This document provides an overview of the anatomy, blood supply, lymphatic drainage and histology of the esophagus and stomach. It discusses the locations of esophageal and gastric tumors and their associated risk factors. Benign esophageal tumors are rare, accounting for less than 1% of cases, with leiomyomas being most common. Malignant esophageal tumors are usually squamous cell carcinomas in the upper two-thirds and adenocarcinomas in the lower third. Risk factors include smoking, alcohol consumption and Barrett's esophagus. Common clinical features of esophageal cancer include dysphagia, weight loss and cervical lymphadenopathy.
The esophagus is a tubular muscular structure approximately 23 cm in length composed of outer longitudinal and inner circular muscle fibers. The proximal part contains striated muscle fibers while the distal part contains smooth muscle fibers. The transition zone between the two muscle types varies in location. When collapsed, normal longitudinal folds in the esophagus appear as smooth, straight structures up to 3 mm wide. Transverse folds may also occur due to muscle contraction and are associated with gastroesophageal reflux. Extrinsic structures can cause impressions on the esophagus wall including the aortic arch, heart and bronchus.
Radiological Anatomy of pharynx and esophagus abdul finalabduljelil nejmu
This document discusses the anatomy of the pharynx and esophagus. It begins by outlining the gross anatomy, imaging modalities, and subdivisions of the pharynx. It then discusses the introduction, imaging modalities including barium studies and cross-sectional imaging, and vascular and lymphatic anatomy of the esophagus. Key points include that the pharynx is a fibromuscular tube located from the skull base to the level of C6, and the esophagus is a muscular tube that extends from the cricoid cartilage to the stomach at T10. Various imaging modalities can be used to visualize these structures.
ANATOMY OF ESOPHAGUS-Dr.Neeraj Kumar Banoriadrnkb2000
1. The document describes the anatomy and development of the esophagus. It notes that the esophagus is divided into cervical, thoracic, and abdominal parts and discusses the layers of the esophageal wall.
2. Key details are provided on the myenteric plexus and development of the esophagus from the foregut. Figures show the positions of the esophagus relative to other structures in the neck and chest.
3. Anatomical features including constrictions, deviations, and tissues anchoring the esophagus are examined. The fascial planes surrounding the esophagus are also outlined.
The document discusses the anatomy and physiology of the esophagus and swallowing. It describes the layers of the esophageal wall, its blood supply, and relationships to surrounding structures. It then explains the three phases of swallowing - oral, pharyngeal, and esophageal. Key events in each phase are outlined, including soft palate elevation, laryngeal closure to protect airways, and cricopharyngeus relaxation allowing bolus passage. Neural control involves cranial nerves, brainstem swallowing centers, and coordination with respiration. Radiological tests can reveal pathological findings like Killian-Jamieson diverticula or pouches, or cervical esophageal webs causing dysphagia.
The document provides an overview of the anatomy, embryology, imaging, and physiology of the esophagus. It discusses the esophagus' layers, blood supply, lymphatic drainage and innervation. Imaging modalities like barium swallow, endoscopic ultrasound, CT and MRI are described. Barium swallow is useful for evaluating disorders while endoscopic ultrasound is best for T-staging cancer. CT is optimal for assessing extraesophageal disease and lymph nodes. The esophagus acts as a conduit between the pharynx and stomach during swallowing.
The document describes the anatomy and physiology of the esophagus. It details the different segments of the esophagus from the pharyngoesophageal junction to the gastroesophageal junction. Key structures like the lower esophageal sphincter are described. Motility disorders, diseases, cancers and treatments related to the esophagus are summarized. Evaluation methods for esophageal conditions are also outlined.
The document provides an overview of anatomy and physiology of the esophagus, trachea, and neck masses. It describes the structure and function of the esophagus, trachea, and neck anatomy. Diagnostic tests and procedures for evaluating neck masses such as barium X-ray, endoscopy, and biopsy are discussed. Common causes, diagnostic steps, and imaging techniques for neck masses are also summarized.
ANATOMY OF ESOPHAGUS WITH PHYSIOLOGY OF DEGLUTITIONsusritha17
This document provides an overview of the development, anatomy, and physiology of the esophagus. It discusses:
1. The embryological development of the pharynx, esophagus, and trachea from the buccopharyngeal membrane and branchial arches.
2. The anatomy of the esophagus including its course, layers, blood supply, nerve supply, and sphincters.
3. The physiology of deglutition including the oral, pharyngeal, and esophageal phases and the swallow reflex.
The esophagus is a tubular muscular structure approximately 23 cm in length composed of outer longitudinal and inner circular muscle fibers. The proximal part contains striated muscle fibers while the distal part contains smooth muscle fibers. The transition zone between the two muscle types varies in location. When collapsed, normal longitudinal folds in the esophagus appear as smooth, straight structures up to 3 mm wide. Transverse folds may also occur due to muscle contraction and are associated with gastroesophageal reflux. Extrinsic structures can cause impressions on the esophagus wall including the aortic arch, heart and bronchus.
Radiological Anatomy of pharynx and esophagus abdul finalabduljelil nejmu
This document discusses the anatomy of the pharynx and esophagus. It begins by outlining the gross anatomy, imaging modalities, and subdivisions of the pharynx. It then discusses the introduction, imaging modalities including barium studies and cross-sectional imaging, and vascular and lymphatic anatomy of the esophagus. Key points include that the pharynx is a fibromuscular tube located from the skull base to the level of C6, and the esophagus is a muscular tube that extends from the cricoid cartilage to the stomach at T10. Various imaging modalities can be used to visualize these structures.
ANATOMY OF ESOPHAGUS-Dr.Neeraj Kumar Banoriadrnkb2000
1. The document describes the anatomy and development of the esophagus. It notes that the esophagus is divided into cervical, thoracic, and abdominal parts and discusses the layers of the esophageal wall.
2. Key details are provided on the myenteric plexus and development of the esophagus from the foregut. Figures show the positions of the esophagus relative to other structures in the neck and chest.
3. Anatomical features including constrictions, deviations, and tissues anchoring the esophagus are examined. The fascial planes surrounding the esophagus are also outlined.
The document discusses the anatomy and physiology of the esophagus and swallowing. It describes the layers of the esophageal wall, its blood supply, and relationships to surrounding structures. It then explains the three phases of swallowing - oral, pharyngeal, and esophageal. Key events in each phase are outlined, including soft palate elevation, laryngeal closure to protect airways, and cricopharyngeus relaxation allowing bolus passage. Neural control involves cranial nerves, brainstem swallowing centers, and coordination with respiration. Radiological tests can reveal pathological findings like Killian-Jamieson diverticula or pouches, or cervical esophageal webs causing dysphagia.
The document provides an overview of the anatomy, embryology, imaging, and physiology of the esophagus. It discusses the esophagus' layers, blood supply, lymphatic drainage and innervation. Imaging modalities like barium swallow, endoscopic ultrasound, CT and MRI are described. Barium swallow is useful for evaluating disorders while endoscopic ultrasound is best for T-staging cancer. CT is optimal for assessing extraesophageal disease and lymph nodes. The esophagus acts as a conduit between the pharynx and stomach during swallowing.
The document describes the anatomy and physiology of the esophagus. It details the different segments of the esophagus from the pharyngoesophageal junction to the gastroesophageal junction. Key structures like the lower esophageal sphincter are described. Motility disorders, diseases, cancers and treatments related to the esophagus are summarized. Evaluation methods for esophageal conditions are also outlined.
The document provides an overview of anatomy and physiology of the esophagus, trachea, and neck masses. It describes the structure and function of the esophagus, trachea, and neck anatomy. Diagnostic tests and procedures for evaluating neck masses such as barium X-ray, endoscopy, and biopsy are discussed. Common causes, diagnostic steps, and imaging techniques for neck masses are also summarized.
ANATOMY OF ESOPHAGUS WITH PHYSIOLOGY OF DEGLUTITIONsusritha17
This document provides an overview of the development, anatomy, and physiology of the esophagus. It discusses:
1. The embryological development of the pharynx, esophagus, and trachea from the buccopharyngeal membrane and branchial arches.
2. The anatomy of the esophagus including its course, layers, blood supply, nerve supply, and sphincters.
3. The physiology of deglutition including the oral, pharyngeal, and esophageal phases and the swallow reflex.
The oesophagus is a 25cm tube connecting the pharynx to the stomach. It has three normal constrictions and consists of four layers. The main muscle layer contains striated muscle in the upper third and smooth muscle in the lower third. Achalasia cardia is failure of the lower oesophageal sphincter to relax during swallowing. Carcinoma of the oesophagus is often caused by smoking and alcohol and spreads locally and via lymph nodes or blood. Barium swallow and endoscopy are used to diagnose it. Treatment depends on the location but may include surgery, radiation, chemotherapy or palliation.
