Anatomy

of the

Esophagus
and

Stomach

Lecture objectives
Understand the structure and function of
the esophagus and stomach, innervation
blood supply, venous and lymphatic
drainage
Understand the importance of the normal
configuration of the esophago-gastric
junction
Be able to identify the esophagus and
stomach on radiographic and
Computerized Tomographic (CT) images

Location of distal
esophagus and
stomach

Esophagus
Occupies posterior mediastinum in the chest and
is exposed to low pressure
Traverses muscular portion of diaphragm
esophageal hiatus approx level of T10 vertebra
Intraabdominal for ~ 6cm and exposed to the
higher intraabdominal pressure
Enters stomach @ esophagogastric junction an
acute angle is formed which in addition to a
region of high resting muscle tone helps
minimize reflux of gastric content into the
esophageal lumen Gastroesophageal reflux

Esophagogastric junction
~ 7cm segment of high muscle tone
(physiologic sphincter) which relaxes upon
swallowing, no visible anatomic sphincter is
present, site as which squamous mucosa of
esophagus joins columnar gastric mucosa
known as Z line.
Usually in abdomen NOT chest except with
hiatal hernia
NO anatomic sphincter is present however a
segment of high pressure due to smooth muscle
contraction (high pressure zone) minimizes
reflux of gastric content into esophagus

Innervation of esophagus
Parasympathetic innervation via vagus
nerves stimulate peristalsis
Sympathetic innervation via celiac plexus,
mainly cause vasoconstriction of
esophageal arteries and some decrease in
muscular activity
Afferent innervation: follow upper thoracic
sympathetic fibers

Innervation of esophagus and upper stomach

Blood vessels of esophagus:

arteries
small esophageal and of bronchial arterial
branches off of thoracic aorta supply
intrathoracic esophagus
esophagogastric junction supplied by
branches of left gastric artery (a branch of
the celiac axis) and inferior phrenic arteries
which arise from the aorta

Relations and Arterial supply of the thoracic

esophagus

Arterial supply of the distal esophagus

Blood vessels of esophagus:

venous drainage
venous return of thoracic esophagus is via
azygous system (not into portal vein)
venous return of gastroesophageal junction
is via branches of left gastric (coronary
vein) which IS a tributary of portal venous
system, the portal venous system has no
valves, therefore, flow may reverse when
portal venous pressure exceeds systemic
venous pressure

Esophageal blood vessels

Vascular
anatomy of distal
esophagus

Portal-systemic
anastomoses of the
esophago-gastric
junction

Lymphatic drainage of
esophagus
Celiac axis lymph nodes drain lower
segment
Mediastinal nodes drain intrathoracic
portion
Enlargement of nodes in patients with
esophageal malignancies suspicious for
metastasis

Barium esophagogram

Esophageal-gastric relationships - valve function

Endoscopic view esophago-gastric junction

Histology
esophagogastric
junction

Esophago-gastric junction
Normally in abdomen, NOT chest except
with hiatal hernia
NO anatomic sphincter is present however
a segment of high pressure due to smooth
muscle contraction (high pressure zone)
minimizes reflux of gastric content into
esophagus
Reflux of acid highly irritating to squamous
esophageal mucosa

Esophageal pathology

Reflux esophagitis

Barrets esophagus

carcinoma

foreign body

Barretts esophagus

Esophageal carcinoma due to

Barretts esophagus

Stomach
Cardia just distal to esophago gastric
junction or Z line
Fundus portion in contact with diaphragm
above e-g junction
Body largest segment, proximal to antrum
Pyloric antrum or antrum peristaltic
waves in this segment propel food distally
Pylorus narrowed division between
stomach and duodenum, regulated by
pyloric sphincter muscle

Stomach
Lesser curvature upper short concave
border of stomach, angular incisure is sharp
indentation ~ 2/3 of distance along lesser
curve
Greater curvature longer convex inferior
border

Gastric anatomy

Stomach

Rugal folds of stomach:

radiographic and
endoscopic appearance

Endoscopic view stomach

CT and Barium Upper Gastrointestinal x-ray

Pyloric channel

Endoscopic view

Pyloric channel
Anatomically visible sphincter is
present
Regulates rate of emptying of
stomach
Generally prevents reflux of duodenal
juice into stomach which can lead to
severe gastritis or even esophagitis

Relations of stomach

Gastric blood supply: all

branches of celiac trunk
Left gastric artery
Right gastric artery - branch of hepatic
artery
Right gastro-omental artery
Left gastro-omental artery - branch of
splenic artery
Short gastric arteries branches of
splenic artery

Variations in
celiac trunk
anatomy

Arterial supply and

venous drainage of
stomach

Gastric blood supply

The stomach is extremely well
vascularized with multiple collaterals
Generally heals well after surgical
procedures
Bleeds profusely when ulcers erode into
larger blood vessels

Lymphatic drainage of stomach

Why study the lymphatic

drainage of organs?
The route of lymphatic drainage
determines the early sites of metastases
for most malignancies. Presence of
enlarged lymph nodes in the regional
drainage of a malignancy suggests
metastasis. This nodal enlargement can
often be detected on physical exam or with
imaging studies

Gastric innervation
Vagal innervation (parasympathetic) is
stimulatory peristalsis and acid secretion
Sympathetic inhibits smooth m contraction
of wall and vasoconstricts arterial supply
Sympathetics predominantly via celiac
ganglion and plexus (greater splanchnic
nv T6 spinal level)

Innervation of stomach

Gastric pathology

NSAIDS
induced
erosive
gastritis

carcinoma

Giant ulcer

Perforated duodenal ulcer