GIT, Esophagus, Stomach & Abdomen BY Dr. Rabia Inam Gandapore.pptx

Gross anatomy and histology

1. GIT- Esophagus, Abdomen and Stomach Dr. Rabia Inam Gandapore Assistant Professor Head of Department Anatomy (Dentistry-BKCD) B.D.S (SBDC), M.Phil. Anatomy (KMU), Dip. Implant (Sharjah, Bangkok, ACHERS) , CHPE (KMU),CHR (KMU), Dip. Arts (Florence, Italy )

2. Teaching Methodology LGF (Long Group Format) SGF (Short Group Format) LGD (Long Group Discussion, Interactive discussion with the use of models or diagrams) SGD (Short Group) SDL (Self-Directed Learning) DSL (Directed-Self Learning) PBL (Problem- Based Learning) Online Teaching Method Role Play Demonstrations Laboratory Museum Library (Computed Assisted Learning or E-Learning) Assignments Video tutorial method

3. Goal/Aim (main objective) Describe the extent, course, relations, gross structure & histological features of Esophagus . Describe the quadrants, regions and anatomical landmarks of Abdomen , Its applied anatomy of nine quadrants of abdomen. Describe the gross structure, blood, venous drainage & nerve supply of Stomach .

4. Specific Learning Objectives (cognitive) At the end of the lecture the student will able to : Describe the extent, course, relations, gross structure & histological features of Esophagus . Describe the quadrants, regions and anatomical landmarks of Abdomen , Its applied anatomy of nine quadrants of abdomen. Describe the gross structure, blood, venous drainage & nerve supply of Stomach .

5. Psychomotor Objective: (Guided response) A student to draw labelled diagram of Histology of Esophagus

6. Affective domain To be able to display a good code of conduct and moral values in the class. To cooperate with the teacher and in groups with the colleagues. To demonstrate a responsible behavior in the class and be punctual, regular, attentive and on time in the class. To be able to perform well in the class under the guidance and supervision of the teacher. Study the topic before entering the class. Discuss among colleagues the topic under discussion in SGDs. Participate in group activities and museum classes and follow the rules. Volunteer to participate in psychomotor activities. Listen to the teacher's instructions carefully and follow the guidelines. Ask questions in the class by raising hand and avoid creating a disturbance. To be able to submit all assignments on time and get your sketch logbooks checked .

7. Lesson contents Clinical chair side question: Students will be asked if they know what is the function of Outline: Activity 1 Describe the extent, course, relations, gross structure & histological features of Esophagus . Activity 2 Describe the quadrants, regions and anatomical landmarks of Abdomen , Its applied anatomy of nine quadrants of abdomen Activity 3 Describe the gross structure, blood, venous drainage & nerve supply of Stomach .

8. Recommendations Students assessment: MCQs, Flashcards, Diagrams labeling. Learning resources: Langman’s T.W. Sadler, Laiq Hussain Siddiqui, Snell Clinical Anatomy , Netter’s Atlas , BD Chaurasia’s Human anatomy, Internet sources links.

9. Esophagus

10. E sophagus Shape: Tubular structure Size: 10 in. (25 cm) long Location: Above: Continuous with laryngeal part of pharynx opposite C6 vertebra . Passes: through diaphragm at l evel of T10 vertebra to join stomach. In neck : it lies in front of vertebral column Laterally : related to lobes of thyroid gland Anteriorly : incontact with trachea & recurrent laryngeal nerves . I n thorax : it passes downward & to left through superior & then posterior mediastinum . At level of sternal angle , aortic arch pushes esophagus over to midline .

11. Relations of Thoracic Part of E sophagus Anteriorly: Trachea Left recurrent L aryngeal nerve L eft principal bronchus (constricts it) Pericardium (separates it from left atrium) Posteriorly : Bodies of thoracic vertebrae T horacic duct A zygos veins R ight posterior intercostal arteries D escending thoracic aorta

12. Relations of Thoracic Part of Esophagus Right side: Mediastinal pleura Terminal part of Azygos vein Left side: Mediastinal pleura Left subclavian artery Aortic arch Thoracic duct Right Left

