Oesophagus

Question 1

Length
Breadth
How is the lumen flattened

Answer 1

25 cm
2 cm
Flattened antero posteriorly

Question 2

Course

Answer 2

The oesophagus begins in the neck at the lower border of the cricoid cartilage(the lower border of of C6 vertebra) ,descends in the front of the vertebral column ,passes through superior and posterior mediastina,pierces the diaphragm at the level of the T10 vertebra and ends in the abdomen at the cardiac orifice of the stomach at the level of the T11 vertebra

Question 3

Curvatures of oesophagus

Answer 3

Two anteroposterior curvatures

1. Corresponding to the curvature of cervical spine
2. Corresponding to the curvature of thoracic spine

Two side to side urvatures to the left

1. At the root of the neck, before entering the thoracic inlet
2. T7 vertebra before passing in front of the descending thoracic aorta

Question 4

Constrictions in oesophagus

Answer 4

1. C6,6 in,cricipharyngeous
2. T4, 9in,aortA
3. T7,11in,left principal bronchus
4. TWO,15 in, diaphragm

Question 5

What is the narrowest part of oesophagus

Answer 5

Commencement at the cricopharyngeal sphincter

Question 6

Clinical significance of the construction

Answer 6

1. Foreign bodies
2. Corrosive substances
3. Predilection for carcinoma
4. Difficulty of passing oesophagoscope

Question 7

Parts of oesophagus

Answer 7

3 parts
1. Cervical 4cm
From the cricoid cartilage to the upper border of manubrium sterni
2. Thoracic 20 cm till the oesophageal opening of the diaphragm

3. Abdominal till the cardiac end od the stomach.1-2cm

Question 8

Anterior relations

Answer 8

Trachea
Arch of aorta
Right pulmonary artery
Left principal bronchus
Left atrium
Diaphragm

Question 9

Posterior relations

Answer 9

Vertebral column
Right posterior intercostal arteries
Thoracic duct
Azygos vein
Hemiazgos 
Descending thoracic aorta

Question 10

Relations of the right side

Answer 10

Right lung and pleura
Azygos vein
Right vagus nerve

Question 11

Left relations

Answer 11

Left lung and pleura
Arch of aorta
Left subclavian  artery
Thoracic duct
Left recurrent laryngeal nerve
Descending thoracic aorta

Question 12

Anterior relations of the abdominal part of oesophagus

Answer 12

Pósterior surface of the left live of liver

Left gastric nerve

Question 13

Posterior relations of the abdominal part of oesophagus

Answer 13

Left crus of diaphragm

Right gastric nerve

Question 14

Specialty of abdominal part

Answer 14

Shortest

Covered by peritoneum

Question 15

Arterial supply

Answer 15

Cervical- inferior thyroid artery
Thoracic- oesophageal branches of descending thoracic aorta and bronchial arteries
Abdominal - oesophageal branches of left gastric artery and left inferior phrenic artery

Question 16

Venous drainage

Answer 16

Cervical part is drained by inferior thyroid veins . Thoracic part is drained by azygos vein and hemiazgos vein. Abdominal part is drained by two Venus channels namely hemizygous vein a tributary of inferior Vena cava and left gastric vein, a tributary of portal vein. Thus the abdominal part of the oesophagus is the site of portacaval anastomosis.

Question 17

Oesophageal varices

Answer 17

The lower end of the oesophagus is one of the important sides of portocaval anastomosis . In portal hypertension, for example, due to cirrhosis of liver there is back pressure in portal circulation as a result collateral channels of portacaval anastomosis not only open but become dilated and tortuous to form oesophageal varices. The ruptured oesophageal varices cause hematemesis( vomiting of blood).

Question 18

Lymphatic drainage

Answer 18

Cervical,- deep cervical lymph nodes
Thoracic- posterior mediastinal lymph nodes
Abdominal- left gastric and Coeliac lymph nodes

Question 19

Nerve supply

Answer 19

P symp- recurrent laryngeal nerve and oesophageal plexus of vagus
Symp- T5*T9

Question 20

Where is the pain referred to

Answer 20

Lower thoracica and epigastric

Question 21

Microscopic structure

Answer 21

1. Mucosa- epithelium,lamina propria,muscularis mucosa
2. Submucosa
3. Muscular- 3 different parts and muscles
4. Adventita

Question 22

Barret’s oesophagus

Answer 22

A clinical condition where the squamous epithelium of the oesophagus is replaced by the gastric epithelium. It canead to oesophageal carcinoma.

Question 23

Development and abnormalities

Answer 23

It develops from the foregut.
Failure of canalisation leads to oesophagial atresia
(@) separation of laryngotracheal tube by the formation of laryngotracheal septum
(b) recanalization of the obliterated lumen

Question 24

Radiological examination

Answer 24

it is performed to detect the enlargement of the left atrium due to mitral stenosis , oesophageal strictures, and carcinoma and achlasia cardia.

Question 25

Oesophagoscopy

Answer 25

it is performed to visualise the interior of the oesophagus while passing is the oesophagoscope is sites of normal constructions should be kept in mind.

Question 26

Most common motility disorder of the oesophagus

Answer 26

Achlasia cardia
it is a clinical condition in which the sphincter at the lower end of the oesophagus fails to relax when food is swallowed as a result food accumulates in the oesophagus and is regurgitation occurs . This condition occurs probably due to the congenital absence of ganglion cells in the myenteric plexus of nerves in the oesophageal wall a radiographic barium swallow examination of the oesophagus is a characteristic birds beak or rat tail appearance.

Question 27

Causes of dysphagia

Answer 27

(a) compression of the oesophagus from outside by the aortic arch aneurysm,enlargement of lymph nodes,ab normal right subclavian artery passing posterior to the oesophagus and
(b) narrowing of a lumen due to stricture or carcinoma.

Question 28

Most common congenital anomalies of oesophagus

Answer 28

Tracheo oesophageal fistula:-
It is the most common congenital anomaly of the oesophagus that occurs due to the failure of separation of the lumen of the tracheal tube from that of oesophagus by a laryngotracheal septum. In the most common type of tracheoesophageal fistula, the upper oesophagus ends blindly and the lower oesophagus communicates with the trachea at the level of T4 vertebra
Clinically it presents as hydraminos because the foetus is unable to swallow amniotic fluid, stomach is distended with air and infant vomiting every feed given on may cough up bile. The fistula must be closed surgically to avoid the passage of swallowed liquid into the lungs.

Question 29

Commonest site of cancer in the oesophagus

Answer 29

It most commonly occurs in its lower one third . Drains into celiac lymph nodes.