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ESOPHAGUSESOPHAGUS

NORMAN V,VALERA, M.D.NORMAN V,VALERA, M.D.

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SURFACE ANATOMYSURFACE ANATOMY

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ESOPHAGUSESOPHAGUS

Straight muscularStraight muscular

tubetube

23 25 cm23 25 cm

longlong

Extends fromExtends from

pharynx to stomachpharynx to stomach

PropelsPropels

swallowed food toswallowed food tostomachstomach

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Contains mucous glands forContains mucous glands for

lubricationlubrication

Follows the curve of theFollows the curve of the

vertebral column as it descendsvertebral column as it descends

thru the neck and posteriorthru the neck and posterior

mediastinummediastinum

Enters stomach at cardiaEnters stomach at cardia

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Continuous above with theContinuous above with the

laryngeal part of the pharynxlaryngeal part of the pharynx

opposite theopposite the 66thth cervical vertebracervical vertebra

Passes through the diaphragm atPasses through the diaphragm at

the level of thethe level of the 1010thth thoracicthoracic

vertebravertebra to join the stomachto join the stomach

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CavalCaval =T8=T8

Inferior vena cavaInferior vena cavaRight Phrenic nerveRight Phrenic nerve

EsophagealEsophageal ==T10T10 EsophagusEsophagus

Vagus nerveVagus nerve

AorticAortic =T12=T12

AortaAortaThoracic ductThoracic duct

Azygous veinAzygous vein

DIAPHRAGM, INFERIOR VIEW

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Esophageal constrictionsEsophageal constrictions

CERVICAL CONSTRICTION (upperCERVICAL CONSTRICTION (upper

esophageal sphincter):esophageal sphincter):

- beginning at the pharyngoesophageal- beginning at the pharyngoesophageal

junction, approx. 15 cm from the incisorjunction, approx. 15 cm from the incisorteethteeth

- caused by cricopharyngeous muscle.- caused by cricopharyngeous muscle.

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THORACIC (broncho-aortic)THORACIC (broncho-aortic)CONSTRICTIONS: a compoundCONSTRICTIONS: a compoundconstrictionconstriction

- where it is first crossed by the arch- where it is first crossed by the archof aorta, 22.5 cm from the incisorof aorta, 22.5 cm from the incisorteethteeth

- where it is crossed by the left main- where it is crossed by the left mainbronchus, 27.5 cm from the incisorbronchus, 27.5 cm from the incisorteethteeth

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DIAPHRAGMATICDIAPHRAGMATIC

CONSTRICTION:CONSTRICTION:

- it passes through the esophageal- it passes through the esophageal

hiatus of the diaphragm, approx. 40hiatus of the diaphragm, approx. 40

cm from the incisor teeth.cm from the incisor teeth.

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SegmentsSegments

CervicalCervical

begins at the lowerbegins at the lower

end of pharynx (levelend of pharynx (level

ofof66thth cervical vertebracervical vertebra) and extends to the) and extends to the

thoracic inletthoracic inlet((suprasternal notchsuprasternal notch))

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SegmentsSegments

ThoracicThoracic

Upper thoracicUpper thoracic::

fromfrom thoracic inletthoracic inlet toto

level oflevel oftrachealtracheal

bifurcationbifurcation

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SegmentsSegments

Mid thoracicMid thoracic

fromfrom trachealtracheal

bifurcationbifurcation midwaymidwaytoto gastroesophagealgastroesophageal

junctionjunction

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SegmentsSegments

Lower thoracicLower thoracic

from midway betweenfrom midway between

tracheal bifurcationtracheal bifurcation

and gastroesophagealand gastroesophageal

junction to GEjunction to GE

junction, includingjunction, including

abdominal esophagusabdominal esophagus

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SegmentsSegments

Upper thirdUpper third

Middle thirdMiddle third

Lower thirdLower third

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Relations in the NeckRelations in the Neck

AnteriorAnterior::Trachea , RecurrentTrachea , Recurrent

laryngeal nerveslaryngeal nerves

PosteriorPosterior::Prevertebral layer ofPrevertebral layer of

deep cervical fascia,deep cervical fascia,

Longus colli, VertebralLongus colli, Vertebral

columncolumn

LateralLateral:: ThyroidThyroidglandgland

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Relations in the ThoraxRelations in the Thorax

AnteriorAnterior:: Trachea,Trachea,Left recurrent LN, LeftLeft recurrent LN, Leftmain bronchus,main bronchus,PericardiumPericardium

PosteriorPosterior:: Bodies of theBodies of the

Thoracic vertebrae,Thoracic vertebrae,Thoracic duct, AzygousThoracic duct, Azygousveins, Right Posteriorveins, Right Posteriorintercostal Art, Descendingintercostal Art, DescendingThoracic AortaThoracic Aorta

R sideR side:: MediastinalMediastinalpleura, Azygous veinpleura, Azygous vein

L sideL side:: L Subclavian Art.,L Subclavian Art.,Aortic arch, Thoracic duct,Aortic arch, Thoracic duct,Mediastinal pleuraMediastinal pleura

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Relations in the AbdomenRelations in the Abdomen

AnteriorAnterior:: PosteriorPosteriorsurface of the left lobesurface of the left lobeof liverof liver

PosteriorPosterior:: Left crusLeft crusof the diaphragmof the diaphragm Vagus nerveVagus nerve

accompanies theaccompanies theEsophagus through theEsophagus through theDiaphragmDiaphragm

Left and Right Vagi lieLeft and Right Vagi lieon its anterior andon its anterior andposterior surfaces.posterior surfaces.

