ESOPHAGUS & STOMACH

DR. DEEPANSHU SHUKLA

ESOPHAGEAL VARICES

ACHALASIA CARDIA

Due to neuromuscularincoordinationsometimes the lowerend of the esophagusfails to open and doesnot allow smoothpassage of foodleading to dysphagiacalled achalasia cardia.Marked dilatation ofthe esophagus mayoccur due toaccumulation of foodwithin it.

LYMPHATIC DRAINAGE

• The knowledge of lymphatic drainage of the stomach isclinically very important because gastric cancer (carcinomaof stomach) spreads through the lymph vessels.

• For descriptive purposes, the stomach is divided into fourlymphatic territories as follows:

✓ First, divide the stomach into right two-third and left one-third by a line along its long axis.

✓ Now divide the right two-third into upper two-third (area 1)and lower one-third (area 4), and left one-third into upperone-third (area 3) and lower two-third (area 2).

✓ In this way, four lymphatic territories are marked out andnumbered 1 to 4.

Lymphatic Territories

Lymph node groups draining the lymphatic territories of the stomach

Mode of lymphatic drainage from four lymphatic territories into different groups of lymph nodes is as follows

1. Area 1 The lymph from this area is drained into left gastric lymph nodesalong the left gastric artery. These lymph nodes also drain the abdominalpart of the esophagus.

2. Area 2 includes the pyloric antrum and pyloric canal along the greatercurvature of the stomach. (The carcinoma of the stomach mostfrequently occurs in this area.) The lymph from this area is drained intoright gastroepiploic lymph nodes along the right gastroepiploic arteryand pyloric nodes, which lie in the angle between the first and secondparts of the duodenum.

3. Area 3 (also called pancreaticosplenic area) drains intopancreaticosplenic (pancreaticolienal) nodes along the splenic artery.

4. Area 4 includes the pyloric antrum and pyloric canal along the lessercurvature of the stomach. The lymph from this area is drained into rightgastric nodes along the right gastric artery and hepatic nodes along thehepatic artery.The efferents from all these lymph node groups pass to the coeliacnodes. Efferents from coeliac nodes enter the cysterna chyli throughintestinal lymph trunk.

Gastric Carcinoma (Gastric Cancer)

• It commonly occurs in the region of pyloricantrum along the greater curvature of thestomach.

• The gastric cancer spreads by lymph vessels tothe left supraclavicular lymph nodes.

• The enlarged and palpable left supraclavicularnode (Virchow’s node) may be the first sign ofgastric cancer (Troisier’s sign).

• The cancer cells reach the left supraclavicularlymph node through the thoracic duct.