anatomy of abdominal part of esophagus. its blood supply, lymphatic drainage, physiological constrictions of esophagus. clinical aspects of esophagus.

1. ESOPHAGUS & STOMACH
DR SANA YASEEN
ANATOMY DEPARTMENT

2. ABDOMINAL QUADRANTS

3. TRANSPYLORIC PLANE: horizontal line drawn in the mid point of xiphoid
process and the umblicus. It cuts costal margin at the tip of 9th costal
cartilage, at lateral border of rectus abdominis. At the level of L1 vertevrae.
SUCOSTAL PLANE: is transverse plane passes thorugh inferior margin of 10th
costal cartilage at the level of L3.
TRANSTUBERCLE PLANE: Passes through iliac tubercle horizontally at the
level of L5.
MID CLAVICULAR LINE: pair of verticle line on each side extending from mid
of clavicle to midinguinla point.

4. QUADDRANTS
2 quadrants: transpyyloric plane divides body into two
compartments supra colic and infracolic compartments.
4 quadrants :
horizontal transumblical plane
verticle plane – divides abdomin into 4 compartments
(R&L upper, R&L lower quadrants).
9 quadrants

7. R-HYPOCHNDRIUM L-HYPOCHNDRIUM
R-LOIN/ LUMBAR L-LOIN/ LUMBAR
R-ILIAC/ INGUINAL L-ILIAC/ INGUINAL
UMBLICAL
EPI GASTRIUM
HYPO GASTRIUM

10. • ABOMINAL ESOPHAGUS
ESOPHAGUS

11. Is muscular tube runs from pharynx to stomach
Length: ADULT- 18-25cm
CHILDREN- 10-11CM
Diameter: 2cm
Extension from epiglottis/ inferior border of cricoid cartilage up to
gastroesophageal junction. At level of 7th costal cartilage T11, tip of
xiphoid process.
C5/6 to T10/11
Is covered by peritoneum anteriorly and on the left side

13. PHYSIOLOGICAL CONSTRITIONS
A. Cervical constriction:
-At pharyngoesophageal constriction- 15cm
B. Thoracic (bronchoaortic) constriction:
-aortic: 22cm
Left main bronchus: 27cm
C. Diaphragmatic constriction:
-passing through the esophageal hiatus:
40cm

15. ABDOMINAL ESOPHAGUS
Length : 1-2.5cm
Abdominal esophagus is tethered to hiatus in diaphragm
phreno-oesophageal ligament.
GASTROESOPHAGEAL SPHINCTER :
Physiological sphincter under control of vagus
Augment by- gastrin
Reduce by- secretin, cck, glucagon

17. Blood supply
ARTERIAL SUPPLY:
Left gastric artery branch of celiac trunk
Left inferior phrenic artery
VENOUS DRAINAGE:
Sub mucosal vein via left gastric vein to
portal vein
Esophageal vein to azygous vein

18. INFERIOR PHRENIC ARTERY
The inferior phrenic artery is a paired vessel that arises from the
abdominal aorta.
The left and right inferior phrenic arteries emerge immediately
below the diaphragm, being the first set of paired branches of the
abdominal aorta.
Both arteries course over the abdominal surface of the diaphragm
and give off several collateral branches that supply the inferior
diaphragmatic surface, esophagus, trunk wall and suprarenal glands.

19. INFERIOR PHRENIC ARTERY

20. LYMPHATIC :
Left gastric lymph nodes to celiec
nodes
INNERVATIONS:
esophageal plexus/ vagal plexus:
 sympathetic : T6-T10 via greater
splanchnic nerve and celiac and
hepatic plexus.
para sympathetic: vagal nerve
via gastric nerve and esophageal
plexus

22. ENDOSCOPY

23. Achlasia
Due to neuromuscular incoordination, it
may fail to dilate leading to difficulty in
passage of food or dysphagia.
Condition is known as achalasia cardia.
Marked dilatation of esophags may occur
due to collection of foodd in it.

24. GASTROESOPHAGEAL REFULX (GERD)
 Gastroesophageal reflux disease,
or GERD, is a digestive disorder
that affects the ring of muscle
between your esophagus and
your stomach.
 This ring is called the lower
esophageal sphincter (LES).

25. BARRETS ESOPHAGUS
Squamous
epithelium of lower
esophagus is
replaced by
columnar
epithelium.

26. ESOPHAGEAL VARICES
In portal
hypertension,
the anastomosis
shows venous
ilation called
Esophageal
varices.
There rupture
causes severe
haemetemesis.

27. Image taken through endoscopy

28. ESOPHAGEAL CANCER

29. SQUAMOUS CELL CARCINOMA

30. Stages taking to the cancer of esophagus

31. BARIUM SWALLOW