13. Inferiorly to level of roots of lungs , vagus nerves leave pulmonary plexus & join with sympathetic nerves to form esophageal plexus . L eft vagus : lies anterior to esophagus R ight vagus : lies posterior . At opening in diaphragm : esophagus is accompanied by two vagi , branches of left gastric blood vessels , & lymphatic vessels . Fibers from right crus of diaphragm pass around esophagus in form of a sling. In abdomen : e sophagus descends for about 0.5 in. (1.3 cm) & then enters stomach. It is related to: Anteriorly: left lobe of liver Posteriorly: left crus of diaphragm

14. Inferiorly to level of roots of lungs, vagus nerves leave pulmonary plexus & join with sympathetic nerves to form esophageal plexus . At opening in diaphragm : esophagus is accompanied by two vagi , branches of left gastric blood vessels , & lymphatic vessels . Fibers from right crus of diaphragm pass around esophagus in form of a sling. In abdomen : esophagus descends for about 0.5 in. (1.3 cm) & then enters stomach. It is related to: Anteriorly: left lobe of liver Posteriorly: left crus of diaphragm

15. Blood Supply of Esophagus U pper 3 rd of E sophagus : Artery: supplied by inferior thyroid artery Vein: drain into inferior thyroid veins M iddle 3 rd : Artery: by branches from descending thoracic aorta Vein: into azygos veins L ower 3 rd : Artery: by branches from left gastric artery . Vein: into left gastric vein , a tributary of portal vein .

16. Lymph Drainage of Esophagus Lymph vessels from: U pper 3rd of esophagus : drain into deep cervical nodes M iddle 3 rd : into superior & posterior mediastinal nodes L ower 3 rd : into nodes along left gastric blood vessels & celiac nodes

17. Nerve Supply of Esophagus E sophagus is supplied by: Parasympathetic S ympathetic efferent and afferent fibers via vagi & sympathetic trunks. In lower part of its thoracic course esophagus is surrounded by: esophageal nerve plexus .

18. Histology of Esophagus

19. Esophagus Muscular tube Function: Transport food from pharynx to stomach Cross-Section: lumen of esophagus is seen to collapsed due to presence of longitudinal mucosal folds with intervening grooves . When water or bolus of food passes through esophagus, mucosal folds disappear & lumen becomes patent Wall of esophagus consists of 4 coats Mucosa Sub-mucosa Muscularis externa Adventitia

20. a. Mucosa 1. Mucosa: Lined by stratified squamous non-keratinized epithelium 2. Lamina Propria consists of fine connective tissue & lymphatic nodules . Upper & lower 3 rd of esophagus Lamina propria : contains mucus secreting simple branched tubular glands called esophageal cardiac glands 3. Muscularis Mucosa: consists of smooth muscle fibres ( longitudinal direction). This coat is thicker & responsible for presence of longitudinal folds in mucosa of esophagus

21. b. Sub-mucosa Consists: L oose connective tissue ( thick collagen fibres ) M eissner’s plexus of nerves M ucus-secreting branched tubuloacinar glands called Esophageal glands proper. Its Ducts passes through mucosa to open onto luminal surface of esophagus & secretes Mucus to lubricates & protects mucosal surface Duct of these glands: lined by stratified squamous epithelium .

22. c. Muscularis Externa Consists of: I nner circular layer O uter longitudinal layers D iffers from muscularis externa of rest of digestive tract: contains smooth & skeletal muscle . In upper 3 rd of esophagus: skeletal muscle is present (continuation of pharyngeal musculature). In middle 3 rd of organ: skeletal & smooth muscles In lower 3 rd of esophagus: smooth muscle is present M yenteric plexus of nerves : lies between inner circular & outer longitudinal layers of muscularis externa

23. d. Adventitia In cervical & thoracic regions: esophagus is surrounded by Adventitia of loose connective tissue containing: Blood vessels Nerves Lymphatics A bdominal part of esophagus: covered by serosa

24. Abdomen BODY CAVITIES & MEMBRANES

25. Body Cavities & Membranes Posterior Aspect: Two Cavities: Cranial Vertebral Anterior Aspect: Thoracic Abdominopelvic Cavity

26. Abdominopelvic Regions 9 Smaller Imaginary Compartments

27. Membranes Serous Membranes: Lines Thoracic & Abdominopelvic Cavities PARIETAL LAYER: Visceral Layer Serous Cavity

28. Digestive System (Gastroenterology) Organs associated with: Ingestion Mastication Deglutition Digestion Absorption Excretion

