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

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 vv. drain into SVC via azygous & hemiazygous v. Esophageal vv. drain into portal v. via branches of left gastric v. (a “portal- caval anastomosis”) Esophageal Veins

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. 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 Esophageal Anatomy Esophageal Constrictions

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. Stomach Anatomy Regions of stomach: Cardiac Fundus Corpus Pyloric: antrum, canal, sphincter Lesser & greater omental Winslow’s foramen: communication of lesser & greater sacs stomach esophagus greater curvature lesser curvature Pyloric sphincter duodenum Lower esophageal sphincter 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 rugae antrum

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

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

14. Radiology Stomach Anatomy Imaging Modalities COMPUTED TOMOGRAPHY

15. Radiology Stomach Anatomy Imaging Modalities COMPUTED TOMOGRAPHY