Anatomy Test 5: Esophagus & Stomach

How long is the esophagus?
What level does it pass through the diaphragm?

25cm
T10

What level does it join the stomach?
What is this point called?

T11
Gastroesophageal (or cardioesophageal) junction

What is the lymph drainage of the abdominal esophagus?

Left gastric nodes
Celiac nodes

What is the blood supply of the abdominal esophagus?

Esophageal branch of the left gastric artery

What region (of the 9 abdominal regions) is pain associated with....
the foregut?
the midgut?
the hindgut?

Epigastrium
Umbilical
Hypogastrium

Where does the left gastric vein go before going to IVC? Why?

Goes to hepatic portal vein which takes blood from the entire GI tract and sends it to the liver (for detoxification) before it goes back to the heart.

What happens to venous blood in cirrhosis when liver gets harder and blocks these veins?

Blood will have to flow backwards --> Back to left gastric vein, back to azygos

If blood flows backwards all the way to the esophagus, veins inside the esophagus are so tiny that they will protrude (called ________ _________).
If veins get too large they will rupture and this bleeding is called _________.

esophageal varices
hematomesis

What is the sympathetic nerve supply of the esophagus (from top to bottom?

Greater splanchnic
Celiac plexus

What is the parasympathetic nerve supply of the esophagus (from top to bottom)?

Vagus nerve
Esophageal plexus (off of vagus)
Vagal trunk

Which direction do the R & L vagus nerves turn when the gut rotates 90 degrees in development?

R vagus: Posterior esophogaus
L vagus: Anterior esophagus

What is at zigzag Z line juncture of esophageal and gastric mucosa?

PHYSIOLOGICAL sphincter (there is no anatomical sphincter)

What is the most common cause of substernal pain? What can it be mistaken for?

Pyrosis (heartburn)
Mistaken for angina pectoris

What is the name of a hernia associated with heartburn? Why?

Sliding hiatal hernia
The physiological sphincter is no longer working because the junction is no longer there (thanks due weakness of diaphragm musculature) so acidic gastric contents will go into esophagus.

Why should chronic heartburn not be ignored?

Chyme will erode the esophagus and mutate the cells into possible cancer.

What is the name of the hernia where the physiological junction is still intact?

Paraesophageal hiatus hernia

In Barrett's esophagus, _______ is when stratified squamous epithelium is replaced by simple columnar epithelium.

Metaplasia

What regions (of the 9 abdominal regions) is the stomach in?

Epigastric & left hypochondriac areas

Hypotonic stomach is when it gets bigger or smaller? What can cause this?

Hypotonic = stomach gets bigger and extends down and can even go into hypogastric region
Can happen when we over eat because the smooth muscle will expand

What has happened to the stomach if it's atonic?
What is this usually a problem from?

Stomach has lost all of it's tone
Usually a problem with vagus/vagal trunks

The angular notch (incisure) is where the ________ curvature on body of stomach meets the _________.

lesser; pyloris
(so where the vertical part of stomach meets horizontal part)

2 parts of the pyloris

Pyloric Atrium (like a funnel from stomach)
Pyloric Canal

Within the pyloric canal is the _______ _______ which is thick and well developed.
Is it palpable?

Pyloric sphincter
Yes

The part of the stomach that you see in X rays below left side of stomach is the _______.
It is filled with _______ and NEVER filled with _______.

Fundus
gas; Never food

What level is the cardia usually found at? This is associated with the ______ left costal cartilage.

T11
6th

Why is it important for the cardia to have a reflex to make us vomit when it fills up with food when we overeat?

So we can continue breathing

What is the pylorus the midway point between (transpyloric plane)?

Juglar notch and pubic crest

If patient has pain around stomach area, you can palpate right below the _______ _______ to see if it's the stomach.

Xiphoid process

Why is there a lesser curvature on right and greater curvature on the left?

The liver grows on the right side, so the stomach expanded to the left. Left side = bigger.

MNEUMONIC
for 8 structures of stomach bed:
Slippery Stomach Acid Can Kill Patients More Drastically

Slippery Stomach Acid Can Kill Patients More Drastically
Spleen
Suprarenal gland
Artery (splenic)
Colon (transverse)
Kidney (left)
Pancreas
Mesocolon (transverse)
Diaphragm (left dome)

How can pathology of the stomach affect the structures in the stomach bed?

A gastric ulcer can make a hole through the stomach = Gastric Perforation, and acidic contents will leak to these structures.

What happens if the splenic artery is what gets damaged from stomach contents leaking?

It will erode and you will bleed out internally.

Where will pain from the retroperitoneal structures be referred to?
How do you know this isn't musculoskeletal pain?

To the back
Musculoskeletal pain will change with posture and movement.
If there's pain and no change of pain with movement, you need to figure out what structure is causing this!

If you have both stomach and retroperitoneal pain, you will only will which one is stronger. This is called the _______ theory when the brain can only feel one sensation at any given time. What's another example of this?

Gating
When you press hard on your temples with a headache so you feel the pressure instead of pain.

What are the gastric pits for? (Little tiny holes throughout stomach)

To release stomach secretions

The gastric artery that branches to supply the stomach and esophagus is a brach of what?

Celiac trunk

What arteries supply the lesser curvature of the stomach?

R & L gastric arteries
(Left on top, right on bottom)

What arteries supply the greater curvature of the stomach?

R & L gastroepiploic arteries
(Left on top, right on bottom)

Which artery supplies the funds of the stomach?

Short gastric artery

Congenital hypertrophic pyloric stenosis is more common in male or female babies?
When the baby vomits, there will be no bile because it never went to the _______.

Males
Duodenum

Also because contents never made it to the duodenum, there will be no _______.
Is this condition treatable?

Defecation
Yes, with surgery

Why do you have to feed babies all the time?

Stomach is 70x smaller in babies than in adults (adults= 1.5-2L, babies = 1ounce)

70% of gastric ulcers are from ________ infections.
How does this bacteria work?

H. pylori
Destroys cells that produce mucous so you can't neutralize acids. It also increases cells that make acid.

Perforation in anterior wall from chronic untreated ulcers can cause ____________.
In posterior wall, can cause erosion of pancreas (pancreatitis will refer pain where?) or erosion of splenic artery leading to what?

Generalized peritonitis
Referred pain to back
Hemorrhage into lesser sac then greater sac