29. Liver Large Location: Upper Part of of Abdominal Cavity under ribs & coastal cartilages Extends: upto epigastric region

30. Gall Bladder Pear shaped sac Adhere to undersurface of right lobe of liver Its fundus projects below inferior border of liver

31. Esophagus Tubular s tructure joins pharynx to stomach (O.5 inch, Enters stomach on right side) Deeply placed & lying behind left lobe of liver

32. Stomach Dilated part of alimentary canal between esophagus & small intestine Occupies left upper quadrant, epigastric &umbilical region under ribs

33. Small Intestine Divided into 3 regions Duodenum: First part of Small intestine, deeply placed on posterior abdominal wall . Situated in epigastric & umbilical regions . C Shaped tube extends from stomach around head of pancreas to join Jejunum Jejunum: Jejunum + ileum measure 20 feet long, 2/5 th makes jejunum & begins at duodenojejunal junction . Occupies upper left part of abdominal cavity Ileum: ends at ileocecal junction , Occupies lower right part of abdominal & pelvic cavity

34. Large Intestine Divided into Cecum : Blind ended Sac , projects downward in right iliac region below ileocecal junction. Appendix: worm-shaped tube arises from its medial side Ascending colon: Extends upward from cecum to inferior surface of right lobe of liver occupying right lower quadrants . On reaching liver, it bends to left forming right colic flexure Transverse colon: crosses abdomen in umbilical region from right colic flexure to left colic flexure . It forms a U-Shaped curve. In erect position, lower part of U may extend down into pelvis & on reaching region of spleen bends downward forming left colic flexure to become decending colon

35. 5. Descending colon : extends from left colic flexure to pelvic inlet below & occupies left upper & Lower quadrants . 6. Sigmoid colon : begins at pelvic inlet and continuation of descending colon. It hangs down into pelvic cavity in form of a loop to join rectum infornt of secrum 7. Rectum: occupy posterior part of pelvic cavity . Continuous above with sigmoid colon & descends infront of sacrum to leave pelvis by piercing pelvic floor. It becomes continuous with anal canal in perineum. 8. Anal Canal : below rectum in perineum region

36. Pancreas Soft , Lobulated organ Stretches obliquely across posterior abdominal wall in epigastric region Situated: behind stomach Extends: from duodenum to spleen

37. Spleen Soft mass of lymphatic tissue Occupies: left upper part of abdomen between stomach & diaphragm Lies along long axis of 10 th left rib

38. Kidney 2 reddish brown organs Situated high up posterior abdominal wall o n either side of vertebral column Left kidney lies slightly higher than right (Because left lobe of liver is smaller than right) Each kidney give rise to ureter

39. Suprarenal Glands 2 yellowish organs Lie on upper poles of kidney on posterior abdominal wall

40. Applied Anatomy of 9 Quadrants of Abdomen

41. Right Hypochondriac Region Organs: Liver (right lobe), gallbladder, right kidney (upper pole), parts of the small intestine. Clinical Relevance: Gallstones : Pain due to gallstones Hepatomegaly : Enlargement of liver

42. Epigastric Region Organs: Stomach, liver (left lobe), pancreas, duodenum, spleen, adrenal glands. Clinical Relevance: Gastritis or peptic ulcers : Pain often manifests in epigastric region. Pancreatitis : Inflammation of pancreas causes severe pain in this area.

43. Left Hypochondriac Region Organs: Spleen, stomach (fundus), left kidney (upper pole), pancreas (tail). Clinical Relevance : Splenomegaly : Enlarged spleen is often palpable. Rib fractures: Can cause pain radiating to region.

44. Right Lumbar (Flank) Region Organs: Ascending colon, right kidney (mid-portion). Clinical Relevance: Kidney stones : Pain from kidney stones. Appendicitis : Can start as diffuse pain that eventually localizes to the right lower quadrant

45. Umbilical Region Organs: Umbilicus, small intestine, transverse colon, pancreas (lower part). Clinical Relevance: Appendicitis : Initial pain may be felt here before migrating. Bowel obstruction : Can cause pain & distension

46. Left Lumbar (Flank) Region Organs: Descending colon, left kidney. Clinical Relevance: Diverticulitis : Inflammation of diverticula, often found in descending colon, causes pain here. Kidney stones : kidney stones can cause pain here.