The esophagus is a tubular structure about 25 cm long that begins at the pharynx and pierces the diaphragm to join the stomach. It has cervical, thoracic, and abdominal parts. In the neck it is posterior to the trachea and recurrent laryngeal nerves. In the thorax it passes through the mediastinum and is related anteriorly to the trachea and bronchus. It has three constrictions and two sphincters that control passage of food and prevent reflux. Arterial supply comes from the inferior thyroid, bronchial, and left gastric arteries. Venous drainage involves the inferior thyroid, azygos, and left gastric veins. Lymphatic drainage involves cervical
The document summarizes the anatomy of the esophagus. It describes the embryology, extent, parts, relations, blood supply, nerve supply, lymph drainage, and microscopic structure. The esophagus develops from the foregut and functions to transport food from the pharynx to the stomach. It extends from the lower border of the cricoid cartilage to the cardiac orifice of the stomach. Knowledge of the anatomy is important for understanding diseases that can impair its function.
This document provides an overview of the surgical anatomy of the esophagus. It discusses the embryology, structure, and applied anatomy of the esophagus in the neck, thorax, and abdomen. Key points include that the esophagus deviates left in the neck but is midline in the thorax and curves left in the abdomen. It describes the layers of the esophagus including the external fibrous layer, muscular layer, submucosal layer, and mucosal layer. It also discusses the arterial supply, venous drainage, lymphatic drainage, and nerve supply of the esophagus.
The esophagus is a 25 cm long muscular tube that extends from the lower border of the cricoid cartilage to the stomach. It has three parts - cervical, thoracic, and abdominal. Each part has unique anatomical features and relationships. The esophagus develops from the endoderm-lined yolk sac and is completely differentiated by week 12 of gestation. It has four layers - mucosa, submucosa, muscularis propria, and adventitia. The esophagus functions to transport food from the pharynx to the stomach through peristaltic contractions.
This document provides an overview of gastrointestinal anatomy including:
1. The embryonic precursors of the GI tract - foregut, midgut, and hindgut - and their derivatives.
2. The anatomy of the individual organs that make up the GI tract from the pharynx to the anus.
3. Key anatomical structures such as the peritoneum, mesentery, retroperitoneal space, and pelvic compartments.
4. Radiographic anatomy seen on abdominal x-rays including the liver and spleen shadows, bowel gas patterns, and signs of abnormalities.
The document summarizes the anatomy and physiology of the oesophagus. It notes that the oesophagus is approximately 25 cm long, extending from the lower end of the pharynx to the stomach. It describes the three normal constriction points where foreign bodies commonly become lodged. The wall of the oesophagus consists of four layers - mucosa, submucosa, muscular layer, and fibrous layer. Parasympathetic fibers from the vagus nerve and sympathetic fibers from the sympathetic trunk supply the oesophagus. Lymphatic drainage occurs to the deep cervical, posterior mediastinal and gastric nodes. Peristaltic movements propel food through the oesophagus and into
The document summarizes key aspects of esophageal anatomy and physiology. It describes the esophagus as a muscular tube divided into cervical, thoracic, and abdominal segments. It discusses the layers of the esophageal wall, blood supply, innervation, and functions of the upper and lower esophageal sphincters. Common esophageal disorders like GERD, diverticula, and motility disorders are also summarized.
1. The document describes the gross examination procedures for esophagectomy and gastrectomy specimens. Key steps include opening the specimens longitudinally, measuring length, circumference, and wall thickness, and examining the tumor appearance and relationship to anatomical structures.
2. Resection margins of 5 cm for adenocarcinoma and 10 cm for squamous cell carcinoma must be achieved. Common esophagectomy procedures include Ivor Lewis technique, thoracoabdominal esophagectomy, and transhiatal esophagectomy.
3. For stomach specimens, biopsies and polypectomy specimens are handled differently than resection specimens. Resection specimens require adequate fixation before further examination of margins, tumor characteristics, and lymph nodes.
Anatomy of gastroesophagial junction with specail reference to hiatus hernia...Rana Singh
This document discusses the anatomy of the gastroesophageal junction, with a focus on hiatal hernia and the anatomical basis for therapeutic intervention. Key points include:
- The gastroesophageal junction is defined anatomically by the squamocolumnar junction, the transition from esophageal to gastric lining, and the junction of the esophageal and gastric musculature.
- Hiatal hernias are classified based on the location of the hernia, with type I being a sliding hernia and type II being a paraesophageal hernia where the gastric fundus herniates alongside a normal cardia.
- Indications for surgical repair of paraesophageal hernias include symptoms and the risk
This document provides an overview of the anatomy and embryology of the small intestine. It discusses the gross anatomy, blood supply, innervation and lymphatic drainage of the duodenum, jejunum, and ileum. Imaging modalities for evaluating the small intestine are also mentioned, including plain radiography, ultrasound, and barium studies. The small intestine extends from the pylorus to the ileocecal junction, and consists of the duodenum, jejunum, and ileum. It has important functions in digestion and absorption of nutrients.
colon anatomy, anatomy of large intestine, anatomy of large bowel, histology of large intestine, large intestine, histology, colon, appendices epiploica, taenia coli, haustrautions, ilio caecal valve
The document summarizes the anatomy and embryology of the esophagus. It discusses the esophagus' location, length, diameter at different ages, layers, blood supply, nerve supply, and more. Some key points:
- The esophagus is a muscular tube that transports food from the pharynx to the stomach. It has an upper and lower sphincter.
- During development, the esophagus forms from the foregut and separates from the trachea by the esophagotracheal septum.
- It has cervical, thoracic, and abdominal portions with different anatomical relationships in each region.
- The esophagus has four layers - fibrous, muscular
This document provides an overview of oesophageal anatomy, staging, and the diagnostic workup for oesophageal cancers. It describes the gross anatomy and course of the oesophagus, its arterial and venous blood supply, lymphatic drainage, and histology. Risk factors for oesophageal cancer are smoking, alcohol, and diet. Common symptoms are dysphagia and weight loss. The diagnostic workup includes imaging like barium swallow and CT scan, as well as endoscopy with biopsy. Staging is an important part of evaluating oesophageal cancers.
This document summarizes the development of the pancreas from embryology through its various anatomical structures and developmental anomalies. It describes how the pancreas develops from dorsal and ventral buds, and how the pancreatic ducts form. Signaling pathways that guide development are discussed. Common anatomical variations like pancreas divisum and annular pancreas are summarized, including their presentations and treatments. The Todani classification of choledochal cysts is also briefly outlined.
The document describes the anatomy and development of the esophagus. It begins by defining the esophagus as a conduit connecting the pharynx to the stomach. It then discusses the esophagus' length, course through the neck and chest, and termination in the abdomen. The summary continues with the following key points:
- The esophagus develops from the foregut and tracheobronchial diverticulum. Its musculature differentiates into striated muscle proximally and smooth muscle distally.
- It has two sphincters - the upper esophageal sphincter between the pharynx and cervical esophagus, and the lower esophageal sphincter where it joins
The document summarizes the anatomy and features of the esophagus. It notes that the esophagus is 25 cm long and connects the pharynx to the stomach. It passes downwards in front of the vertebral column and behind the trachea. The esophagus is divided into three parts: cervical, thoracic, and abdominal. The cervical part extends from the lower border of the cricoid cartilage to the superior border of the manubrium sterni. It is anterior to the trachea and recurrent laryngeal nerve, and posterior to the prevertebral fascia and longus colli muscles.
Anatomy, physiology and diagnosis of oesophageal diseasesAnwaaar
This document discusses the anatomy, physiology, and diagnosis of oesophageal diseases. It covers the surgical anatomy of the oesophagus, its physiology during swallowing, common symptoms of oesophageal diseases, and investigations used in diagnosis including barium swallow, endoscopy, endosonography, manometry, and pH monitoring. It also discusses specific oesophageal diseases and conditions such as congenital lesions, benign tumors, cancer, foreign bodies, perforations, gastroesophageal reflux disease, hiatal hernia, and motility disorders.
- The document discusses treatment options for advanced gastric cancer, including chemotherapy regimens that have shown effectiveness in clinical trials such as combinations of 5-fluorouracil, capecitabine, cisplatin, and oxaliplatin.
- A key trial found that adding trastuzumab to chemotherapy improved outcomes for patients with HER2-positive advanced gastric cancer. Median overall survival increased from 11.1 to 13.8 months with the addition of trastuzumab.
- A phase III trial compared FOLFIRI chemotherapy to ECX as first-line treatment and found that FOLFIRI resulted in significantly longer time to treatment failure without differences in progression-free or overall survival.
The document discusses the anatomy, histology, and physiology of the esophagus and diaphragmatic hernias. It provides details on:
1. The layers of the esophagus including mucosa, submucosa, and muscularis.
2. The three parts of the esophagus - cervical, thoracic, and abdominal.
3. Key anatomical relationships and structures like the aortic arch.
4. Innervation and blood supply of the esophagus.
5. The normal three-stage swallowing process - oral, pharyngeal, and esophageal phases.
6. Sphincter functions including the upper and lower esophageal sphincters
The oesophagus is a 25cm tube connecting the pharynx to the stomach. It has three normal constrictions and consists of four layers. The main muscle layer contains striated muscle in the upper third and smooth muscle in the lower third. Achalasia cardia is failure of the lower oesophageal sphincter to relax during swallowing. Carcinoma of the oesophagus is often caused by smoking and alcohol and spreads locally and via lymph nodes or blood. Barium swallow and endoscopy are used to diagnose it. Treatment depends on the location but may include surgery, radiation, chemotherapy or palliation.
