice at the cardiac notch.
It forms an arch which is directed backwards, upwards and to the left .
PARTS
(1) Fundus :
It is the part that lies to the left and above the cardiac orifice.
It is the bottom of the stomach.
Usually it is full with gas.
PARTS
(2) Body :
It Extends from the cardiac orifice to the incisura angularis .
3. Pyloric antrum:
It extends from the incisura to the pylorus.
PARTS
(4) Pylorus :
It is the tubular part of the stomach.
It lies at the level of L1 (transpyloric plane).
Pyloric canal:
It is the cavity of the pylorus.
GASTRIC ORIFICES
(1) Cardiac:
It is the opening the stomach.
where the esophagus communicates with It is not an anatomical sphincter.
Its mechanism of
action is physiologic.
GASTRIC ORIFICES
(2) Pyloric orifice :
It is an
anatomical and physiological sphincter.
It is formed by the circular muscle layer of the stomach.
GASTRIC ORIFICES
Its position is indicated by a circular groove on the surface of the stomach ( pyloric constriction ). In the living it is indicated by the prepyloric vein .
GASTRIC SURFACES
(A) Antero superior :
It is in contact with the diaphragm which separates it from: Left pleura, base of left lung.
Pericardium .
Left lobe of the liver.
GASTRIC SURFACES
(B) Postero- inferior (stomach bed) : It is related to the diaphragm .
Left suprarenal Upper part of the left kidney .
Spleen.
gland.
Splenic artery .
Transverse mesocolon.
GASTRIC SURFACES
Anterior surface of the pancreas .
Left colic flexure.
The stomach is separated from sac ( omental bursa).
them by the lesser
PERITONEUM
The stomach is by visceral peritoneum.
completely covered 1. Lesser omentum: It is attached to the lesser curvature.
It contains the right and left gastric vessels (in the attached border ).
PERITONEUM
2. Gastrosplenic ligament: It connects the stomach to the hilum of the spleen.
It is attached to the curvature,
upper part of the greater to the left side of the fundus.
It contains the short
gastric and left gastroepiploic branches of the splenic artery.
PERITONEUM
3. Greater omentum :
It is attached to the lower part of the greater curvature.
The right and left gastroepiploic vessels pass between its two layers.
ARTERIAL SUPPLY
Celiac trunk:
(1) Left gastric .
(2) Common hepatic :
a. Right gastric.
b. Right gastro epiploic .
(3) Splenic :
A. Short gastric.
B. Left gastro epiploic .
VENOUS DRAINAGE
To the portal vein.
1. Direct to Portal vein : Right gastric.
2. To Splenic vein : Short gastric.
Left gastro-epiploic.
3. To Superior
mesenteric vein : Right gastro-epiploic.
LYMPH DRAINAGE
Lymph vessels follow the arteries to: 1. Left and Right gastric nodes.
2. Left and Right gastro epiploic nodes.
3. Short gastric nodes.
Eventually to :
Celiac nodes.
NERVE SUPPLY
(1) Anterior vagal trunk:
It supplies the anterior surface.
Gives a hepatic branch to the liver and a pyloric branch to the pylorus.
NERVE SUPPLY
(2) Posterior vagal trunk: Supplies the posterior surface.
It is distributed through the celiac and superior mesenteric plexuses. It Supplies the intestine till the splenic flexure.
SPLEEN
It is the largest single mass of lymphoid tissue .
It is soft, very and highly vascular.
friable consistence
LOCATION
It lies in the left hypochondrium.
Its posterior edge extends to the epigastric region.
It lies between the fundus of the stomach and the diaphragm .
LOCATION
It is close to the 9 th 10 th and 11 th ribs.
Its long axis lies in line of the 10 th rib.
,
Its lower pole
extends as far as the mid-axillary line.
It is not palpable on clinical examination.
DESCREPTION
It presents :
Surfaces :
diaphragmatic visceral .
and Borders :
Upper and lower .
Extremities : Anterior and posterior .
BORDERS
The upper border : Separates the diaphragmatic gastric
surface and the impression.
It presents fetal life.
notches that indicate the lobulated character of the spleen in the
BORDERS
The lower border :
Is blunter and more rounded than the upper.
It separates the diaphragmatic
surface from the renal impression.
HILUM
it is a long vessels.
fissure for the entrance and exit of nerves and
RELATIONS
Posterior : surface :
(diaphragmatic) 0 . Diaphragm.
0 . Left costo-
diaphragmatic recess.
0 . Left lung.
0 . Ribs (9, 10 & 11).
RELATIONS
Anterior :
( visceral) surface : 1. Posterior wall of the stomach, from which it is separated by the Lesser sac .
RELATIONS
2. Anterior surface of the Left kidney.
3. Left colic impression .
4. Tail of the pancreas.
PERITONEUM
It is almost entirely surrounded by peritoneum.
1. splenicorenal ligament:
Between the left
kidney and the spleen.
It contains the splenic vessels and the the pancreas .
tail of
PERITONEUM
2. Gastrosplenic ligament.
3. phrenicocolic ligament.
ARTERIAL SUPPLY
Splenic artery :
It runs along the upper border of the pancreas.
It has a tortuous course.
It passes through the lienorenal ligament.
SPLENIC ARTERY
At the hilum, it 6 ) branches which ramify on the surface.
divides into (5 or
VENOUS DRAINAGE
Splenic vein :
It is formed from the junction of tributaries which emerge from the hilum.
SPLENIC VEIN
It passes behind the body and tail of the pancreas .
It joins the superior mesenteric vein to
form the portal vein behind the neck of the pancreas.