ESOPHAGUS Flashcards
describe the esophagus?
narrowest part of digestive tube
what is the extension of esophagus?
extends from the pharynx to the stomach
what are the parts of the esophagus?
cervical 4 cm
thoracic 20 cm
abdomen 1.25 cm
describe the course of the esophagus?
starts from the lower border of cricoid at C6
pierces the diaphragm at T10
where is the 1st constriction of esophagus located?
at the junction of esophagus with the pharynx
15 cm from incisor teeth
where is the 2nd constriction of esophagus located?
when the arch of aorta crosses the esophagus
22 cm from the incisor teeth
where is the 3rd constriction of esophagus located?
when the esophagus gets compressed by the left main bronchus
27 cm from the incisor teeth
where is the 4th constriction of esophagus located?
at the esophageal hiatus ( when it pierces the diaphragm at t10 )
40 cm from incisor teeth
what is the common site for foreign bodies become trapped in the esophagus?
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%
what is the location of the esophageal hiatus ?
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
what anteriorly to the abdominal esophagus?
left lobe of the liver and anterior vagal trunk
what is posteriorly to the abdominal esophagus?
left crus of the diaphragm and posterior vagal trunk
what covers the abdominal esophagus anteriorly?
covered with peritoneum of the greater sac
what covers the abdominal esophagus posteriorly?
peritoneum of the omental bursa ( lesser sac )
what are the ligaments found in relation to the lesser omentum?
hepatogastric ligament
hepatoduodenal ligament
what are the ligaments found in relation to the greater omentum?
gastrophrenic ligament
gastrosplenic ligament
gastrocolic ligament
describe the gastric-esophageal junction/inferior esophageal sphincter ( cardiac sphincter )?
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
what factors control the cardiac sphincter ?
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
gastroesophageal reflux is a symptom of what?
abnormalities at the diaphragmatic hiatus
what are the 2 types of hiatus hernia?
sliding hernia
paraesophageal/rolling hernia
describe the sliding hernia?
the fundus of the stomach and abdominal esophagus ascends into the thorax through a lax/enlarged diaphragmatic opening
what happens to the angle in sliding hernia ?
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
describe paraesophageal / rolling hernia?
the cardia remain in normal position
the fundus extends through the esophageal hiatus —> usually no regurgitation of gastric content occur
what happens to the angle in paraesophageal/rolling hernia?
no change in the angle because the content of the stomach doesnt go up.
what is fundoplication?
procedure where the fundus of the stomach is wrapped around the back the esophagus until the both sides of the fundus meet again
what happens to the crura of the diaphragm in fundoplication ?
approximated and sutured
what is the effect of fundoplication ?
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
what is the blood supply for the cervical part of the esophagus?
inferior thyroid artery
what is the blood supply of the thoracic part of the esophagus?
descending aorta
what is the blood supply of the abdominal part of the esophagus?
left gastric
left inferior phrenic arteries
what are the 3 branches of the celiac trunk?
splenic
left gastric
common hepatic
describe the left gastric artery?
branch of the celiac trunk and it is associated with the lesser curvature of the stomach and the abdominal part of the esophagus
describe the inferior phrenic arteries?
bilateral branches —> left and right
it is the 1st branch of the abdominal aorta
what is the intra esophageal venous drainage?
submucosal venous plexus found in the submucosa
Extend from the cervical esophagus to the abdominal esophagus
what is the extra esophageal drainage venous drainage?
these venous are found in the adventitia —> outermost layer
drain into corresponding veins of each arterial supply
what is the venous drainage of the cervical esophagus?
it is supplied by the inferior thyroid artery so the venous drainage is :
inferior thyroid vein
what is the venous drainage for the thoracic esophagus?
it is supplied by descending aorta so the venous drainage is by :
azygous and hemiazygos
what is the venous drainage for the abdominal esophagus?
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
what happens in patients who come vomiting blood?
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 )
describe why submucosal varices are major hemorrhage sources in conditions such as cirrhosis?
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 )
what is the lymphatic drainage for the cervical esophagus?
jugolo omohyoid lymph nodes
what is the lymphatic drainage of thoracic esophagus?
paratracheal, tracheobronchial and posterior mediastinal lymph nodes
what is lymphatic drainage for abdominal esophagus?
celiac group of lymph nodes ( lymph nodes around the celiac artery)
what is the significance of these lymph nodes and their interconnections?
important for tumor spread
bidirectional spread ( spread in both directions )
tumor can spread very easily from abdomen to thorax or neck
what does the bidirectional lymph flow may explain ?
retrograde tumor seeding if the flow is blocked
what is innervation of the esophagus?
parasympathetic
which part of the parasympathetic is innervating the esophagus?
vagus and recurrent laryngeal nerves
what is the function of the parasympathetic on esophagus?
induce peristalsis and stimulate glands to secrete
motor to the smooth muscles of the wall of the abdominal viscera
what is the innervation of the upper 1/3 esophagus?
upper 1/3 is the cervical esophagus —> via the recurrent laryngeal branch of the vagus nerve
what is the innervation of the lower 2/3 of the esophagus?
lower 2/3 is the thoracic esophagus —> via mesh like network of the neurons called esophageal plexus
what forms the esophageal plexus?
sympathetic and parasympathetic fibers
what happens to the parasympathetic fibers later on?
form left and right vagus nerve
what is the sympathetic innervation for the upper 1/3 esophagus ( the cervical esophagus )
postganglionic fibers arise from cervical and T1 region of sympathetic trunk
what is the innervation of the lower 2/3 esophagus?
postganglionic fibers arise from the T2-T5/6 ganglia of the sympathetic trunk
what is the function of the sympathetic system on esophagus?
vasoconstriction
inhibit peristalsis
where is the referred pain felt?
T1-T4/5 dermatomes
because the afferent visceral pain fibers travel via the sympathetic fibers to spinal cord segment T1-T4/5
what happens when the myenteric plexus ( between longit and circular layers ) and other vagal elements degenerate ?
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
what does failure of lower esophageal sphincter form in fluoroscopy?
results in dilation of the esophageal proximal to the area of obstruction leading to BIRD’S BEAK DEFORMITY
what is the last portion of GIT supplied by ?
pelvic nerves ( large intestines for example )