The esophagus is a tubular structure about 25 cm long that begins at the pharynx and pierces the diaphragm to join the stomach. It has cervical, thoracic, and abdominal parts. In the neck it is posterior to the trachea and recurrent laryngeal nerves. In the thorax it passes through the mediastinum and is related anteriorly to the trachea and bronchus. It has three constrictions and two sphincters that control passage of food and prevent reflux. Arterial supply comes from the inferior thyroid, bronchial, and left gastric arteries. Venous drainage involves the inferior thyroid, azygos, and left gastric veins. Lymphatic drainage involves cervical
The document summarizes the anatomy of the esophagus. It describes the embryology, extent, parts, relations, blood supply, nerve supply, lymph drainage, and microscopic structure. The esophagus develops from the foregut and functions to transport food from the pharynx to the stomach. It extends from the lower border of the cricoid cartilage to the cardiac orifice of the stomach. Knowledge of the anatomy is important for understanding diseases that can impair its function.
This document provides an overview of the surgical anatomy of the esophagus. It discusses the embryology, structure, and applied anatomy of the esophagus in the neck, thorax, and abdomen. Key points include that the esophagus deviates left in the neck but is midline in the thorax and curves left in the abdomen. It describes the layers of the esophagus including the external fibrous layer, muscular layer, submucosal layer, and mucosal layer. It also discusses the arterial supply, venous drainage, lymphatic drainage, and nerve supply of the esophagus.
The esophagus is a 25 cm long muscular tube that extends from the lower border of the cricoid cartilage to the stomach. It has three parts - cervical, thoracic, and abdominal. Each part has unique anatomical features and relationships. The esophagus develops from the endoderm-lined yolk sac and is completely differentiated by week 12 of gestation. It has four layers - mucosa, submucosa, muscularis propria, and adventitia. The esophagus functions to transport food from the pharynx to the stomach through peristaltic contractions.
This document provides an overview of gastrointestinal anatomy including:
1. The embryonic precursors of the GI tract - foregut, midgut, and hindgut - and their derivatives.
2. The anatomy of the individual organs that make up the GI tract from the pharynx to the anus.
3. Key anatomical structures such as the peritoneum, mesentery, retroperitoneal space, and pelvic compartments.
4. Radiographic anatomy seen on abdominal x-rays including the liver and spleen shadows, bowel gas patterns, and signs of abnormalities.
The document summarizes the anatomy and physiology of the oesophagus. It notes that the oesophagus is approximately 25 cm long, extending from the lower end of the pharynx to the stomach. It describes the three normal constriction points where foreign bodies commonly become lodged. The wall of the oesophagus consists of four layers - mucosa, submucosa, muscular layer, and fibrous layer. Parasympathetic fibers from the vagus nerve and sympathetic fibers from the sympathetic trunk supply the oesophagus. Lymphatic drainage occurs to the deep cervical, posterior mediastinal and gastric nodes. Peristaltic movements propel food through the oesophagus and into
The document summarizes key aspects of esophageal anatomy and physiology. It describes the esophagus as a muscular tube divided into cervical, thoracic, and abdominal segments. It discusses the layers of the esophageal wall, blood supply, innervation, and functions of the upper and lower esophageal sphincters. Common esophageal disorders like GERD, diverticula, and motility disorders are also summarized.
1. The document describes the gross examination procedures for esophagectomy and gastrectomy specimens. Key steps include opening the specimens longitudinally, measuring length, circumference, and wall thickness, and examining the tumor appearance and relationship to anatomical structures.
2. Resection margins of 5 cm for adenocarcinoma and 10 cm for squamous cell carcinoma must be achieved. Common esophagectomy procedures include Ivor Lewis technique, thoracoabdominal esophagectomy, and transhiatal esophagectomy.
3. For stomach specimens, biopsies and polypectomy specimens are handled differently than resection specimens. Resection specimens require adequate fixation before further examination of margins, tumor characteristics, and lymph nodes.
Anatomy of gastroesophagial junction with specail reference to hiatus hernia...Rana Singh
This document discusses the anatomy of the gastroesophageal junction, with a focus on hiatal hernia and the anatomical basis for therapeutic intervention. Key points include:
- The gastroesophageal junction is defined anatomically by the squamocolumnar junction, the transition from esophageal to gastric lining, and the junction of the esophageal and gastric musculature.
- Hiatal hernias are classified based on the location of the hernia, with type I being a sliding hernia and type II being a paraesophageal hernia where the gastric fundus herniates alongside a normal cardia.
- Indications for surgical repair of paraesophageal hernias include symptoms and the risk
This document provides an overview of the anatomy and embryology of the small intestine. It discusses the gross anatomy, blood supply, innervation and lymphatic drainage of the duodenum, jejunum, and ileum. Imaging modalities for evaluating the small intestine are also mentioned, including plain radiography, ultrasound, and barium studies. The small intestine extends from the pylorus to the ileocecal junction, and consists of the duodenum, jejunum, and ileum. It has important functions in digestion and absorption of nutrients.
colon anatomy, anatomy of large intestine, anatomy of large bowel, histology of large intestine, large intestine, histology, colon, appendices epiploica, taenia coli, haustrautions, ilio caecal valve
The document summarizes the anatomy and embryology of the esophagus. It discusses the esophagus' location, length, diameter at different ages, layers, blood supply, nerve supply, and more. Some key points:
- The esophagus is a muscular tube that transports food from the pharynx to the stomach. It has an upper and lower sphincter.
- During development, the esophagus forms from the foregut and separates from the trachea by the esophagotracheal septum.
- It has cervical, thoracic, and abdominal portions with different anatomical relationships in each region.
- The esophagus has four layers - fibrous, muscular
This document provides an overview of oesophageal anatomy, staging, and the diagnostic workup for oesophageal cancers. It describes the gross anatomy and course of the oesophagus, its arterial and venous blood supply, lymphatic drainage, and histology. Risk factors for oesophageal cancer are smoking, alcohol, and diet. Common symptoms are dysphagia and weight loss. The diagnostic workup includes imaging like barium swallow and CT scan, as well as endoscopy with biopsy. Staging is an important part of evaluating oesophageal cancers.
This document summarizes the development of the pancreas from embryology through its various anatomical structures and developmental anomalies. It describes how the pancreas develops from dorsal and ventral buds, and how the pancreatic ducts form. Signaling pathways that guide development are discussed. Common anatomical variations like pancreas divisum and annular pancreas are summarized, including their presentations and treatments. The Todani classification of choledochal cysts is also briefly outlined.
The document describes the anatomy and development of the esophagus. It begins by defining the esophagus as a conduit connecting the pharynx to the stomach. It then discusses the esophagus' length, course through the neck and chest, and termination in the abdomen. The summary continues with the following key points:
- The esophagus develops from the foregut and tracheobronchial diverticulum. Its musculature differentiates into striated muscle proximally and smooth muscle distally.
- It has two sphincters - the upper esophageal sphincter between the pharynx and cervical esophagus, and the lower esophageal sphincter where it joins
The document summarizes the anatomy and features of the esophagus. It notes that the esophagus is 25 cm long and connects the pharynx to the stomach. It passes downwards in front of the vertebral column and behind the trachea. The esophagus is divided into three parts: cervical, thoracic, and abdominal. The cervical part extends from the lower border of the cricoid cartilage to the superior border of the manubrium sterni. It is anterior to the trachea and recurrent laryngeal nerve, and posterior to the prevertebral fascia and longus colli muscles.
Anatomy, physiology and diagnosis of oesophageal diseasesAnwaaar
This document discusses the anatomy, physiology, and diagnosis of oesophageal diseases. It covers the surgical anatomy of the oesophagus, its physiology during swallowing, common symptoms of oesophageal diseases, and investigations used in diagnosis including barium swallow, endoscopy, endosonography, manometry, and pH monitoring. It also discusses specific oesophageal diseases and conditions such as congenital lesions, benign tumors, cancer, foreign bodies, perforations, gastroesophageal reflux disease, hiatal hernia, and motility disorders.
- The document discusses treatment options for advanced gastric cancer, including chemotherapy regimens that have shown effectiveness in clinical trials such as combinations of 5-fluorouracil, capecitabine, cisplatin, and oxaliplatin.
- A key trial found that adding trastuzumab to chemotherapy improved outcomes for patients with HER2-positive advanced gastric cancer. Median overall survival increased from 11.1 to 13.8 months with the addition of trastuzumab.
- A phase III trial compared FOLFIRI chemotherapy to ECX as first-line treatment and found that FOLFIRI resulted in significantly longer time to treatment failure without differences in progression-free or overall survival.
