Esophagus

• Esophagus


  Straight muscular tube that joins the pharynx to the stomach
• Esophagus


  • 10 inches / 25 cm long
  • Extends from pharynx to stomach
  • Propels swallowed food to stomach
  • Contains mucous glands for lubrication
  • Follows the curve of the vertebral column as it descends thru the neck and posterior mediastinum
  • Pierces the diaphragm slightly to the left of the midline and after a short course of about 0.5 inch / 1.25 cm enters the stomach on its right side
  • Deeply placed lying behind the left lobe of the liver
  • Continuous above with the laryngeal part of the pharynx opposite the 6th cervical vertebra
  • Passes through the diaphragm at the level of the 10th thoracic vertebra to join the stomach
• Esophageal constrictions


  • Sites where swallowed foreign bodies can lodge
  • Difficult to pass an Esophagoscope
  • Strictures develop
  • Common sites of carcinoma
• Types of esophageal constrictions

  • Upper / Pharyngoesophageal
  • Middle / Thoracic
  • Inferior / Diaphragmatic
• Upper / Pharyngoesophageal constriction

  Where the pharynx joins the upper end / at the beginning of esophagus caused by cricopharyngeus muscle
• Middle / Thoracic constriction


  Where the aortic arch and left main bronchus cross its anterior surface
• Inferior / Diaphragmatic constriction


  Where the esophagus passes through the diaphragm at the esophageal hiatus
• Anatomic Divisions


  • Cervical
  • Thoracic
  • Abdominal
• Cervical


  • Begins at the lower end of the pharynx (level of 6th vertebra or lower border of cricoid cartilage)
  • Extends to the thoracic inlet (suprasternal notch)
  • 18cm from incisors
• Thoracic


  • Upper thoracic: from thoracic inlet to level of tracheal bifurcation; 18-23cm
  • Mid thoracic: from tracheal bifurcation mmidway to gastroesophageal junction to GE junction, including abdominal esophagus; 32-40c
• Abdominal


  • Considered part of lower thoracic esophagus; 32-40cm
• Anterior


  Posterior surface of the left lobe of liver
• Posterior


  Left crus of the diaphragm
• Vagus nerve


  1. Accompanies the Esophagus through the Diaphragm

  2. Left and Right Vagi lie on its anterior and posterior surfaces
• Remember: LARP
• Venous drainage


  1. Upper third - Inferior thyroid vein

  2. Middle third - Azygous vein

  3. Lower third - Left gastric vein
• Esophageal arterial supply


  1. Upper third - Inferior thyroid artery from Subclavian artery

  2. Middle third - Descending thoracic aorta

  3. Lower third - Left gastric artery from Celiac trunk of Abd'l aorta
• Esophageal lymph drainage


  1. Upper - Deep cervical

  2. Middle - Mediastinal

  3. Lower - Celiac
• Esophageal lymph drainage


  1. Upper - Deep cervical

  2. Middle - Mediastinal

  3. Lower - Celiac
• Gastroesophageal reflux or Heartburn


  May result from an incompetent lower esophageal sphincter; complains of substernal burning pain that is worse when lying down
• Achalasia


  • The smooth muscle fails to relax; difficulty swallowing liquids and solids; have dilated esophagus and experience abnormal contractions of the smooth muscle proximal to the affected segment; failure of relaxation of the inferior esophageal sphincter
• Hiatal hernia


  At the esophageal hiatus; sliding type - the abdominal part of the esophagus and part of stomach herniate into the mediastinum; heartburn may be seen
• Sengstaken-Blakemore balloon insertion


  1. For Esophageal hemorrhage from esophageal varices

  2. Gastric balloon anchors the tube against the esophageal gastric junction; occludes the varices by counterpressure
• Average distance between the external orifices of the nose and stomach - 17.2 inches / 44 cm
• Venous drainage of the esophagus

  • Upper third - Inferior thyroid vein
  • Middle third - Azygous vein
  • Lower third - Left gastric vein
• Stomach (Gaster)


  • 1.5-liter capacity
  • Acts as food blender and reservoir
  • Enzymatic digestion
• Parts of the stomach

  • Cardia – near the gastroesophageal junction
  • Fundus – dilated superior part
  • Body – major part, lies between fundus and pyloric antrum
  • Pylorus – distal part; divisible into pyloric antrum (wide part) and pyloric canal (narrow part)
• Curvatures


  • Lesser curvature – forms the shorter concave border of the stomach; the angular incisure / notch is the sharp indentation approximates the junction of the body and pyloric part of the stomach
  • Greater curvature – forms the longer convex border of the stomach
• Cardiac orifice


  Lies posterior to the 6th left costal cartilage, 2 – 4 cm from the median plane at the level of T 10 or T 11 vertebra
• Fundus


  Lies posterior to the 5th left rib in the midclavicular plane
• Greater curvature


  Passes inferiorly to the left as far as the 10th left costal cartilage
• Pyloric antrum


  Lies at the level of the 9th costal cartilage or at the level of the L 1 vertebra
• Pyloric orifice


  Approximately 1.25 cm left of the midline
• Pyloric canal


  Lies at the right side; location varies from the L2 to the L4 vertebra
• Hypertrophic Pyloric Stenosis


  Muscularis externa in the pyloric region hypertrophies, leading to a narrow pyloric lumen that obstructs the passage of food
• Hypertrophic Pyloric Stenosis


  • Associated clinically with projectile vomiting after feeding
  • Associated clinically with a small palpable mass at the right costal margin
• Arterial blood supply of stomach

  • Right (Hepatic) and Left (Celiac) gastric arteries - lesser curvature
  • Right (Gastroduodenal-Hepatic) and Left gastroepiploic arteries - greater curvature
  • Short gastric (Splenic) - fundus
• Venous drainage of stomach

  • Right and Left gastric veins to Portal vein
  • Left gastroepiploic and Short gastric veins to Splenic vein to Portal vein
  • Right gastroepiploic vein to Superior mesenteric vein to Portal vein
• Stomach bed


  The structure on which the stomach rests when a person is in the supine position
• Stomach bed


  • Formed by the structures forming the posterior wall of the Omental bursa
  • From superior to inferior - left dome of the diaphragm, spleen, left kidney and suprarenal gland, splenic artery, pancreas, transverse mesocolon and colon