Radiological Anatomy of the Upper Gastrointestinal Tract

1. Radiological Anatomy of the Upper Gastrointestinal Tract Dr. Yasir Al Sheikh Consultant Radiologist Radiology & Medical Imaging Department King Khalid University Hospital 2014

2. Esophageal Anatomy • Fibromuscular tube about 10” (25 cm)long: C6–T10 • Variation in length according to age. (Pedia:C5-T9) • Flat in upper 2/3 & rounded in lower 1/3 • Esophageal plexus (vagus + sympathetics) • Vagal trunks (anterior & posterior) • Esophageal hiatus in diaphragm • Right crus of diaphragm forms a sphincter-like sling

3. Esophageal Anatomy Esophageal Constrictions • Superiorly: level of cricoid cartilage, juncture with pharynx • Middle: crossed by aorta and left main bronchus • Inferiorly: diaphragmatic sphincter

4. Esophageal Anatomy Esophageal Arteries • Upper esophageal sphincter and cervical esophagus: inferior thyroid artery • Thoracic esophagus: terminal branches of bronchial arteries • Lower esophageal sphincter and distal esophagus: left gastric artery and a branch of the left phrenic artery Esophageal Veins • Esophageal vv. drain into SVC via azygous & hemiazygous v. • Esophageal vv. drain into portal v. via branches of left gastric v. (a “portal- caval anastomosis”)

5. Radiology of Esophageal Anatomy • Imaging Modalities • Fluoroscopy (Barium Swallow, Upper GI) • CT 

6. Radiology of Esophageal Anatomy • Imaging Modalities • Fluoroscopy (Barium Swallow, Upper GI) • This is dynamic study which allow • visualization of outline and movement • (peristalsis) • Examination may be performed using • single-contrast or double-contrast. • Patients are asked to be NPO 8 hours • prior to examination.

7. Radiology of Esophageal Anatomy • Imaging Modalities • Fluoroscopy (Barium Swallow, Upper GI) • Ba Swallow Indications: • Dysphagia • Pain • Tracheo-esophageal Fistula • Esophageal perforation • Pre-operative assessment of bronchial Ca

8. Esophageal Anatomy Esophageal Constrictions This oblique view of a normal barium swallow shows the normal impressions made by (A) aortic arch. (B) left mainstem bronchus. (LA) left atrium on the esophagus

9. Esophageal Anatomy Esophageal Peristalsis Normal: Primary contraction: Propels bolus through the esophagus Secondary contraction: Follows primary contraction and propels any remaining bolus from thoracic esophagus

10. Esophageal Anatomy ** Esophageal Peristalsis Abnormal: Tertiary contractions.(A) presbyesophagus: Nonpropulsive contractions Diffuse esophageal spasm** Nutcracker esophagus Decreased peristalsis resulting from achalasia, scleroderma, dermatomyositis, polymyositis, esophagitis, …….

11. esophagus Stomach Anatomy Lower esophageal sphincter stomach lesser curvature rugae • Regions of stomach: • • Cardiac • • Fundus • • Corpus • • Pyloric: antrum, canal, sphincter • Lesser & greater omental • Winslow’s foramen: communication of lesser & greater sacs Pyloric sphincter antrum greater curvature duodenum Rugae are mucosal folds seen in the nondistended stomach. The areae gastricae represent the normal reticular mucosal pattern of the stomach, most prominent in the body and antrum. The lesser curvature forms the right gastric border and extends from the cardia to the pylorus

12. Radiology Stomach Anatomy • Imaging Modalities • Fluoroscopy (Barium Swallow, Upper GI) • CT  Exam may be performed Single-contrast Double-contrast

13. Radiology Stomach Anatomy esophagus Lower esophageal sphincter stomach lesser curvature rugae Pyloric sphincter antrum greater curvature duodenum

14. Radiology Stomach Anatomy • Imaging Modalities • COMPUTED TOMOGRAPHY 

15. Radiology Stomach Anatomy • Imaging Modalities • COMPUTED TOMOGRAPHY 

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