ESOPHAGUS

Question 1

describe the esophagus?

Answer 1

narrowest part of digestive tube

Question 2

what is the extension of esophagus?

Answer 2

extends from the pharynx to the stomach

Question 3

what are the parts of the esophagus?

Answer 3

cervical 4 cm

thoracic 20 cm

abdomen 1.25 cm

Question 4

describe the course of the esophagus?

Answer 4

starts from the lower border of cricoid at C6

pierces the diaphragm at T10

Question 5

where is the 1st constriction of esophagus located?

Answer 5

at the junction of esophagus with the pharynx

15 cm from incisor teeth

Question 6

where is the 2nd constriction of esophagus located?

Answer 6

when the arch of aorta crosses the esophagus

22 cm from the incisor teeth

Question 7

where is the 3rd constriction of esophagus located?

Answer 7

when the esophagus gets compressed by the left main bronchus

27 cm from the incisor teeth

Question 8

where is the 4th constriction of esophagus located?

Answer 8

at the esophageal hiatus ( when it pierces the diaphragm at t10 )

40 cm from incisor teeth

Question 9

what is the common site for foreign bodies become trapped in the esophagus?

Answer 9

level of cricopharyngeal sling –> 70% ( 1st constriction )

mid esophagus – when aortic arch overlap the esophagus –> 15% ( second constriction )

lodged at the lower esophageal sphincter at gastroesophageal junction —-> 15%

Question 10

what is the location of the esophageal hiatus ?

Answer 10

it is the where the esophagus enter the diaphragm

located at the right crus of the diaphragm

enters the abdomen - esophageal hiatus of the diaphragm on the left of the midline

becomes continuous with the stomach at cardiac orifice

the right border is continuous with the lesser curvature

left border is separated from the fundus of the stomach by cardiac notch

Question 11

what anteriorly to the abdominal esophagus?

Answer 11

left lobe of the liver and anterior vagal trunk

Question 12

what is posteriorly to the abdominal esophagus?

Answer 12

left crus of the diaphragm and posterior vagal trunk

Question 13

what covers the abdominal esophagus anteriorly?

Answer 13

covered with peritoneum of the greater sac

Question 14

what covers the abdominal esophagus posteriorly?

Answer 14

peritoneum of the omental bursa ( lesser sac )

Question 15

what are the ligaments found in relation to the lesser omentum?

Answer 15

hepatogastric ligament

hepatoduodenal ligament

Question 16

what are the ligaments found in relation to the greater omentum?

Answer 16

gastrophrenic ligament

gastrosplenic ligament

gastrocolic ligament

Question 17

describe the gastric-esophageal junction/inferior esophageal sphincter ( cardiac sphincter )?

Answer 17

lies to the left of T11 vertebrae

the Z line is a jagged line where the mucosa abruptly changes from esophageal to gastric mucosa

is a physiological sphincter - prevents reflux of gastric content into the esophagus

cannot be demonstrated anatomically

Question 18

what factors control the cardiac sphincter ?

Answer 18

valvular effect of the esophago -gastric angle

rosette-like folds of the gastric mucous membrane at cardia

the presence of a length of intra-abdominal esophagus

the clamp like action of the right crus of the diaphragm

Question 19

gastroesophageal reflux is a symptom of what?

Answer 19

abnormalities at the diaphragmatic hiatus

Question 20

what are the 2 types of hiatus hernia?

Answer 20

sliding hernia

paraesophageal/rolling hernia

Question 21

describe the sliding hernia?

Answer 21

the fundus of the stomach and abdominal esophagus ascends into the thorax through a lax/enlarged diaphragmatic opening

Question 22

what happens to the angle in sliding hernia ?

Answer 22

the normal acute oesohago gastric angle is reduced so that reflux is common even though the intrinsic lower sphincter is normal

reduced because the content of the stomach come back up

Question 23

describe paraesophageal / rolling hernia?

Answer 23

the cardia remain in normal position

the fundus extends through the esophageal hiatus —> usually no regurgitation of gastric content occur

Question 24

what happens to the angle in paraesophageal/rolling hernia?

Answer 24

no change in the angle because the content of the stomach doesnt go up.

Question 25

what is fundoplication?

Answer 25

procedure where the fundus of the stomach is wrapped around the back the esophagus until the both sides of the fundus meet again

Question 26

what happens to the crura of the diaphragm in fundoplication ?

Answer 26

approximated and sutured

Question 27

what is the effect of fundoplication ?

Answer 27

the collar of the wrap has the effect of creating a one way valve in the esophagus to allow food to pass into the stomach--> act like a sphincter

Question 28

what is the blood supply for the cervical part of the esophagus?

Answer 28

inferior thyroid artery

Question 29

what is the blood supply of the thoracic part of the esophagus?

Answer 29

descending aorta

Question 30

what is the blood supply of the abdominal part of the esophagus?

Answer 30

left gastric left inferior phrenic arteries

Question 31

what are the 3 branches of the celiac trunk?