47. Right Iliac (Inguinal) Region Organs: Cecum, appendix, right ovary and fallopian tube (in females). Clinical Relevance: Appendicitis : Classic pain location as inflammation progresses. Ovarian cysts : Pain from ovarian issues may localize here.

48. Hypogastric ( Suprapubic ) Region Organs: Bladder, sigmoid colon, small intestine, uterus (in females). Clinical Relevance: Urinary tract infections : Pain & urgency Diverticulitis : pain if sigmoid colon is involved. Uterine issues : fibroids or endometriosis cause pain

49. Left Iliac (Inguinal) Region Organs: Sigmoid colon, left ovary and fallopian tube (in females). Clinical Relevance: Diverticulitis : C ommon site for diverticular disease, older adults. Ovarian cysts : pain may localize here.

50. Stomach

51. Stomach O rgan of digestive system , specialized in accumulation & digestion of food. C onsists of four parts, two curvatures

52. Relations Anteriorly: diaphragm,liver (left lobe) & anterior abdominal wall Posteriorly: omental bursa (lesser sac), pancreas, left kidney & adrenal gland, spleen, & splenic artery Superiorly: esophagus & diaphragm Inferiorly & laterally: transverse mesocolon

53. Cardia Fundus Body pyloric part Mnemonic: Cows Find Bulls Passionate

54. Parts Cardiac Part: surrounds cardiac orifice & is opening between esophagus & stomach . Ingested food passes through ( inflow part ). Fundus Part: superior dilation of stomach & located superiorly relative to horizontal plane of cardiac orifice. Corpus or G astric body: largest part of organ. P yloric part: represents outflow section of stomach, passing stomach contents into duodenum . Its divided into 2 areas : Pyloric antrum : connected to stomach P yloric canal: connected to duodenum & contents of pyloric canal enter into duodenum via pyloric orifice , opening & closing of which are controlled by pyloric sphincter ( pylorus) , a circular layer of smooth muscle.

55. Stomach is J-shape created by 2 unequal curvatures: 1. Greater curvature: longer & convex curvature located on left of stomach , this starts from cardiac notch that is formed between esophageal border & fundus. 2. Lesser curvature: shorter concave curvature found to right & contains a small notch called angular incisure which marks the line of intersection between body & pyloric part of stomach.

56. Stomach Location Its covered & connected to other organs by peritoneum . L esser omentum : connects stomach to liver & extends around stomach. G reater omentum : then continues inferiorly from stomach , hanging from it like a curtain . P eritoneum has convoluted course that requires visualization.

57. Functions Mechanical chemical digestion: Enzymes & hydrochloric acid (pH 1-2) in gastric juice break food down, forming a semi-liquid substance called chime & passes into duodenum through pyloric orifice by a process called gastric peristalsis Absorption hormone secretion: gastrin , cholecystokinin, secretin, and gastric inhibitory peptide . accumulates 2 and 3 liters of food.

58. Layers (Histology) Mucosa membrane: thick, vascular, rugae (Flattened when stomach is distended) Submucosa M uscularis E xterna S erosa Mnemonic : M.S.M.S

59. Blood supply Left & Right Gastric arteries Left & right gastroomental arteries ( gastroepiploic ) S hort gastric arteries P osterior gastric arteries G astroduodenal artery

60. Veins Drains into portal circulation Left & right gastric vein -Directly into portal vein Short gastric vein & left gastroepiploic vein joins splenic vein Right gastroepiploic vein joins superior mesenteric vein

61. Innervation Parasympathetic : left & right vagus nerve (CN X) Sympathetic : celiac plexus (T5-T12)

62. Lymphatics Juxtacardial Left & right Gastric nodes S hort gastric nodes Left & right gastroomental nodes P yloric lymph nodes Drain to C eliac N odes → intestinal lymphatic trunk → cisterna chyli → thoracic duct

63. Clinical Relevance Hiatal hernia Cause not known. Weakness of supporting tissue Age Obesity S moking

64. Thank You Any Questions?