esophagus Flashcards
what does the esophagus do
muscular alimentary tube 25cm long that connects the pharynx to the stomach
levels of the esophagus
starts at cricoid cartilage (6th cerv vert) and ends just below diaphragm (11th thoracic vert)
15cm from incisors to about 40cm from incisors
3 areas of esophageal narrowing
- prox esophagus at level of cricopharyngeus muscle
- midesophageal at level of aortic arch
- dist narrowing as level of diaphragm
two functional sphincters in esophagus
- UES at cricopharyngeus muscle
- LES between esophagus and stomach
arterial/venous/lymphatic supply of cervical esophagus
- inferior thyroid artery from thyrocervical trunk artery
- inferior thyroid vein
- deep cervical (jugular) nodes
arterial/venous/lymphatic supply of thoracic esophagus
- bronchial arteries and small esophageal arteries from thoracic aorta
- azygos being and hemiazygos vein
- nodes in posterior mediastinum (paratracheal and pulmonary hilar)
arterial/venous/lymphatic supply of distal esophagus
- left gastric artery
- coronary and left gastric vein
- celiac, left gastric, parahiatal nodes
what leads to esophageal varices
in liver cirrhosis w portal vein htn, the lower esophageal venous plexus provides collateral drainage from portal venous system to azygos veins
nerves of the proximal esophagus
recurrent laryngeal nerves of the vagus nerve and cervical sympathetic chain
what happens when there is damage to the recurrent laryngeal nerve
disrupts vocal cords and swallowing mechanism of upper esophagus inc risk of aspiration
nerves of mid and distal esophagus
vagus and thoracic sympathetic chain
what happens when the myenteric plexus is damaged
leads to achalasia (failure of esophageal muscle relaxation)
motor innervation of the esophagus is supplied through
vagus
4 layers of esophageal wall
mucosa(superficial and deep), submucosa, muscularis propria, adventitia
cell type of muscularis propria
striated muscle fibers of prox 1/3 to smooth muscle distal 2/3
cell type of mucosa
nonkeratinizing, stratified squamous epithelium
Barrett’s esophagus
presence of columnar epithelium in the esophagus; results from a metaplastic change caused by repeated inflammation of normal squamous epithelium; small, but significant tendency toward the development of cancer.
GERD
what does the resting high pressures of the sphincters help prevent
reflux and regurg of digestive material back up the esophagus
dysphagia
difficulty w transition of ingested substances from the mouth to the stomach; liquids and solids
food becomes “stuck”
odynophagia
painful swallowing; can be due to esophageal infx, foreign body in esophagus or injury of esophagus
globus hystericus
“lump in throat”
heartburn
pyrosis or water brash; assoc w GERD, achalasia, esophageal stricutes;
regurgitation
passive return of ingested material into oropharynx
vomiting
active return of stomach contents into oropharynx
mc cause of esophageal bleeding
ulcerative esophagitis; usually causes occult blood in stool
singultus
“hiccup”; diaphragmatic irritation and may indicate hernia
different dx eval of esophagus
- barium esophagography: pt swallows barium and monitored w real time video to assess esophageal motility and look for hiatal hernia, diverticula or obstruction
- esophageal manometry:direct simultaneous measurement of intraluminal pressures at multiple levels; function of both UES and LES; tube in nose and swallow water; achalasia, esophageal spasm and GERD
- esophageal pH monitoring:distal esophagus for GERD, 24hr study w pH probe in nose ph
imaging studies
- CT: esophageal perf
- upper endoscopy: visualization and bx, dilations, injections
- endoscopic us (EUS): detailed imaging of esophageal wall and adjacent lymph node;fine needle aspiration; cancer,lesions
causes of poor LES function leading to GERD
-hiatal hernia, inc intra abd or gastric pressures, food/drug induced relaxation, abnorm esophageal peristaltic activity
pt with heartburn, regurg, and dysphagia, dyspepsia after heavy/greasy meal
GERD
how can symptoms of GERD be induced
lie supine or lean over to tie shoes
late complications of GERD
- schatzki’s ring: stricture of distal esophagus
- Barrett’s esophagus: intestinal metaplasia of distal esophageal mucosa
recommendation for managing Barretts esophagus assoc w low grade dysplasia
routine f/u endoscopy every 6-12m w 4 quadrant bx ever 1-2cm of involved esophagus
w/u for GERD
- barium swallow
- esophageal manometry
- 24 hr ph study
- upper endoscopy
tx GERD
- behavioral modifications: eating habits, posture, avoid triggers (smoking, alcohol, anticholinergics, calcium, beta blockers, xanthines, aspirin, acidic foods, fatty meals, caffeine, chocolate)
- PPIs- nexium, prevacid, prilosec, protonix,
- surgery
principles of antireflux surgery
(1) restoration of an intra-abdominal segment of esophagus, (2) reconstruction of the esophageal hiatus in the diaphragm, and (3) reinforcement of the LES, usually with a fundoplication.