Esophagus Flashcards
Runs from pharynx to thorax, through superior & posterior mediastinum
Esophageal hiatus at T10
3 constrictions:
- junction between pharynx & esophagus
- tracheal bifurcation
- gastroesophageal junction
Esophagus
Smooth muscle
Functional sphincter
Relaxes during swallowing, prevents reflux
Lower esophageal sphincters (LES)
May constrict the esophagus
Enlarged R atrium
Enlarged LN –> indentation on esophagus seen on barium swallow
Bronchogenic CA
MC: lower 1/3
Metastasize below the diaphragm to celiac LN
Malignant esophageal tumors
May tear the posterior wall
- Mallory-Weiss tears; mucosa & sub mucosal layers only
- Boerhaave syndrome: all layers
Patient profile: alcoholic, bulimic, pregnant
SSX: severe retrosternal pain postvomiting & extravasated contrast media
Forceful vomiting
Stomach & GE junction herniates through the diaphragm
(+)reflux
Sliding hiatal hernia
Only the stomach herniates through the diaphragm
No reflux but strangulation or obstruction may occur
Paraesophageal hiatal hernia
LES fails to relax during swallowing due to absence of myenteric plexus
SSX: progressive dysphagia
Barium swallow: dilated esophagus above LES, distal stenosis at LES (bird beak)
Chaga’s disease by Trypanosoma cruzi
Achalasia
Hypotonic LES
Scleroderma may be a systemic cause
Esophageal reflux
Replacement of stratified squamous epithelium with columnar (gastric) epithelium
Long history of reflux
May lead to esophageal adenocarcinoma
Barrett esophagus
Caustic strictures (ingestion of acids, alkali)
Recurrent mucosal destruction due to gastric acid reflux
Esophageal strictures (narrowing)
Skeletal muscle
Consists of:
- cricopharyngeus muscle
- inferior pharyngeal constrictor muscle
Relaxes during swallowing
Upper esophageal sphincters (UES)