Answer 31

splenic left gastric common hepatic

Question 32

describe the left gastric artery?

Answer 32

branch of the celiac trunk and it is associated with the lesser curvature of the stomach and the abdominal part of the esophagus

Question 33

describe the inferior phrenic arteries?

Answer 33

bilateral branches ---> left and right it is the 1st branch of the abdominal aorta

Question 34

what is the intra esophageal venous drainage?

Answer 34

submucosal venous plexus found in the submucosa Extend from the cervical esophagus to the abdominal esophagus

Question 35

what is the extra esophageal drainage venous drainage?

Answer 35

these venous are found in the adventitia ---> outermost layer drain into corresponding veins of each arterial supply

Question 36

what is the venous drainage of the cervical esophagus?

Answer 36

it is supplied by the inferior thyroid artery so the venous drainage is : inferior thyroid vein

Question 37

what is the venous drainage for the thoracic esophagus?

Answer 37

it is supplied by descending aorta so the venous drainage is by : azygous and hemiazygos

Question 38

what is the venous drainage for the abdominal esophagus?

Answer 38

it is supplied by left gastric and left phrenic arteries so the venous drainage is by ? Left gastric of portal system + inferior vena cava + hemiazygos

Question 39

what happens in patients who come vomiting blood?

Answer 39

the formation of the portal vein is at the level of transpyloric plane ( L1 ) ( formed by splenic and superior mesenteric veins in case of liver cirrhosis of the liver - the road is blocked so the blood backflow to the esophagus ( not being able to drain from the esophagus )

Question 40

describe why submucosal varices are major hemorrhage sources in conditions such as cirrhosis?

Answer 40

the submucosal connections between the portal and systemic venous system in the distal esophagus form esophageal varices in cases of portal hypertension--> source of hemorrhage in cirrhosis can also cause blood backflow to esophagus and can be caused by thrombus in portal veins ( not only cirrhosis )

Question 41

what is the lymphatic drainage for the cervical esophagus?

Answer 41

jugolo omohyoid lymph nodes

Question 42

what is the lymphatic drainage of thoracic esophagus?

Answer 42

paratracheal, tracheobronchial and posterior mediastinal lymph nodes

Question 43

what is lymphatic drainage for abdominal esophagus?

Answer 43

celiac group of lymph nodes ( lymph nodes around the celiac artery)

Question 44

what is the significance of these lymph nodes and their interconnections?

Answer 44

important for tumor spread bidirectional spread ( spread in both directions ) tumor can spread very easily from abdomen to thorax or neck

Question 45

what does the bidirectional lymph flow may explain ?

Answer 45

retrograde tumor seeding if the flow is blocked

Question 46

what is innervation of the esophagus?

Answer 46

parasympathetic

Question 47

which part of the parasympathetic is innervating the esophagus?

Answer 47

vagus and recurrent laryngeal nerves

Question 48

what is the function of the parasympathetic on esophagus?

Answer 48

induce peristalsis and stimulate glands to secrete motor to the smooth muscles of the wall of the abdominal viscera

Question 49

what is the innervation of the upper 1/3 esophagus?

Answer 49

upper 1/3 is the cervical esophagus ---> via the recurrent laryngeal branch of the vagus nerve

Question 50

what is the innervation of the lower 2/3 of the esophagus?

Answer 50

lower 2/3 is the thoracic esophagus ---> via mesh like network of the neurons called esophageal plexus

Question 51

what forms the esophageal plexus?

Answer 51

sympathetic and parasympathetic fibers

Question 52

what happens to the parasympathetic fibers later on?

Answer 52

form left and right vagus nerve

Question 53

what is the sympathetic innervation for the upper 1/3 esophagus ( the cervical esophagus )

Answer 53

postganglionic fibers arise from cervical and T1 region of sympathetic trunk

Question 54

what is the innervation of the lower 2/3 esophagus?

Answer 54

postganglionic fibers arise from the T2-T5/6 ganglia of the sympathetic trunk

Question 55

what is the function of the sympathetic system on esophagus?

Answer 55

vasoconstriction inhibit peristalsis

Question 56

where is the referred pain felt?

Answer 56

T1-T4/5 dermatomes because the afferent visceral pain fibers travel via the sympathetic fibers to spinal cord segment T1-T4/5

Question 57

what happens when the myenteric plexus ( between longit and circular layers ) and other vagal elements degenerate ?

Answer 57

the lower esophageal sphincter will be unable to relax leading to the esophagus being distended with food and fluid ----> then when the upper esophagus sphincter relaxes during sleep the content of the esophagus goes to the pharynx and lung ---> ASPIRATION PNEUMONIA

Question 58

what does failure of lower esophageal sphincter form in fluoroscopy?

Answer 58

results in dilation of the esophageal proximal to the area of obstruction leading to BIRD'S BEAK DEFORMITY

Question 59

what is the last portion of GIT supplied by ?

Answer 59

pelvic nerves ( large intestines for example )