Oesophagus

Course

Crosses from right of thoracic aorta to anterior position Has a slight antero- posterior curvature parallels the curvature of thoracic vertebral column Secured by its attachment to pharynx and diaphragm

Objectives

state the length, position and immediate relations of the oesophagus state the blood supply, lymphatic drainage and nerve supply of the oesophagus describe the histological structure of the oesophagus state how the histological structure of the oesophagus is adapted to perform its function state the clinical importance of the oesophagus

Oesophagus

Muscular tube 10 inches/25 Cms. long Pharynx in the neck stomach of abdomen Lower border of the cricoid cartilage (C6) cardiac orifice of the stomach(T11) Descend anteriorly to bodies of vertebrae in the midline Closer to the diaphragm-anterior and to the left

Oesophagus

Relations-Cervical part

Median plane in the neck Anterior- trachea, thyroid gland Posterior- lower cervical vertebrae prevertebral fascia either side- common carotid arteries recurrent laryngeal nerves Left side- subclavian artery terminal thoracic duct

Relations of the oesophagus

Course- Thoracic part

first superior mediastinum then- posterior mediastinum From left midline at T5

Downwards, forwards and to the left reaching the oesophageal hiatus at T10

Left lateral view of the mediastinum

Relations- Thoracic part

Anterior trachea left bronchus Pericardium-L/Atrium** diaphragm Posterior thoracic vertebrae thoracic duct Azygos vein and tributaries Descending aorta

Relations- Thoracic part

Left side left subclavian artery Terminal aortic arch L/ Recurrent laryngeal nerve Thoracic duct L/ pleura In the posterior mediastinumdescending aorta

Relations- Thoracic part

Right side Pleura Azygos vein Below the lung root vagi form a plexus on it Left vagus anterior Right vagus-posterior

Abdominal Oesophagus

Passes through the right crus of the diaphragm Lie in the oesophageal groove on the posterior surface of left lobe of liver

Narrowings

narrowed at 4 sites Junction with the pharynx in the neck In superior mediastinum- is crossed by the arch of the aorta In posterior mediastinum- compressed by left main bronchus In posterior mediastinum- at the oesophageal hiatus

Narrowings

Importance- clinical sequences

Swallowed objects likely to get lodged Ingested corrosive substances would move slowly through such regions more damage

Problems during passage of instruments

Blood supply

Inferior thyroid artery Branches from descending thoracic artery Left gastric artery Bronchial arteries Cervical part Thoracic part Abdominal Part Inferior thyroid veins Azygos vein left gastric vein

Lymphatic drainage

Peri- oesophageal lymph plexus Poserior mediastinal nodes

Supraclavicular nodes

Nodes around left gastric vesels

Structure
Mucosa stratified squamous epithelium lamina propria- lower end oesophageal cardiac mucous glands muscularis mucosae very thick Submucosa mucous glands

Structure
Muscularis externa Inner circular Outer longitudinal Proximal end- Striated muscle Mid region- mixture of striated and smooth muscles Distal en smooth muscles only Adventitia- Cervical and thoracic Serosa- Abdominal

How it Functions

Clinical Importance
Oesophagoscopy Measurements are made from upper incisor teeth 3 important levels- 17 cms - commencement of oesophagus 28 cms. - At the level it is crossed by left bronchus 43cms.- termination

Clinical Importance

Site of anastomosis between sytemic and portal systems Osphageal veins of azygos and left gastric veins Oesophageal varices Hematomesis Relationship of oesophagus with left atrium Barium swallow marked backward displacement of oesophagus left atrial enlargement Tracheo- oesophageal fistula