Q: Approximately how long is the oesophagus? (cm) A: 25 cm Q: What is the approxiamte vertebral level of the oesophagus? A: CV6 to TV11 Q: At what vertebral level does the oesphagus pass through the diaphragm? A: TV10 Q: What type of muscle is found in the upper 1/3 of the oesophagus? A: Striated Q: What type of muscle is found in the middle 1/3 of the oesophagus? A: Mixed striated and smooth Q: What type of muscle is found in the lower 1/3 of the oesophagus? A: Smooth Q: What are the 4 major constrictions (or impressions) of the oesophagus? A: * CV6 - inferior constrictor of pharynx * TV4 - aortic arch * TV 5,6 - left main bronchus * TV10 - diaphragm Q: What are the important anterior relations to the cervical part of the oesophagus? A: * trachea * thyroid isthmus * left recurrent laryngeal nerve Q: What are the important posterior relations to the cervical part of the oesophagus? A: * vertebrae * longus colli Q: What are the important left relations to the cervical part of the oesophagus? A: * left inferior thyroid A. * left common carotid A. * thyroid * left subclavian A. * thoracic duct Q: What are the important right relations to the cervical part of the oesophagus? A: * right common carotid A. * right recurrent laryngeal N. * thyroid Q: What are the important anterior relations to the thoracic part of the oesophagus? A: * left main bronchus * left atrium * left vagus N. * diaphragm * right pulmonary A. * left carotid (in superior thorax) Q: What are the important posterior relations to the thoracic part of the oesophagus? A: * vertebrae * right vagus N. * thoracic duct * right posterior intercostal A. Q: What are the important left relations to the thoracic part of the oesophagus? A: * left pleura * aortic arch * thoracic aorta Q: What are the important right relations to the thoracic part of the oesophagus? A: * right pleura * azygos V. Q: What are the important anterior relations to the abdominal part of the oesophagus? A: * anterior vagal trunk * left liver lobe * lesser omentum Q: What are the important posterior relations to the abdominal part of the oesophagus? A: * vertebrae * posterior vagal trunk * left crus of diaphragm Q: What are the important left relations to the abdominal part of the oesophagus? A: * spleen * fundus Q: What are the important right relations to the abdominal part of the oesophagus? A: * aorta * coeliac plexus Q: What is the blood supply of the cervical part of the oesophagus? A: Inferior thyroid branch of thyrocervical trunk Q: What is the blood supply of the thoracic part of the oesophagus? A: * branches of the descending aorta * bronchial arteries Q: What is the blood supply of the abdominal part of the oesophagus? A: * branches from the left gastric artery * branches from the inferior phrenic artery Q: What is the venous drainage of the cervical part of the oesophagus? A: The inferior thyroid veins Q: What is the venous drainage of the thoracic part of the oesophagus? A: * azygos V. * hemiazygos V. * accessory hemiazygos V. Q: What is the venous drainage of the abdominal part of the oesophagus? A: * abdominal azygos V. * left gastric V. Q: True or false? The cervical oesophagus is a site of portal systemic anastomosis. A: False. The *lower* oesophagus is a site of portal systemic anastomosis. Q: What is the lymph drainage of the cervical part of the oesophagus? A: Deep cervical lymph nodes Q: What is the lymph drainage of the thoracic part of the oesophagus? A: Posterior mediastinal lymph nodes Q: What is the lymph drainage of the abdominal part of the oesophagus? A: Left gastric lymph nodes Q: What is the innervation of the cervical part of the oesophagus? A: * Recurrent laryngeal nerve * Cervical sympathetic trunks (via the plexus around the inferior thyroid artery) Q: What is the innervation of the thoracic part of the oesophagus? A: * Oesophageal plexus * Recurrent laryngeal nerve * Vagal trunks * Greater splachnic nerves Q: What is the innervation of the abdominal part of the oesophagus? A: * vagal trunks (ant. and post. gastric Ns) * thoracic sympathetic trunks * greater (and sometimes lesser) splanchnic nerves * plexuses around the left gastric and inferior phrenic arteries