Esophagus Flashcards
Anatomic location of esophagus
Pharynx to stomach- goes down/left, then right, then left again to connect to stomach.
Posterior border- vertebral column and thoracic duct
Anterior- trachea
Lateral- pleura
Left- Aorta
Nerves of esophagus (on outside)
Vagus nerve makes a plexus around it, condenses to form 2 trunks on the lateral esophagus. Trunks rotate- left trunk goes anterior, right trunk goes posterior
Layers of the esophagus
Mucosa (squamous epithelium, becomes columnar near GE jn)
Submucosa (contains meissner plexus)
2 muscular layers (longitudinal and circular) with Auerbach’s plexus in bt
Esophagus does NOT have a serosa as the outermost layer like other GI stuff.
Arterial supply to esophagus
Upper esophagus- superior and inferior thyroid arteries
Lower- intercostal arteries, left gastric, phrenic arteries
Venous drainage of esophagus
Upper esophagus- to inferior thyroid vein and vertebral veins
Mid and lower- to azygous, hemiazygous, left gastric veins
In what pts do esophageal submucosal veins become enlarged? and what happens?
In pts w portal HTN
It can cause varices and life-threatening bleeding
Where do lymphatics from the esophagus drain into?
cervical, mediastinal, celiac, gastric nodes
Innervation of the esophagus
Vagus
Cervical sympathetic ganglion
Splanchnic ganglion
Celiac ganglion
T/F there is not a true sphincter in the lower esophagus
True! LES- no such thing. Gastric reflux prevented by increased tone.
T/F esophageal neoplasms are usually not malignant
False. They are almost always malignant.
What are the benign lesions of the esophagus
Benign lesions only account for 1%. They are leiomyomas, hemangiomas, cysts, polyps.
99% are malignant.
What kind of esophageal cancer is most common?
In USA- adenocarcinoma
In the world- squamous cell
Pathogenesis of esophageal ca (lifestyle)
Mucosal insult- hot liquids, burns from acid/base ingestion, radiation-induced esophagitis, reflux esophagitis
Alch, cig, nitrosamines, malnutrition
Barret’s esophagus
Plummer-Vinson
HPE of esophageal adenocarcinoma
Progressive dysphagia to solids
esp in older male w hx of GERD.
Usu no other sx, appear well.
HPE of esophageal squamous cell carcinoma
Heavy alch/tobacco use
Usu px w more pronounced sx (dysphagia to solids) dt more advanced dz
Dx Eval for esophageal lesions
Barium esophagogram- inital study for new dysphagia
Def Dx- tsu confirm by flexible esophagoscopy w biopsy.
EUS to determine stage
Mets- CT/PET
T/F the esophageal dz is usu locally invasive or metastatic on px
True bc there is no serosa to keep it contained
Rx for esophageal ca
rad, chemo, surg
if contained local dz- esophaectomy
Why does achalasia occur?
No peristalsis + LES doesn’t relax w swallowing.
Probably a problem w Auerbach’s plexus (which is in bt the muscular layers)
What is the most common esophageal motility disorder?
achalasia
HPE of achalasia
Dysphagia
Regurgitation (non-sour, bc didn’t get to stomach) esp w recumbent position
Hx of pneumonia (aspiration)
Dx Eval for achalasia
Esophagography- shows distal narrowing. Also, must do this to r/o ca! and look for strictures
Dynamic video img- abn peristalsis
bird’s beak and/or prox dilaton
Rx for achalasia
Surgery- esophagomyotomy (heller myotomy) via laproscopy. partial fundoplication also performed often in addition to reduce post-op gerd
Can also use botox but doesn’t really work for long.
Can also use pneumatic balloon dilatation of LES, but not as good as surg
When does esophageal perforation usually occur?
Iatrogenic, after instrumentation
Can also be from foreign bodies, penetrating trauma
What is Boerhaave syndrome?
Spontaneous esophageal rupture after vom
HPE esophageal perf
recent instrumentation, recent vom (boerhaave).
epigastric abd pain, shoulder pain
subcutanous emphysema
abd tenderness/distention
if delayed dx- sepsis (fever, tachy, hypotension)
Hydropneumothorax
Dx eval for esophageal perf
CXR- shows pleural effusion, hydropneumothorax, mediastinal emphysema
Esophageal contrast study- shows location of perf
If needed, flexible endoscopy
Throacentesis- empyema
Rx for esophageal perf
immediate exploratory throacotomy and repair of perf
drain w chest tubes post-op
if small lacerations, can give abx and observe
T/F if esophageal perforation is not treated immediately, there is very high mortality
True. >50% if not treated in 24hrs
