Esophagus 10 27

ESOPHAGUS NORMAN V,VALERA, M.D.

SURFACE ANATOMY

ESOPHAGUS Straight muscular tube  23 – 25 cm long  Extends from pharynx to stomach  Propels swallowed food to stomach 

 Contains

mucous glands for lubrication  Follows the curve of the vertebral column as it descends thru the neck and posterior mediastinum  Enters stomach at cardia

 Continuous

above with the laryngeal part of the pharynx opposite the 6th cervical vertebra

 Passes

through the diaphragm at the level of the 10th thoracic vertebra to join the stomach



Caval =T8 Inferior vena cava Right Phrenic nerve



Esophageal =T10 Esophagus Vagus nerve



Aortic =T12 Aorta Thoracic duct Azygous vein

DIAPHRAGM, INFERIOR VIEW

Esophageal constrictions  CERVICAL

CONSTRICTION (upper esophageal sphincter): - beginning at the pharyngoesophageal junction, approx. 15 cm from the incisor teeth - caused by cricopharyngeous muscle.



THORACIC (broncho-aortic) CONSTRICTIONS: a compound constriction - where it is first crossed by the arch of aorta, 22.5 cm from the incisor teeth - where it is crossed by the left main bronchus, 27.5 cm from the incisor teeth

 DIAPHRAGMATIC

CONSTRICTION: - it passes through the esophageal hiatus of the diaphragm, approx. 40 cm from the incisor teeth.

Segments 

Cervical – begins at the lower end of pharynx (level of 6th cervical vertebra ) and extends to the thoracic inlet (suprasternal notch)

Segments 

Thoracic



Upper thoracic: – from thoracic inlet to level of tracheal bifurcation

Segments 

Mid thoracic – from tracheal bifurcation midway to gastroesophageal junction

Segments 

Lower thoracic – from midway between tracheal bifurcation and gastroesophageal junction to GE junction, including abdominal esophagus

Segments 

Upper third



Middle third



Lower third

Relations in the Neck 

Anterior:

Trachea , Recurrent laryngeal nerves 

Posterior:

Prevertebral layer of deep cervical fascia, Longus colli, Vertebral column 

Lateral: gland

Thyroid

Relations in the Thorax 

Anterior:



Posterior:



R side:



L side:

Trachea, Left recurrent LN, Left main bronchus, Pericardium Bodies of the Thoracic vertebrae, Thoracic duct, Azygous veins, Right Posterior intercostal Art, Descending Thoracic Aorta Mediastinal pleura, Azygous vein L Subclavian Art., Aortic arch, Thoracic duct, Mediastinal pleura

Relations in the Abdomen 

Anterior: Posterior surface of the left lobe of liver

 





Posterior:

Left crus of the diaphragm Vagus nerve accompanies the Esophagus through the Diaphragm Left and Right Vagi lie on its anterior and posterior surfaces. Remember: LARP

Esophagus Right border of esophagus is continuous w/ lesser curvature of stomach  Left border of esophagus is separated from the fundus of the stomach by the cardiac notch 

Cardiac notch

Esophageal sphincter 

Located at inferior end of esophagus



Within esophagogastric junction



Contracts and relaxes

 When

one is not eating, ES is closed to prevent reflux of food or stomach juices to esophagus  Food momentarily stops here before entering stomach

Arterial Supply:  Upper

third – Inferior thyroid artery from Subclavian artery

 Middle

aorta

 Lower

third – Descending thoracic

third – Left gastric artery from Celiac trunk of Abd’l aorta

Arterial Supply: 

Inferior Thyroid artery



Descending Thoracic aorta – esophageal branch



Left gastric

Venous Drainage:  Upper

vein

third – Inferior thyroid

 Middle  Lower

third – Azygous vein third – Left gastric vein

Venous Drainage: 

Inferior Thyroid vein



Azygous vein



Left Gastric

Lymphatic Drainage Left gastric lymph nodes  Efferent lymphatic vessel from these nodes drain mainly to celiac lymph nodes 

Nerve Supply Vagal trunks  Thoracic sympathetic trunks  Greater and lesser splanchnic nerves 

THANK YOU. 

“ in due time we shall reap…. if we don’t lose heart”.

QUIZ 

SET A



SET B



1. Esophagus is continuous above with the laryngeal part of the pharynx opposite about what level of cervical vertebra?



1. Esophagus enters the esophageal opening of the diaphragm opposite what level of thoracic vertebra?



Set A



Set B



2. Give the arterial supply of the upper 3rd of the esophagus?



2. Give the arterial supply of the lower 3rd of esophagus?



Set A



Set B



3. Give the venous drainage of the lower 3rd of the esophagus?



3. Give the venous drainage of the upper 3rd of the esophagus?



Set A



Set B



4 – 6: Enumerate the 3 levels of esophageal constrictions.



4 – 6: Enumerate the 3 levels of esophageal constrictions.



Set A



Set B



7. Which vagus nerve accompanies the esophagus in the diaphragm on its posterior surface? Left or Right?



7. Which vagus nerve accompanies the esophagus in the diaphragm on its anterior surface? Left or Right?



Set A



Set B



8. Give one structure related to esophagus anteriorly in the neck region?



8. Give one structure related to esophagus posteriorly in the neck region?



Set A



Set B



9. Give function of esophagus?



9. Give function of glands in esophagus?



Set A



Set B



10. The muscle layer of the lower 3rd of esophagus is made up of what type of muscle?



10. The muscle layer of the upper 3rd of esophagus is made up of what type of muscle?

THANK YOU.