The document discusses the anatomy, histology, and physiology of the esophagus and diaphragmatic hernias. It provides details on:
1. The layers of the esophagus including mucosa, submucosa, and muscularis.
2. The three parts of the esophagus - cervical, thoracic, and abdominal.
3. Key anatomical relationships and structures like the aortic arch.
4. Innervation and blood supply of the esophagus.
5. The normal three-stage swallowing process - oral, pharyngeal, and esophageal phases.
6. Sphincter functions including the upper and lower esophageal sphincters
Gastric cancer
Second most common cancer-related death.
4th most common cancer
Korea, Japan, China, Taiwan high rates.
with 875,000 injured annually person in the world.
Palliative chemotherapy with:
Irinotecan and cisplatin.
Folic acid, 5-FU, and irinotecan (FOLFIRI).
Leucovorin, 5-FU, and oxaliplatin (FOLFOX).
Phase II studies evaluating irinotecan-based or oxaliplatin-based regimens demonstrate similar response rates
The document describes the structure and layers of the digestive tract, with a focus on the esophagus, stomach, and small intestine. It notes that the digestive tract consists of four functional layers - the mucosa, submucosa, muscularis externa, and adventitia/serosa. It provides detailed information on the histological structure and cell types present in the mucosa and submucosa of the esophagus, stomach, and small intestine. It highlights key features such as the stratified squamous epithelium of the esophagus, gastric pits and glands of the stomach, and villi and crypts of the small intestine.
The document provides information on the esophagus and stomach. It discusses the anatomy of the lower esophagus, including its blood supply and clinical aspects like esophageal constrictions. It then covers the position, shape, divisions, interior structure, blood supply, nerve supply, and clinical applications of the stomach, such as gastric ulcer, carcinoma, and gastroscopy. Key points include the esophagus passing through the diaphragm and having portosystemic anastomoses, and the stomach's J-shape and divisions into cardiac, fundic, and pyloric portions supplied by branches of the celiac artery.
Gastric cancer discussion slides final version.pptnew.pptzoezettemarc
1) Peri-operative chemotherapy with ECX before and after surgery improves overall survival compared to surgery alone in resectable gastric cancer based on the MAGIC trial.
2) The ACTS-GT trial showed adjuvant S-1 chemotherapy improves 3-year survival compared to observation alone after D2 gastrectomy for stage II-III gastric cancer.
3) Combination chemotherapy improves survival over best supportive care alone in advanced gastric cancer, with regimens including anthracyclines and cisplatin or oxaliplatin showing better efficacy.
The document describes the anatomy of the abdominal regions, abdominal wall and cavity, and gastrointestinal organs including the esophagus, stomach, and small intestine. It divides the abdomen into 9 regions based on 4 reference planes and lists the organs contained within each region. It details the layers of the abdominal wall and peritoneal cavity. It provides information on the esophagus, stomach sections and functions, and sections of the small intestine including the duodenum.
Anatomy of abdomen and regions of trunkFaarah Yusuf
The document describes the anatomy of the abdominal regions and organs. It discusses nine abdominal regions defined by four planes. Each region contains specific organs. It then details the layers of the abdominal wall and peritoneal cavity. Finally, it provides in-depth descriptions of key abdominal organs including the liver, gallbladder, stomach, small intestine, large intestine and their structures and functions.
The document describes the anatomy of the abdominal regions and organs. It discusses nine abdominal regions defined by four planes. Each region contains specific organs. It then describes the layers of the abdominal wall and the peritoneal cavity. Finally, it provides details on the anatomy and structures of several key abdominal organs, including the liver, gallbladder, stomach, small intestine, large intestine, and biliary tree.
The document describes the anatomy of the abdominal regions, abdominal wall and cavity, and gastrointestinal organs including the esophagus, stomach, and small intestine. It divides the abdomen into 9 regions based on 4 reference planes and lists the contents of each region. It details the layers of the abdominal wall and peritoneal cavity. It provides information on the esophagus, stomach sections and functions, and sections of the small intestine including the duodenum.
Blood supply, lymphatic drainage and nerves of the gastrointestinal systemkhaledshora
This document provides information on the blood supply, lymphatic drainage, and nerves of the gastrointestinal system. It begins by outlining the objectives of defining, describing, and outlining the various arteries including the celiac trunk, superior mesenteric artery, and inferior mesenteric artery. It then describes the foregut, midgut, and hindgut regions and their primary arterial blood supplies. The document proceeds to provide detailed descriptions of each of the major arteries and their branches, as well as clinical considerations regarding various conditions.
The stomach is a J-shaped organ located in the upper abdomen between the esophagus and small intestine. It acts as a reservoir for food and aids in the digestion of carbohydrates, proteins, and fats. The stomach has two openings - the cardiac orifice where it connects to the esophagus and the pyloric orifice where it connects to the small intestine. It is divided into sections including the fundus, body, antrum, and pyloric canal. The stomach receives blood supply from branches of the celiac artery and drains into gastric lymph nodes. It is innervated by both the sympathetic and parasympathetic nervous systems to aid in digestion. Diseases that commonly
The document discusses the planes and regions of the abdomen, as well as the contents and structures of the abdominal wall and viscera. There are four planes that divide the abdomen into nine regions. The peritoneum lines the abdominal cavity and forms mesenteries that attach organs. Key abdominal structures include the stomach, duodenum, small and large intestines, liver, pancreas and spleen. Blood supply is primarily from the celiac trunk and superior and inferior mesenteric arteries.
The esophagus is a muscular tube that connects the pharynx to the stomach. It passes through the neck and thorax and has portions that are lined with striated muscle, smooth muscle, or a mixture. The esophagus contains two sphincters - the upper esophageal sphincter at the pharynx and the lower esophageal sphincter at the stomach - that prevent backflow of food and gastric contents. The document describes the anatomy, histology, blood supply, lymphatic drainage and development of the esophagus.
The esophagus is a muscular tube that connects the pharynx to the stomach. It passes through the neck and thorax and has portions that are composed of striated muscle, smooth muscle, or a mixture. The esophagus contains two sphincters - the upper esophageal sphincter at the pharynx and the lower esophageal sphincter at the stomach - that help regulate food passage. The document describes the anatomy, histology, blood supply, lymphatic drainage and development of the esophagus.
The stomach is a J-shaped muscular sac located in the upper abdomen between the esophagus and small intestine. It has four regions: the cardia, fundus, body, and pyloric part. The stomach is supplied by branches of the celiac artery and drains into the portal vein. Lymph from the stomach drains to nearby lymph nodes. The vagus and splanchnic nerves provide the main innervation to the stomach.
The esophagus is a muscular tube that connects the pharynx to the stomach. It passes through the neck and thorax and has a cervical, thoracic, and abdominal portion. The esophagus contains two sphincters - the upper esophageal sphincter at the pharyngeal junction and the lower esophageal sphincter at the gastroesophageal junction - that help regulate the passage of food. The document provides detailed anatomical and clinical information about the structure, blood supply, lymphatic drainage and development of the esophagus.
Anatomy and malignant diseases of esophagusDr Sajad Nazir
This presentation is for post graduate surgery residents. Anatomy with pictorial representation and management of carcinoma esophagus is being explained. Barretts esophagus, diagnosis and management is being explained. This presentation is subjected to errors and mistakes. I have consulted 2, 3 books to make this presentation.
The document provides an overview of the anatomy of the upper abdominal cavity. It describes the structures and organs contained within the upper abdominal cavity, including the stomach, liver, gallbladder, spleen, esophagus and duodenum. It discusses the layers of the peritoneum and how different organs are related to the peritoneum (intraperitoneal, retroperitoneal, etc.). It also describes the ligaments connecting structures like the liver, stomach and duodenum.
This document provides an overview of abdominal radiological anatomy. It discusses the anatomy of major abdominal organs including the liver, biliary tract, spleen, pancreas, kidneys, adrenal glands, and gastrointestinal tract. For each organ, it describes key anatomical features visible on imaging modalities like ultrasound, CT, and MRI. It also reviews some common anatomical variants seen in these structures.
This document provides a detailed overview of the radiologic anatomy and vascular supply of the small and large intestines. It discusses the anatomy and vascular supply of the duodenum, jejunum, ileum, cecum, appendix, colon, and pancreas. It also describes some congenital anomalies of the pancreas, including agenesis of the dorsal pancreas. Key points include the locations and branches of the celiac axis, superior mesenteric artery, and inferior mesenteric artery, which supply the intestines, as well as anatomical landmarks like the ligament of Treitz.
The stomach is a J-shaped organ located in the upper left portion of the abdomen. It has several key functions, including forming a reservoir for food, mixing food with gastric juices, controlling emptying into the small intestine, and destroying bacteria. The stomach has four parts - the cardiac part, fundus, body, and pyloric part. It receives blood supply from several arteries and innervation from both the sympathetic and parasympathetic nervous systems. Diseases like gastric cancer commonly affect specific regions like the pyloric antrum. Surgical procedures like vagotomy are sometimes used to treat ulcers.
