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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.