Q: What are the 2 surfaces of the stomach? A: * anterosuperior * posteroinferior Q: What are the 2 curvatures of the stomach? A: * greater * lesser Q: What are the 2 openings of the stomach? A: * cardiac * pyloric Q: What is the approximate capacity of the stomach in adult life? (mL) A: 1500 mL Q: Where is the cardiac part of the stomach situated? A: * Left of the midline * Behind the 7th costal cartilage (2.5 cm from sternal junction) * TV11 Q: What part of the stomach is the fundus? A: The part above the cardiac notch (or incisure) Q: To what part of the stomach does the lesser omentum attach? A: The lesser curvature Q: On what border of the stomach is the angular incisure found? A: The lesser curvature (at its most dependent part) Q: To what part of the stomach does the gastrosplenic ligament attach? A: The greater curvature Q: To what part of the stomach does the greater omentum attach? A: The greater curvature Q: What type of muscle forms the pyloric sphincter? A: Smooth muscle Q: What structure is found right of the angular incisure of the stomach and leads into the thick walled pyloric canal? A: The pyloric antrum Q: What vein crosses the anterior surface of the pyloric constriction vertically? A: The prepyloric vein. Q: Where is the pyloric orifice in relation to the midline in the transpyloric plane when the stomach is empty and the patient is supine? A: It is about 1.2 cm to the right of it Q: What are the important relations of the anertosuperior surface of the stomach? A: * left costal margin * left diaphragm (6th to 9th intercostal spaces) * gastric surface of the spleen * left and quadrate lobes of the liver * anterior abdominal wall * transverse colon (when stomach is empty) Q: What are the important relations of the anertosuperior surface of the stomach? A: * diaphragm (Left crus) * Left suprarenal gland * upper pole of left kidney * splenic A. * anterior pancreatic surface * left colic flexure * transverse mesocolon Q: True or false? The posterior surface of the stomach is entirely covered by peritoneum. A: False. The posterior surface of the stomach is covered by peritoneum *except* at the cardiac region. Q: What structures does the stomach relate to directly on the posterior surface at the cardiac region? A: * the left crus of the diaphragm * the left suprarenal gland Q: What are the rugae of the stomach? A: Longitudinal mucosal folds Q: True or false? The rugae of the stomach (leading from high in the body to the pyloric antrum and canal) can be seen in x-rays of patients who have consumed barium meals. A: True. Q: What are the 3 phases of gastric secretion? A: * cephalic * gastric * intestinal Q: What is the cephalic phase of gastric secretion? A: Secretion in reponse to smell and taste of food. Q: What is the gastric phase of gastric secretion? A: In response to the presence of food in the stomach. Q: What is the gastric phase of intestinal secretion? A: Gastric secretion and motility is decreased by impulses from the duodenum. Q: Which arteries supply the lesser curvature of the stomach? A: The left and right gastric arteries. Q: Which arteries supply the greater curvature of the stomach? A: * The left and right gastro-epiploic arteries * The short gastric artery (supplies the far left of the greater curvature) Q: What does the short gastric artery supply? A: * The fundus * The far left greater curvature Q: What arteries supply the pyloric sphincter? A: * gastric arteries * pyloric arteries (rami of the right gastric and gastro-epiploic arteries) Q: Where does the right gastroepiploic vein drain into? A: The superior mesenteric vein Q: Where does the left gastroepiploic vein drain into? A: The splenic vein Q: Where does the superior mesenteric vein drain into? A: The portal vein Q: Where does the splenic vein drain into? A: The portal vein Q: Where do the right and left gastric veins drain to? A: The portal vein Q: Approximately how long is the coeliac trunk? (cm) A: 1.25 cm Q: How many branches does the coeliac trunk give? A: 3 Q: True or false? The gastric lymphatics are continuous at the pylorus with the duodenal lymphatics. A: True. Q: True or false? The gastric lymphatics are continuous at