This document describes the anatomy and blood supply of the abdominal organs. It begins by introducing the abdominal aorta and its branches, which can be divided into anterior, lateral, and dorsal groups. The anterior group includes the celiac trunk, superior mesenteric artery, and inferior mesenteric artery. The celiac trunk supplies the foregut organs via its branches: the left gastric, common hepatic, and splenic arteries. The superior and inferior mesenteric arteries supply the midgut and hindgut, respectively. The document then provides detailed descriptions of the branches and blood supply territories of each artery.
anatomy of large intestine all info. is from snell clinical anatomy
this lecture composed of :- cecum , appendix , colon , rectum and anal canal
with all relation (location , blood supply , lymphatic drainage and nerve supply)
This document provides an overview of the anatomy of the stomach, including its location, shape, divisions, blood supply, nerve supply, and relations to surrounding organs. Key points include that the stomach has a J-shape and can be divided into sections including the fundus, body, and pylorus. It receives blood supply from the coeliac axis and drains into the portal system. The vagus nerve provides motor and secretomotor innervation while sensory fibers pass through the sympathetic trunks.
gastrointestinal system anatomy04042010small ipdfMBBS IMS MSU
The document summarizes the anatomy and features of the gastrointestinal system, specifically focusing on the small intestine. It describes the parts of the small intestine including the duodenum, jejunum and ileum. It details the length, location and distinguishing characteristics of each part. The document also discusses the blood supply, lymphatic drainage and innervation of the small intestine.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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2. ANATOMY
●
The esophagus is a 25-
cm long muscular tube
that connects the pharynx
to the stomach.The
esophagus extends from
the lower border of the
cricoid cartilage (at the
level of the sixth cervical
vertebra) to the cardiac
orifice of the stomach at
the side of the body of the
11th thoracic vertebra.
3. ●
The first constriction is at 15 cm from the upper
incisor teeth, where the esophagus commences
at the cricopharyngeal sphincter; this is the
narrowest portion of the esophagus and
approximately corresponds to the sixth cervical
vertebra
●
The second constriction is at 23 cm from the
upper incisor teeth, where it is crossed by the
aortic arch and left main bronchus
●
The third constriction is at 40 cm from the upper
incisor teeth, where it pierces the diaphragm;
the lower esophageal sphincter (LES) is
situated at this level[1, 2, 3]
4. ●
These measurements are clinically important
for endoscopy and endoscopic surgeries of
the esophagus
5. ●
The esophagus has been subdivided into 3
portions, as follows:
●
The cervical portion extends from the
cricopharyngeus to the suprasternal notch
●
The thoracic portion extends from the
suprasternal notch to the diaphragm
●
The abdominal portion extends from the
diaphragm to the cardiac portion of the
stomach.
6. Blood supply
●
Cervical portion
---INF THYROID
ARTERY
●
Thoracic portion
------- bronchial and
esophageal
branches of the
thoracic aorta
●
Abdominal portion
---ascending
branches of the left
phrenic and left
gastric arteries
7. VENOUS DRAINAGE
●
Venous blood from the esophagus drains into a
submucosal plexus---->blood drains to
periesophageal venous plexus--->Esophageal
veins drain in a segmental way similar to the
arterial supply, as follows:
●
From the cervical esophagus---> the inferior
thyroid vein
●
From the thoracic esophagus,-----> the azygos
veins, hemiazygos, intercostal, and bronchial
veins
9. LYMPHATIC DRAINAGE
Submucosal lymphatic system .The esophagus
has 2 types of lymphatic vessels. A plexus of
large vessels is present in the mucous
membrane, and it is continuous above with the
mucosal lymphatic vessels of pharynx and
below with mucosal lymphatic vessels of gastric
mucosa.
●
The second plexus of finer vessels is situated in
the muscular coat. Efferent vessels from the
cervical part drain into the deep cervical nodes.
10. ●
Vessels from the thoracic part drain to the
posterior mediastinal nodes and from the
abdominal part drain to the left gastric nodes.
Some vessels may pass directly to the thoracic
duct.Lymphatic drainage of the esophagus
contains little barrier to spread, and esophageal
lymphatics are densely interconnected. Hence,
esophagus carcinoma can spread through the
length of the esophagus via lymphatics and
may have nodal involvement several
centimeters away from the primary lesion.
11.
12. NERVE SUPPLY
●
Upper 1/3rd
----Recurrent laryngeal branches of the
vagus nerve supply the striated muscle.
●
Motor supply to the nonstriated muscle is
parasympathetic, vagus.These fibers reach the
esophagus through the vagus and its recurrent
laryngeal branches. They synapse in the esophagus
wall in the ganglia of submucosal plexus (Meissner)
and myenteric plexus (Auerbach) between the outer
longitudinal and inner circular muscle fibers supply
mucous glands and smooth muscle fibers within the
walls
13. Vasomotor sympathetic fibers that supply the
esophagus arise from the upper 4-6 thoracic
spinal cord segments.The axons of these
neurons innervate the vessels of the cervical
and upper thoracic esophagus and distil
esophagus.
14. HISTOLOGY
●
Histologically, the esophagus has the following
4 concentric layers (see the image below)[3] :
●
Mucosal layer
●
Submucosal layer
●
Muscular layer
●
Adventitial layer
15. STOMACH
●
The stomach is the first intra-abdominal part of
the gastrointestinal (GI), or digestive, tract. The
stomach lies in the left upper quadrant of the
abdomen.The thoracic esophagus enters the
abdomen via the esophageal hiatus of the
diaphragm at the level of T10. The abdominal
portion of the esophagus has a small intra-
abdominal length (2-3 cm). The
esophagogastric junction (cardia), therefore,
lies in the abdomen below the diaphragm to the
left of the midline at the T11 level.
16. ●
The cardiac notch (incisura cardiaca gastri) is
the acute angle between the abdominal
esophagus and the fundus of the stomach,
which is the part of stomach above a
horizontal line drawn from the cardia. The
body (corpus) of the stomach leads to the
pyloric antrum (at the incisura angularis). The
pyloric antrum narrows toward the right to
become the pyloric canal, surrounded by the
pyloric sphincter, which joins the duodenum at
the L1 level (transpyloric plane) to the right of
the midline .
17.
18. RELATIONS
●
The anterior surface of stomach is related to
the left lobe of the liver the anterior abdominal
wall, and the distal transverse colon. The
posterior surface of the stomach is related to
the left hemidiaphragm, the spleen, the left
kidney, and the pancreas (stomach bed).
●
The omental bursa (lesser sac) lies behind the
stomach and in front of the pancreas; it
communicates with the greater sac (main
peritoneal cavity) via the omental (epiploic)
foramen (of Winslow) behind the
hepatoduodenal ligament.
19.
20. ●
The convex greater curvature of the stomach
starts at the left of the cardia and runs from
the fundus along the left border of the body of
the stomach and the inferior border of the
pylorus. The concave lesser curvature starts
at the right of the cardia as a continuation of
the right border of the abdominal esophagus
and runs a short distance along the right
border of the body of the stomach and the
superior border of the pylorus. The junction of
the vertical and horizontal parts of the lesser
curvature is called incisura angularis.
21.
22. ●
The stomach and the first part of the
duodenum are attached to the liver by the
hepatogastric ligament (the left portion of the
lesser omentum), to the left hemidiaphragm by
the gastrophrenic ligament, to the spleen by
the gastrosplenic/gastrolienal ligament
containing short gastric vessels, and to the
transverse colon by the gastrocolic ligament
(part of the greater omentum). Few peritoneal
bands may be present between the posterior
surface of the stomach and the anterior
surface of the pancreas.
23. ●
Part of the greater omentum hangs like an
apron from the transverse colon, with 4 layers
of the peritoneum (often fused): 2 layers go
downward from the stomach and then run
upward to be attached to the transverse colon.
24. BLOOD SUPPLY
●
The celiac trunk (axis) arises from the anterior
surface of the abdominal aorta at the level of L1.
It has a short length (about 1 cm) and trifurcates
into the common hepatic artery (CHA), the
splenic artery, and the left gastric artery (LGA).
●
The LGA runs toward the lesser curvature of the
stomach and divides into an ascending branch
(supplying the abdominal esophagus) and a
descending branch (supplying the stomach).
25.
26. ●
The CHA runs toward the right on the superior
border of the pancreas and gives off the
gastroduodenal artery (GDA), which runs
down behind the first part of the duodenum.
After giving off the GDA, the CHA continues as
the proper hepatic artery.The right gastric
artery, a branch from the proper hepatic artery,
runs along the lesser curvature from right to
left and joins the descending branch of the
LGA to form an arcade along the lesser
curvature supplying body of stomach.
27. ●
The GDA divides into the right gastro-omental
(gastroepiploic) artery (RGEA) and the anterior
superior pancreaticoduodenal artery (SPDA); it
also gives off the small supraduodenal artery
(of Wilkie). The RGEA runs along the greater
curvature from right to left.The splenic artery
runs toward the left on the superior border of
the distal body and tail of pancreas and gives
off the left gastro-omental artery (LGEA),
28. ●
which runs from left to right along the greater
curvature and joins the RGEA to form an arcade
along the greater curvature between the two
leaves of peritoneum of the greater omentum.
29. ●
The greater curvature arcade formed by the
RGEA and the LGEA provides several
omental (epiploic) branches to supply the
highly vascular greater omentum. The splenic
artery also gives off 3-5 short gastric arteries
that run in the gastrosplenic ligament and
supply the upper part of the greater curvature
and the gastric fundus. The stomach has a
rich network of vessels in its submucosa.