RememberRemember:: LARPLARP

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EsophagusEsophagus Right borderRight border ofof

esophagus isesophagus is

continuous w/ lessercontinuous w/ lesser

curvature of stomachcurvature of stomach

Left borderLeft border

ofof

esophagus isesophagus is

separated from theseparated from the

fundus of thefundus of the

stomach by thestomach by the

cardiac notchcardiac notch

Cardiac

notch

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Esophageal sphincterEsophageal sphincter

Located at inferiorLocated at inferior

end of esophagusend of esophagus

WithinWithinesophagogastricesophagogastric

junctionjunction

Contracts andContracts andrelaxesrelaxes

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When one is not eating, ES isWhen one is not eating, ES is

closed to prevent reflux of foodclosed to prevent reflux of food

or stomach juices to esophagusor stomach juices to esophagus

Food momentarily stops hereFood momentarily stops here

before entering stomachbefore entering stomach

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Arterial Supply:Arterial Supply:

Upper thirdUpper third Inferior thyroid artery Inferior thyroid arteryfrom Subclavian arteryfrom Subclavian artery

Middle thirdMiddle third Descending thoracic Descending thoracicaortaaorta

Lower thirdLower third Left gastric artery from Left gastric artery fromCeliac trunk of Abdl aortaCeliac trunk of Abdl aorta

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Arterial Supply:Arterial Supply:

Inferior ThyroidInferior Thyroid

arteryartery

DescendingDescendingThoracic aorta Thoracic aorta

esophagealesophageal

branchbranch

Left gastricLeft gastric

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Venous Drainage:Venous Drainage:

Upper thirdUpper third Inferior thyroid Inferior thyroid

veinvein

Middle thirdMiddle third Azygous vein Azygous vein

Lower thirdLower third Left gastric vein Left gastric vein

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Venous Drainage:Venous Drainage:

Inferior ThyroidInferior Thyroid

veinvein

Azygous veinAzygous vein

Left GastricLeft Gastric

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Lymphatic DrainageLymphatic Drainage

Left gastricLeft gastric

lymph nodeslymph nodes

EfferentEfferent

lymphatic vessellymphatic vesselfrom these nodesfrom these nodes

drain mainly todrain mainly to

celiac lymphceliac lymph

nodesnodes

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Nerve SupplyNerve Supply

Vagal trunksVagal trunks

ThoracicThoracic

sympatheticsympathetic

trunkstrunks

Greater andGreater and

lesser splanchniclesser splanchnicnervesnerves

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THANK YOU.THANK YOU.

in due time wein due time we

shallshallreap.reap.

if we dont loseif we dont lose

heart.heart.

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QUIZQUIZ

SET ASET A

1. Esophagus is1. Esophagus is

continuouscontinuousabove with theabove with thelaryngeal part oflaryngeal part ofthe pharynxthe pharynx

opposite aboutopposite aboutwhat level ofwhat level ofcervicalcervicalvertebravertebra??

SET BSET B

1. Esophagus1. Esophagus

enters theenters theesophagealesophagealopening of theopening of thediaphragmdiaphragm

oppositeopposite whatwhatlevel of thoraciclevel of thoracicvertebravertebra??

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Set ASet A

2. Give the2. Give the

arterial supplyarterial supply ofofthethe upper 3upper 3rdrd ofof

the esophagus?the esophagus?

Set BSet B

2. Give the2. Give the

arterial supplyarterial supply ofofthethe lower 3lower 3rdrd ofof

esophagus?esophagus?

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Set ASet A

3. Give the3. Give the

venous drainagevenous drainageof theof the lower 3lower 3rdrd ofof

the esophagus?the esophagus?

Set BSet B

3. Give the3. Give the

venous drainagevenous drainageof theof the upper 3upper 3rdrd ofof

the esophagus?the esophagus?

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Set ASet A

4 6: Enumerate4 6: Enumerate

thethe 3 levels3 levels ofofesophagealesophageal

constrictions.constrictions.

Set BSet B

4 6: Enumerate4 6: Enumerate

thethe 3 levels3 levels ofofesophagealesophageal

constrictions.constrictions.

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Set ASet A

7. Which7. Which vagusvagus

nervenerveaccompanies theaccompanies theesophagus in theesophagus in thediaphragm on itsdiaphragm on its

posteriorposteriorsurfacesurface??

Left or Right?Left or Right?

Set BSet B

7. Which7. Which vagusvagus

nervenerveaccompanies theaccompanies theesophagus in theesophagus in thediaphragm on itsdiaphragm on its

anterior surfaceanterior surface??

Left or Right?Left or Right?

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Set ASet A

8. Give one8. Give one

structure relatedstructure relatedtoto esophagusesophagus

anteriorlyanteriorly in thein the

neck region?neck region?

Set BSet B

8. Give one8. Give one

structure relatedstructure relatedtoto esophagusesophagus

posteriorlyposteriorly in thein the

neck region?neck region?

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Set ASet A

9. Give9. Give functionfunction

of esophagus?of esophagus?

Set BSet B

9. Give9. Give functionfunction

of glandsof glands ininesophagus?esophagus?

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Set ASet A

10. The muscle10. The muscle

layer of thelayer of thelower 3lower 3rdrd ofof

esophagusesophagus isis

made up ofmade up ofwhatwhat

type of muscletype of muscle??

Set BSet B

10. The muscle10. The muscle

layer of thelayer of theupper 3upper 3rdrd ofof

esophagusesophagus isis

made up ofmade up ofwhatwhat

type of muscletype of muscle??

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THANK YOU.THANK YOU.