the cardia with the duodenal lymphatics. A: False. The gastric lymphatics are continuous at the cardia with the oesophageal lymphatics. Q: What 4 main groups of lymphatics have been identified for the stomach? A: * Left gastric group * pancreaticollienal group * Right gastroepiploic group * Right gastric and pyloric nodes Q: The left gastric group of lymph nodes drains the region of the stomach supplied by what artery? A: The left gastric artery Q: The pancreaticolienal group of lymphatics drain what area of the stomach? A: * The fundus * the part of the body left of a vertical drawn from the oesophagus Q: What area does the right gastroepiploic group of lymph nodes drain? A: The greater curvature of the stomach as far as the pylorus Q: What area do the right gastric and pyloric lymph nodes drain? A: The pyloric part of the stomach Q: What nerves provide the sympathetic supply of the stomach? A: * greater and lesser splanchnic nerves * left phrenic nerve to coeliac plexus * extensions of the coeliac plexus along the gastric and gastroepiploic arteries Q: What nerves provide the parasympathetic supply of the stomach? A: * vagus nerves * anterior gastric nerve (mainly from left vagus) * posterior gastric nerve (mainly from right vagus) Q: What branches do the anterior gastric nerves give? A: * hepatic branches * pyloric branches (generally 2) Q: What branches do the posterior gastric nerves give? A: * gastric branches (posterior surface * coeliac branches Q: What are the branches that the coelilac trunk gives? A: * Left gastric artery * Common hepatic artery * Splenic artery Q: What branches does the left gastric artery give? A: 2 or 3 oesophageal branches Q: True or false? The common hepatic artery is accompanied by the cerebral plexus. A: False. The common hepatic artery is accompanied by the hepatic plexus. Q: What 3 branches does the common hepatic artery give? A: * The hepatic artery * right gastric artery * gastroduodenal artery Q: What branches does the gastroduodenal artery give? A: * right gastroepiploic artery * ant. and post. superior pancreaticoduodenal arteries Q: What does the superior pancreaticoduodenal artery supply? A: The duodenum and pancreas as far as the greater duodenal papilla Q: Which is the largest branch of the coeliac trunk? A: The splenic artery Q: What are the branches of the splenic artery? A: * pancreatic braches * short gastric arteries * posterior gastric artery (58% of cases) * left gastroepiploic artery * terminal splenic branches Q: True or false? The spleen is situated in the left hypochondrium of the abdomen between the gastric fundus and the diaphragm. A: True Q: What rib does the long axis of the spleen lie along? A: Rib 10 Q: What are the dimensions of the spleen? (cm) A: 12 by 8 by 3.5cm Q: True or false? The anterior extremity of the spleen usually extends 5 cm anterior to the midaxillary line. A: False. The anterior extremity of the spleen usually does not extend anterior to the midaxillary line. Q: What is the most common way of finding the superior border of (orienting) the spleen? A: The superior border is usually notched. Q: Which surface of the diaphragm is the diaphragmatic surface of the spleen related to? A: The abdominal surface. Q: What are the 4 impressions on the visceral surface of the spleen? A: * Gastric impression * renal impression * colic impression * pancreatic impression Q: What forms the gastric impression on the spleen? A: The fundus and posterior aspect of the stomach. Q: What forms the renal impression on the spleen? A: The left kidney Q: What forms the colic impression on the spleen? A: * left colic flexure * phrenicocolic ligament Q: What ligament connects the spleen to the posterior abdominal wall? A: The lienorenal ligament. Q: What ligament connects the spleen to the stomach? A: The gastrosplenic ligament Q: True or false? The spleen developes in the doral mesogastrium. A: True. Q: What is the arterial blood supply of the spleen? A: * splenic artery * inferior pancreatic artery Q: What is the venous drainage of the spleen? A: The splenic vein - into the portal vein. Q: What is the nerve supply of the spleen? A: From branches of the coeliac plexus.