30. VENOUS DRAINAGE
●
The left gastric (coronary) vein drains into the
portal vein at its formation (by the union of the
splenic and superior mesenteric veins). The
right gastric and right gastro-omental veins
drain into the portal vein. The left gastro-
omental vein drains into the splenic vein, as
do the short gastric veins.
31.
32. ●
The gastrocolic trunk is present in a large
number of cases and lies at the junction of the
small bowel mesentery and the transverse
mesocolon. It may drain the right colic, middle
colic, and right gastro-omental veins.
●
The short gastric arteries and veins are
sometimes collectively referred to as the vasa
brevia.
34. NERVE SUPPLY
●
The esophageal plexus of vagus (para-
sympathetic) nerves lies in the posterior
mediastinum below the hila of the lungs. It
divides into 2 vagal trunks that enter the
abdomen along with the esophagus through
the esophageal hiatus in the left dome of
diaphragm. The right (posterior) vagus is
behind and to the right of the intra-abdominal
esophagus, whereas the left vagus is in front
of the intra-abdominal esophagus.
35. ●
The right vagus gives off a posterior gastric
branch called the criminal nerve of Grassi,
which traverses to the left and supplies the
cardia and fundus of the stomach; the nerve is
so called because it is often missed during
vagotomy and is then responsible for
recurrence of peptic ulcer. The right vagus
gives off a celiac branch (which supplies the
pancreas and the small and large bowel), and
the left vagus gives off a hepatic branch (which
supplies the liver and the gallbladder).
36. ●
After giving off the celiac and hepatic
branches, respectively, the right and left vagal
trunks continue along the lesser curvature of
the stomach (in close company with the
vascular arcade formed by the left and right
gastric vessels) as the posterior and anterior
gastric nerves of Latarjet, which supply the
corpus (body) of the stomach, the antrum, and
the pylorus.
37. HISTOLOGY
●
The innermost lining of the
stomach wall is mucosa, which
consists of columnar epithelium,
lamina propria, and muscularis
mucosa. Submucosa contains a
rich network of blood vessels and
Meissner’s nerve plexus. The
smooth muscles of the stomach
are arranged in 3 layers: inner
oblique (unique to stomach),
middle circular (forms the
pylorus), and outer longitudinal.
These muscles are supplied by
the Auerbach’s nerve plexus.
Serosa is the visceral peritoneum
that covers most of the stomach.
Mucosa and submucosa are
thrown into several longitudinal
folds called rugae.
38. ●
The lower esophageal sphincter (LES), or
gastroesophageal sphincter, is not a true
(anatomic) sphincter; however, the pylorus is a
true sphincter composed of circular muscles.
39. ●
The lower esophageal sphincter (LES), or
gastroesophageal sphincter, is not a true
(anatomic) sphincter; however, the pylorus is a
true sphincter composed of circular muscles.
40. BENIGN TUMORS ESOPHAGUS
●
Benign tumours of the oesophagus account for
less than 1% of all oesophageal neoplasms.
Leiomyomas are the most common; rarer
entities include papillomas, fibrovascular
polyps, granular cell tumours, adenomas,
haemangiomas, neurofibromas, and lipomas.
●
Leiomyomas are smooth-muscle tumours
arising in the oesophageal wall. They are
usually solitary, well encapsulated with an intact
overlying mucosa, and grow slowly. Most small
(>5 cm) leiomyomas are asymptomatic and are
incidental finding on barium study .
41. MALIGNANT TUMOR OESOPHAGUS
●
Cancer in the upper two-thirds is a squamous
cell carcinoma and one in the lower one-third
is an adenocarcinoma.
●
RARE
leiomyosarcoma, malignant melanoma,
rhabdomyosarcoma, lymphoma ,muco-
epidermoid carcinoma, small cell carcinoma,
adenoid cystic carcinoma, adenosquamous
carcinoma.
42. FACTORS ASSOCIATED WITH
CARCINOMA ESOPHAGUS
●
Smoking , History of aerodigestive tract
malignancy*
●
Alcohol consumption, Achalasia*
●
Hot beverages*
●
N-nitroso compounds* Plummer vinson
(paterson kelley) syndrome*
●
Betel nut chewing*
●
Deficiencies of*:
●
Green vegetables Barrett's oesophagus†
●
Vitamins A, C and E
43. ●
in the past three decades was the increase in
incidence of adenocarcinomas of the lower
oesophagus and gastric cardia. Gastro-
oesophageal reflux disease, obesity, and the
pre-malignant condition of Barrett's
oesophagus.Barrett's oesophagus is a
condition in which the squamous epithelium of
the distal oesophagus is replaced by a
columnar epithelium characterized by the
presence of specialized intestinal metaplasia..
The Barrett's epithelium progresses through
low-grade to high-grade dysplasia to invasive
44. CLINICAL FEATURES
●
50 years of age
●
male predominance.
●
Dysphagia is the most common symptom, and is
rapid in onset, progressing from difficulty in swallowing
solid food and later to liquid within a matter of weeks.
Symptom of dysphagia is usually not felt until the
tumour is advanced.
●
Regurgitation (GERD)
●
, loss of weight,Haemorrhage
Cervical lymph nodes
45. Substernal pain or discomfort
●
Hoarseness signifies recurrent laryngeal nerve
palsy from direct tumour infiltration or from
lymphatic spread and is thus a poor prognostic
sign.
●
Coughing or choking on eating may be due to
aspiration, predisposed by the presence of
vocal cord palsy if present, or the development
of an oesophageal-respiratory fistula.
●
Squamous cell cancers of the oesophagus
rarely bleed.
46. ●
Fistulas may develop between the esophagus
and the trachea, increasing the pneumonia
risk;cough, fever or aspiration.
Hematogenous Spread:liver metastasis could
cause jaundice and ascites, lung metastasis
could cause shortness of breath, pleural
effusions.
48. INVESTIGATIONS
●
SPECIFIC:
UPPER GI ENDOSCOPY AND BIOPSY
●
A barium swallow identifies the location and
length of oesophageal narrowing, mucosal
irregularity, dilatation of the proximal
oesophagus.
●
CT SCAN
●
LAPAROSCOPY,LARYNGOSCOPY,
THORACOSCOPY,BRONCHOSCOPY
49.
50. Stage groupings for oesophageal cancer
●
T: Primary tumour
●
Tx Tumour cannot be assessed
●
Tis In situ carcinoma
●
T1 Tumour invading lamina propria or the
submucosa, does not breach submucosa
●
T2 Tumour invading into but not beyond the
muscularis propria
●
T3 Tumour invades the adventitia but not the
adjacent structure
●
T4 Tumour invades the adjacent structure
51. ●
N: Regional lymph nodes*
●
NX Regional nodal status cannot be assessed
●
N0 No regional lymph node involvement
●
N1 Regional lymph node involved
●
M: Distant metastases
●
Mx Distant metastases cannot be assessed
●
M0 No distant metastasis
●
M1a Upper thoracic oesophagus with
metastases to cervical nodes.
52. ●
Lower thoracic oesophagus with metastases to
coeliac nodes
●
M1b Upper thoracic oesophagus with
metastases to other non-regional nodes or
other distant sites
●
Lower thoracic oesophagus with metastases to
other non-regional nodes or other distant sites
●
Middle thoracic oesophagus with metastases to
cervical, coeliac, other non-regional nodes or
other distant sites.
53. ●
For cervical oesophageal cancer, regional
nodes are the cervical nodes. For intrathoracic
cancers, the mediastinal and perigastric nodes
(excluding coeliac nodes), are considered
regional.
54. TNM STAGING
●
Stage 0 Tis N0 M0
●
Stage I T1 N0 M0
●
Stage IIa T2 N0 M0
●
T3 N0 M0
●
Stage IIb T1 N1 M0
●
T2 N1 M0
●
Stage III T3 N1 M0
●
T4 N0;N1 M0
●
Stage IVa Any T Any N M1a
●
Stage IVb Any T Any N M1b
55. ●
Endoscopic ultrasonography (EUS) is best in
T-stage and regional nodal (N) staging.Recent
advances also allow EUS-guided fine needle
aspiration cytology of suspicious lymph nodes
to be carried out.
56. PRINCIPLES OF TREATMENT
●
Patients with early disease generally do well
with surgical resection, provided an R0
resection (curative procedure with macroscopic
and microscopic clear margins) can be
performed.Patients with local-regional
advanced disease, upfront combined
treatments including chemotherapy and
radiotherapy are often used, and subsequent
surgical resection depending on response.
There is, however, no clear evidence that this
gives superior result to surgical resection alone.
57. OPERATIVE TREATMENT
●
Potential surgical candidates should have a
careful risk assessment especially with
regards to cardiopulmonary status. Smoking
should be stopped and active chest
physiotherapy instituted.
●
Pre-operative enteral nutrition or parenteral
nutrition may be beneficial.
