Anatomy
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Abdomen
A patient presents to ED complaining of foreign body sensation in his oesophagus after swallowing a large unchewed piece of steak. The oesophagus passes through the diaphragm at which vertebral level:
Answer:
The abdominal oesophagus emerges through the oesophageal hiatus in the diaphragm at vertebral level T10.Oesophagus (Abdominal)
Anatomy / Abdomen / Gastrointestinal Tract
Last Updated: 7th June 2022
The abdominal oesophagus represents the short distal part (about 2 cm) of the oesophagus located in the abdominal cavity.
Emerging through the right crus of the diaphragm at the level of vertebra T10, it passes from the oesophageal hiatus to the cardiac orifice of the stomach just left of the midline at the level of vertebra T11.
Factors guarding against gastric reflux
Anatomical factors that help guard against gastric reflux include:
- The diaphragmatic pinchcock effect where at the oesophageal hiatus, diaphragmatic crural fibres exert pressure on the oesophageal wall and serve as an extrinsic sphincter
- The lower oesophageal sphincter which is a high-pressure zone of smooth muscle in the oesophageal wall maintained in a state of tonic contraction (except during swallowing, belching or vomiting)
- Intra-abdominal pressure which maintains the oesophagus in a state of collapse when empty
- The angle of His formed at the junction of the oesophagus and the gastric fundus, which together with the posterolateral position of the gastric fundus, minimises contact of gastric content with the gastro-oesophageal junction
- The gastric mucosal rosette-like folds formed at the gastro-oesophageal junction which compress against each other with increased intraabdominal pressure to prevent reflux
Abdominal Oesophagus. (Image modified by FRCEM Success. [CC BY-SA 3.0 , via Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
