Anatomy Ch 4 297-306 Case 2
Anatomy Ch 4 297-306
Abdominal Viscera – Esophagus-Large Intestine
Abdominal Esophagus – shirt, distal part of esophagus in abdominal cavity; emerges from R crus
at vertebral level T-10 just left of the midline
-Anterior Vagal Trunk – come from LEFT vagus nerve, pushed anterior during stomach rotation
-Posterior Vagal Trunk – 1 trunk coming from RIGHT vagus nerve, pushed back during rotation
-arterial supply of abdominal esophagus is:
-esophageal branches of L gastric artery
-esophageal branches of left inferior phrenic artery (from abdominal aorta)
Stomach – dilated, J-shaped part of GI tract, in the epigastric, umbilical, and left hypochondrium
regions of the abdomen, and is divided into 4 regions:
1. Cardia – opening of esophagus into stomach
2. Fundus – area above cardial orifice
3. Body – largest region
4. Pyloric Part – divided into pyloric antrum and pyloric canal (distal end)
-most distal part of stomach is the pylorus marked by a pyloric constriction containing layer of
gastric circular muscle (pyloric sphincter) that surrounds the pyloric orifice
-other features of the stomach include:
1. Greater curvature – attachment of GASTROSPLENIC ligament and greater omentum
2. Lesser curvature – attachment of LESSER OMENTUM
3. Angular Incisure – bend on the lesser curvature
-arterial supply to the stomach comes from:
-L gastric artery from celiac trunk
-R gastric artery from hepatic artery proper
-R gastro-omental artery from gastroduodenal artery
-L gastro-omental artery from splenic artery
-Posterior gastric artery from splenic artery
Small Intestine – longest part of GI tract extending from pyloric orifice to ileocecal fold
Duodenum – C-shaped next to head of pancreas and is above level of umbilicus
-it is retroperitoneal except for it’s beginning, connected to liver by hepatoduodenal ligament
-duodenum divided into 4 parts:
1. Superior part – pyloric orifice  neck of gallbladder, to the right of vertebra L1 and
passes anteriorly to bile duct, gastroduodenal artery, portal vein, and IVC
-called ampulla or duodenal cap, most ULCERS occur here
2. Descending part – neck of gallbladder  lower part of vertebra L3, crossed by
transverse colon, posterior to right kidney
-contains major duodenal papilla – entrance of bile and pancreatic ducts
-contains minor duodenal papilla –entrnce for accessory pancreatic duct
3. Inferior part – longest section, crosses IVC, aorta, and vertebral column; crossed
anteriorly by superior mesenteric artery and vein
4. Ascending part – passes up or to the left of aorta to vertebra L2 and terminates at the
duodenojejunal flexure. It is surrounded by fold of peritoneum called suspensory
ligament of duodenum
Anatomy Ch 4 297-306 Case 2
-arterial supply of duodenum comes from: gastroduodenal artery, supraduodenal artery,
anterior/posterior superior/inferior pancreaticoduodenal artery, jejunal branch of superior
mesenteric artery
Jejunum – proximal 2/5ths of the rest of intestine and is in upper left quadrant and larger in
diameter than ileum
-inner mucosal lining of jejunum has numerous folds called plicae circulares
-less prominent arterial arcades and longer vasa recta compared to those of ileum
Ileum – distal 3/5ths of small intestine and is in lower R quadrant; has thinner walls, fewer
mucosal folds (plicae circulares), shorter vasa recta, more mesenteric fat, and more arterial
arcades than jejunum
-ileum opens into large intestine where cecum and ascending colon join together
-2 flaps project into lumen of large intestine ileocecal folds surround the opening and come
together at the end to form ridges
-prevents reflux from cecum into ileum and regulates passage of contents from ileum to
cecum
-blood supply is: ileal arteries from superior mesenteric artery and ileocolic artery
Epithelial Transition between abdominal esophagus and stomach – gastroesophageal junction
marked by conversion of one epithelial type to another, and can predispose someone to cancer
if it is found elsewhere
Duodenal Ulceration – usually occur in the superior part of duodenum
-drugs were developed to block acid stimulation and secretion (H2-receptor antagonists)
-proton pump inhibitors exist, and patients screened for H. pylori
-duodenal ulcers can occur anteriorly and posteriorly
-posterior ulcers erode on gastroduodenal artery or posterior superior
pancreaticoduodenal artery, which can produce hemorrhage
-anterior ulcers erode on peritoneal cavity , causing peritonitis
Examination of the Bowel Lumen – barium sulfate solutions may be swallowed by patient and
can be visualized using X-ray fluoroscopy
-peristaltic waves can be assessed
Examination of the bowel wall and extrinsic masses – Endoscopy assesses surfaces of an organ
by inserting a tube into the body with camera and light source
Meckel’s Diverticulum – remnant of proximal part of yolk stalk (vitelline duct)
-typical findings are hemorrhage, intussusception, diverticulitis, ulceration, and obstruction
Carcinoma of the Stomach – chronic GI inflammation (gastritis), pernicious anemia, and polyps
predispose to development of cancer
-symptoms are epigastric pain, fullness when eating, bleeding to chronic anemia, and
obstruction