58. OPERATIVE TREATMENT
●
Potential surgical candidates should have a
careful risk assessment especially with
regards to cardiopulmonary status. Smoking
should be stopped and active chest
physiotherapy instituted.
●
Pre-operative enteral nutrition or parenteral
nutrition may be beneficial.
59. ENDOSCOPIC MUCOSAL RESECTION
●
Forms of endoscopic therapy have been used
for Stage 0 and I disease: endoscopic
mucosal resection (EMR) and mucosal
ablation using radiofrequency ablation,
photodynamic therapy, Nd-YAG laser, or argon
plasma coagulation.
●
The major complications of endoscopic
mucosal resection include postoperative
bleeding, perforation and stricture formation.
60. ●
If the person cannot swallow at all, an
esophageal stent may be inserted to keep the
esophagus open; stents may also assist in
occluding fistulas. A nasogastric tube may be
necessary to continue feeding while treatment
for the tumor is given, and some patients
require a gastrostomy /iliostomy(feeding hole
in the skin that gives direct access to the
stomach). The latter two are especially
important if the patient tends to aspirate food
or saliva into the airways, predisposing for
aspiration pneumonia.
61. Oesophagectomy
is the removal of a segment of the esophagus; as this shortens the
length of the remaining esophagus, some other segment of the
digestive tract (typically the stomach or part of the colon or jejunum)
is pulled up to the chest cavity and interposed.[29] If the tumor is
unresectable or the patient is not fit for surgery, palliative esophageal
stenting can allow the patient to tolerate soft diet.
Types of esophagectomy:
The thoracoabdominal approach opens the abdominal and thoracic
cavities together.
The two-stage Ivor Lewis (also called Lewis–Tanner) approach
involves an initial laparotomy and construction of a gastric tube,
followed by a right thoracotomy to excise the tumor and create an
esophagogastric anastomosis.
The three-stage McKeown approach adds a third incision in the neck
to complete the cervical anastomosis.
62. ●
Lewis-Tanner (Ivor Lewis) operation
●
For tumours of the middle and lower third of the
oesophagus.The stomach, the blood supply of
which is based on the right gastric and right
gastroepiploic vessels, is mobilised via
laparotomy. A pyloroplasty or pyloromyotomy is
performed to enhance gastric drainage. The
oesophagus is then resected through a right
thoracotomy. The stomach is delivered up into
the thorax via the diaphragmatic hiatus to
anastomose with the divided oesophagus near
the apex of the thoracic cavity.
63.
64. ●
In type II and III tumours around the
gastrooesophageal junction, an extended total
gastrectomy with a distal oesophageal
resection is often performed, although some
surgeons advocate a proximal gastric and distal
oesophageal resection. Both can be
accomplished via the abdomen or with an
additional thoracotomy.
●
In tumours of the upper thoracic oesophagus,
oesophagectomy can be performed through a
right thoracotomy, then by simultaneous left
cervical and abdominal incisions the stomach
can be prepared and delivered up to the neck
for anastomosis
65. McKeown's procedure
●
A three-phase oesophagectomy. The colon is
placed in the retrosternal route in this example
with anastomosis in the neck.
●
In transhiatal oesophagectomy, the
oesophagus is ‘shelled’ out by the surgeon's
hand introduced in the posterior mediastinum
via the diaphragmatic hiatus and the neck
without a thoracotomy. This partly blind
procedure may lead to injury to mediastinal
structures, such as the membranous trachea,
and has also been criticised as an inadequate
cancer operation.
66. ●
In experienced hands however, it is safe, and
its proponents claim similar survival to the
transthoracic approach. Various minimal-
access methods including combinations of
thoracoscopy, laparoscopy and
mediastinostomy have been attempted.
●
lymphadenectomy of the upper abdomen and
mediastinum (two-field dissection).
●
the addition of bilateral neck dissection (three-
field dissection) because of the high incidence
of positive cervical lymph nodes found when
neck dissection is carried out (up to 30%), and
better cure rate.
67. ●
The stomach is most commonly used for
oesophageal substitution. In patients with
previous gastric surgery, other substitutes like
the colon or jejunum can be used. In cases
where the substitute is brought to the neck for
anastomosis, the posterior mediastinum
(orthotopic), retrosternal route or subcutaneous
space are alternatives.
●
Tumours of the cervical oesophagus require the
resection of the larynx and pharynx, and the
stomach is usually used to restore continuity
(pharyngo-laryngo-oesophagectomy).
68. ●
A terminal tracheostome is performed and
alternative voice rehabilitation is required. For
tumours limited to the postcricoid region,
resection need not involve the thoracic
oesophagus and a free jejunal graft can be
placed in the neck to restore intestinal
continuity after pharyngo-laryngectomy. For
these tumours, in order to preserve the larynx,
often non-operative treatment such as
chemoradiation therapy is used as an
alternative to surgical resection.
71. ●
Surgical
●
Intra-operative or post-operative haemorrhage
●
Tracheo-bronchial tree injury
●
Recurrent laryngeal nerve injury
●
Anastomotic leakage
●
Gangrene of conduit,,Intra-thoracic gastric
outlet obstruction or gastric stasis
●
Herniation of bowel through diaphragmatic
hiatus
●
Chylothorax ,Empyema,Wound infection
72. CHEMORADIO THERAPY
NON OPERATIVE TREATMENT
●
Chemoradiation therapy gives superior result
to radiation alone in the treatment of
oesophageal cancer, both in terms of response
rate, local control, and long-term survival.
Radiotherapy alone has thus mostly a palliative
role in patients who cannot tolerate the addition
of chemotherapy. Brachytherapy, or intraluminal
radiotherapy, whereby radioactivity is delivered
in close proximity to the tumour via a tube
placed inside the oesophagus, can also
produce good palliation.
73. ●
neo-adjuvant or adjuvant therapy with surgery.
●
cisplatin and flurouracil.
●
Placement of a prosthetic tube across the
tumour stenosis may be indicated in patients
not otherwise suitable for other treatment to
palliate the symptom of dysphagia. Traditional
tubes placed by laparotomy (e.g. Celestin tube,
Mousseau-Barbin tube) or oesophagoscopy
under sedation (e.g. Atkinson tube, Souttar
tube) are now rarely used since they have been
superseded by a variety of self-expanding
metallic stents.
74. ●
Laser therapy (Neodymium:yttrium aluminium
garnet [Nd:YAG] laser) vaporises the tumour to
restore luminal patency. Recannulation often
requires repeated treatment sessions, and the
effect is temporary.
●
Other less commonlY ,injection of the tumour
with alcohol or chemotherapeutic agents,
photodynamic therapy, and use of a bicap
heater probe. The choice of therapy depends
on availability, cost and consideration of
efficacy.
75. PROGNOSIS
Patients with squamous cell carcinomas and
who undergo surgical resection alone, 5-year
survival of patients with stage I 83% ,
●
II 32%
●
III 13%
●
IV 7%
76.
77. ADENOCARCINOMA STOMACH
●
2ND COMMONEST AND 90% OF STOMACH
MALIGNANCIES.
●
Gastric cancer overall has a poor prognosis in
most countries with overall 5 years' survival
rate being around 10%.
●
Gastric cancer is generally a disease of the
elderly, with average age at presentation being
70 years and a 2 to 1 male to female
predominance
78. ●
The commonest site of cancers was in the
antrum of the stomach.Over the past 5
decades, antral gastric cancer has become
less common whereas proximal third cancers
more common - to a point where proximal
cancers are now the most commonly seen in
most developed countries.The key identified
aetiological factors for non-cardia gastric
cancer are Helicobacter pylori infection(60%),
high nitrite intake, low intake of fruit and
vegetables, smoking and high salt intake.
79. TYPES ACCORDING TO
PATHOGENESIS
●
Two broad histological types of gastric cancer,
Intestinal type cancers
●
Diffuse type cancers (HEREDITARY--GENE)
●
(around 20–30% have a mixed picture)
80. CLINICAL FEATURES
Indigestion or a burning sensation (heartburn).
Less than 1 in every 50 people going to a
doctor with indigestion have cancer.
●
Loss of appetite, especially for meat
●
Abdominal discomfort or irritation
Weakness and fatigue
●
Bloating of the stomach, usually after meals
81. CLINICAL FEATURES
Abdominal pain in the upper abdomen
●
Nausea and occasional vomiting
●
Diarrhea or constipation
●
Weight loss
●
Bleeding: vomiting blood or having blood in
the stool, the latter apparent as black
discoloration (melena) and sometimes leading
to anemia.
●
Dysphagia: if extension of the gastric tumor
into the esophagus.
82.
83. INVESTIGATIONS
●
CBS (ANEMIA),LFT,
●
esophagogastroduodenoscopy or EGD
●
Double-contrast upper GI series and barium
swallows may be helpful in delineating the
extent of disease when obstructive symptoms
are present or when bulky proximal tumors
prevent passage of the endoscope to examine
the stomach distal to an obstruction (more
common with gastroesophageal [GE]-junction
tumors). These studies are only 75% accurate
and should for the most part be used only
when upper GI endoscopy is not feasible.
84.
85. ●
CT scan or MRI of the chest, abdomen, and
pelvis assess the local disease process as
well as evaluate potential areas of spread (ie,
enlarged lymph nodes, possible liver
metastases).
●
Endoscopic ultrasound allows for a more
precise preoperative assessment of the tumor
stage. Endoscopic sonography is becoming
increasingly useful as a staging tool when the
CT scan fails to find evidence of T3, T4, or
metastatic disease.
86.
87. STAGING
●
Stage 0 - Tis, N0, M0
●
Stage IA - T1, N0 or N1, M0
●
Stage IB - T1, N2, M0 or T2a/b, N0, M0
●
Stage II - T1, N2, M0 or T2a/b, N1, M0 or T2,
N0, M0
●
Stage IIIA - T2a/b, N2, M0 or T3, N1, M0 or
T4, N0, M0
●
Stage IIIB - T3, N2, M0
●
Stage IV - T1-3, N3, M0 or T4, N1-3, M0, or
any T, any N, M1
88. SURVIVAL RATES
●
Stage 0 - Greater than 90%
●
Stage Ia - 60-80%
●
Stage Ib - 50-60%
●
Stage II - 30-40%
●
Stage IIIa - 20%
●
Stage IIIb - 10%
●
Stage IV - Less than 5%.
91. PARTIAL GASTRECTOMY
●
INDICATIONS
●
Gastric neoplasia
●
Recurrent ulcerations after truncal vagotomy and antrectomy
●
CONTRAINDICATIONS
●
Ascites (relative)
●
Unless indicated for palliation, gastrectomy is not performed in
the presence of:
●
Peritoneal disease
●
Hepatic metastases
●
Diffuse nodal metastases
92. PARTIAL GASTRECTOMY
●
INCISION:
An upper midline incision from the xiphoid
process to the umbilicus with an optional
extension inferior to the umbilicus provides
quick and bloodless access to the abdomen.
●
A thorough exploration of the abdominal cavity
to look for metastasis in the liver, peritoneum,
omentum, and pelvis is performed first.
93. ●
After resection of the stomach, continuity can
be achieved via gastroduodenal anastomosis
(Billroth I). A tension-free gastroduodenal
anastomosis requires good duodenal
mobilization. The second option is to close the
duodenal end and to perform a gastrojejunal
anastomosis (Billroth II or its modifications).
Two main variations to the gastrojejunal
anastomosis include an end-to-side
gastrojejunostomy using an uninterrupted loop
of jejunum and an end-to-side
gastrojejunostomy to a Roux loop.
94. Duodenal mobilization:
●
perform a gastroduodenal anastomosis
●
The duodenum is mobilized by incising the
peritoneum along its lateral border and then
reflecting the duodenum to the left side until
the inferior vena cava is exposed. This
process is also referred to as Kocherization.
●
avoid injury to the structures in the lesser
omentum and middle colic vessels
95. ●
Omental mobilization:
●
The greater omentum is freed from the
transverse colon by dividing along the
avascular plane between the transverse colon
and the anterior leaf of the omentum.
●
injury to the middle colic artery.The posterior
wall of the stomach is freed by dividing
gastropancreatic folds of peritoneum.
96. Duodenal division
●
The right gastric artery is identified at the
inferior end of the lesser curvature.This is
doubly ligated and divided. Similarly, the
gastroepiploic artery is identified close to the
inferior end of the greater curvature, doubly
ligated, and divided.At this point, about 1-2 cm
of duodenum adjacent to the pylorus is
cleared of all fat and vascular adhesions. Care
is taken to avoid injury to the pancreatic tissue
while clearing the duodenum. The duodenum
is divided by a linear cutter.
97. ●
Gastric division
Greater curvature of the stomach is mobilized
further by dividing the gastrosplenic ligament.
Depending on the extent of gastrectomy
planned, the greater curvature is mobilized to
the point where the gastroepiploic artery is
closest to the gastric wall (hemigastrectomy)
or farther proximally to the second short
gastric artery (subtotal gastrectomy). The first
short gastric artery is left behind to supply the
remnant stomach.
98. The left gastric artery is divided as
a part of subtotal gastrectomy.
This artery divides into two
branches close to the lesser
curvature. The left gastric artery is
secured via double ligation or
ligation followed by transfixing
suture on the arterial side and a
tie on the gastric side before
being divided.Stomach is divided
with a linear cutter at the site
identified for proximal resection.
At this stage, the specimen is
delivered out.
99. Lymph Node Dissection
Lymph node dissection can be categorized into D1, D2, D3,
or D4 based on the lymph node stations,
●
D1 lymphadenectomy: Removal of perigastric nodes (3
cm around tumor)
●
D2 lymphadenectomy: Removal of nodes along the left
gastric artery, common hepatic artery, celiac trunk,
splenic hilus, and splenic artery
●
D3 lymphadenectomy: Include dissection of lymph nodes
along the hepatoduodenal ligament, posterior surface of
the head of the pancreas, and the root of the mesentery
(superior mesenteric vessels)
●
D4 lymphadenectomy: Dissection along the para-aortic
and paracolic region
100. ●
Resection of adjacent organs
●
Resection of adjacent organs (eg, distal
pancreas, spleen, colon) is performed for
lesions with direct involvement into these
structures. Distal pancreatectomy and
splenectomy are not performed as part of a
conventional D2 lymphadenectomy owing to
increased postoperative morbidity and
mortality.
101. Reconstruction
Reconstruction is performed with Billroth I or Billroth II.
Billroth I
A part of the staple line on the gastric side in the inferior
aspect toward the greater curvature is opened up
corresponding to the duodenal end diameter.
Interrupted delayed absorbable sutures are taken from
the middle of the posterior walls of the stomach and the
duodenum. After all sutures are placed along the
posterior layer, they are tied starting from the lesser
curvature side. Once secured, the anterior layer is then
similarly sutured.
102. ●
Billroth II
●
The duodenal stump remains closed. A loop of jejunum is
identified close to the duodenojejunal flexure.The loop is
anchored to the posterior wall of the stomach with
delayed absorbable seromuscular sutures. An opening is
made in the jejunum equal to about twice the diameter of
Anastomosis is performed with a continuous suture of
absorbable suture starting from the middle of the
posterior layer on either side and continued to meet in
the middle of the anterior layer. A fourth layer of
seromuscular sutures is placed to bury the anterior
continuous suture line. The staple line on the stomach is
opened to correspond to this length.
103. ●
The abdominal wound is lavaged thoroughly. A
right subhepatic drain is useful in early
detection of a possible duodenal stump
blowout. The abdominal wound is then closed
in layers.
104. TOTAL GASTRECTOMY
●
INDICATIONS
●
Linitis plastica
●
Carcinoma of the proximal (upper third)
stomach
●
Lymphosarcoma
●
Sarcomatous degeneration of multiple
leiomyomas
●
Complicated lymphoma of the stomach that
cannot be treated with chemotherapy plus
radiotherapy
●
Palliation
106. PROCEDURE
●
Stomach removed ,tissue
surrounding,Regional lymph nodes are often
removed during surgery (called a
lymphadenectomy) because the cancer may
have spread to those lymph nodes.
●
Roux-en-Y anastomosis: Roux-en-Y, is a
surgically created (end-to-side) anastomosis.
Typically, it is between stomach and small
bowel that is distal (or further down the
gastrointestinal tract) from the cut end.[1]
108. DUMPING SYNDROME
●
Normally, the pyloric valve at the lower end of the
stomach regulates the release of food into the bowel.
When the gastric bypass patient eats a sugary food,
the sugar passes rapidly into the intestine, where it
gives rise to a physiological reaction called dumping
syndrome. The body will flood the intestines in an
attempt to dilute the sugars. An affected person may
feel their heart beating rapidly and forcefully, break
into a cold sweat, get a feeling of butterflies in the
stomach, and may have an anxiety attack. The
person usually has to lie down, and could be very
uncomfortable for 30–45 minutes. Diarrhea may then
follow.
109. CHEMOTHERAPY
●
Palliatively reduce the size of the tumor, relieve symptoms of the
disease and increase survival time. Some drugs used in stomach
cancer treatment have included: 5-FU (fluorouracil) or its analog
capecitabine, BCNU (carmustine), methyl-CCNU (semustine) and
doxorubicin (Adriamycin), as well as mitomycin C, and more
recently cisplatin and taxotere, often using drugs in various
combinations. The relative benefits of these different drugs, alone
and in combination, are unclear.[47] Clinical researchers have
explored the benefits of giving chemotherapy before surgery to
shrink the tumor, or as adjuvant therapy after surgery to destroy
remaining cancer cells.[2] Recently, a targeted treatment called
trastuzumab available.
Radiation therapy (also called radiotherapy) may also be used to treat
stomach cancer, often as an adjuvant to chemotherapy and/or
surgery.
110. PROGNOSIS
●
The prognosis of stomach cancer is generally poor,
due to the fact the tumour has often metastasised by
the time of discovery and the fact that most people
with the condition are elderly (median age is between
70 and 75 years) at presentation. The 5-year survival
rate for stomach cancer is reported to be less than
10%.