ESOPHAGUS

NORMAN V,VALERA, M.D.

SURFACE ANATOMY
 ESOPHAGUS
 Straight muscular
tube
 23 – 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
 Enters stomach at cardia
 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
 DIAPHRAGM, INFERIOR VIEW
 Caval =T8
Inferior vena cava
Right Phrenic nerve
 Esophageal =T10
Esophagus
Vagus nerve
 Aortic =T12
Aorta
Thoracic duct
Azygous vein
 Esophageal constrictions
 CERVICAL CONSTRICTION (upper
esophageal sphincter):
- beginning at the
pharyngoesophageal junction,
approx. 15 cm from the incisor teeth
- caused by cricopharyngeous
muscle.
 THORACIC (broncho-aortic)
CONSTRICTIONS: a compound
constriction
- where it is first crossed by the arch
of aorta, 22.5 cm from the incisor
teeth
- where it is crossed by the left main
bronchus, 27.5 cm from the incisor
teeth
 DIAPHRAGMATIC
CONSTRICTION:
- it passes through the esophageal
hiatus of the diaphragm, approx. 40
cm from the incisor teeth.
 Segments
 Cervical

– begins at the lower

end of pharynx
(level of 6th cervical
vertebra ) and
extends to the
thoracic inlet
(suprasternal
notch)
 Segments

 Thoracic

 Upper thoracic:

– from thoracic inlet

to level of tracheal
bifurcation
 Segments
 Mid thoracic

– from tracheal
bifurcation midway
to gastroesophageal
junction
 Segments
 Lower thoracic

– from midway
between tracheal
bifurcation and
gastroesophageal
junction to GE
junction, including
abdominal
esophagus
 Segments

 Upper third

 Middle third

 Lower third
 Relations in the Neck
 Anterior:
Trachea , Recurrent
laryngeal nerves

 Posterior:
Prevertebral layer of
deep cervical fascia,
Longus colli, Vertebral
column

 Lateral: Thyroid
gland
 Relations in the Thorax
 Anterior: Trachea,
Left recurrent LN, Left
main bronchus,
Pericardium
 Posterior: Bodies of the
Thoracic vertebrae,
Thoracic duct, Azygous
veins, Right Posterior
intercostal Art, Descending
Thoracic Aorta
 R side: Mediastinal
pleura, Azygous vein
 L side: L Subclavian Art.,
Aortic arch, Thoracic duct,
Mediastinal pleura
 Relations in the Abdomen
 Anterior: Posterior
surface of the left lobe
of liver

 Posterior: Left crus

of the diaphragm
 Vagus nerve
accompanies the
Esophagus through the
Diaphragm
 Left and Right Vagi lie
on its anterior and
posterior surfaces.
 Remember: LARP
 Esophagus
Cardiac notch
 Right border of
esophagus is
continuous w/
lesser curvature of
stomach
 Left border of
esophagus is
separated from the
fundus of the
stomach by the
cardiac notch
 Esophageal sphincter

 Located at inferior
end of esophagus

 Within
esophagogastric
junction

 Contracts and
relaxes
 When one is not eating, ES is
closed to prevent reflux of food
or stomach juices to esophagus
 Food momentarily stops here
before entering stomach
 Arterial Supply:

 Upper third – Inferior thyroid

artery from Subclavian artery

 Middlethird – Descending
thoracic aorta

 Lowerthird – Left gastric artery

from Celiac trunk of Abd’l aorta
 Arterial Supply:
 Inferior Thyroid
artery

 Descending
Thoracic aorta –
esophageal
branch

 Left gastric
 Venous Drainage:
 Upper third – Inferior thyroid
vein

 Middle third – Azygous vein

 Lower third – Left gastric vein

 Venous Drainage:
 Inferior Thyroid
vein

 Azygous vein

 Left Gastric
 Lymphatic Drainage

 Left gastric
lymph nodes
 Efferent
lymphatic vessel
from these nodes
drain mainly to
celiac lymph
nodes
 Nerve Supply

 Vagal trunks
 Thoracic
sympathetic
trunks
 Greater and
lesser splanchnic
nerves
 THANK YOU.
 “ in due time we

shall
reap….

if we don’t lose

heart”.
 QUIZ
 SET A  SET B

 1. Esophagus is  1. Esophagus
continuous enters the
above with the esophageal
laryngeal part of opening of the
the pharynx diaphragm
opposite about opposite what
what level of level of thoracic
cervical vertebra?
vertebra?
 Set A  Set B

 2. Give the  2. Give the

arterial supply of arterial supply of
the upper 3rd of the lower 3rd of
the esophagus? esophagus?
 Set A  Set B

 3. Give the  3. Give the

venous drainage venous drainage
of the lower 3rd of the upper 3rd
of the of the
esophagus? esophagus?
 Set A  Set B

 4 – 6: Enumerate  4 – 6: Enumerate
the 3 levels of the 3 levels of
esophageal esophageal
constrictions. constrictions.
 Set A  Set B

 7. Which vagus  7. Which vagus

nerve nerve
accompanies the accompanies the
esophagus in the esophagus in the
diaphragm on its diaphragm on its
posterior anterior surface?
surface?
Left or Right? Left or Right?
 Set A  Set B

 8. Give one  8. Give one

structure related structure related
to esophagus to esophagus
anteriorly in the posteriorly in the
neck region? neck region?
 Set A  Set B

 9. Give function  9. Give function

of esophagus? of glands in
esophagus?
 Set A  Set B

 10. The muscle  10. The muscle

layer of the layer of the
lower 3rd of upper 3rd of
esophagus is esophagus is
made up of what made up of what
type of muscle? type of muscle?
THANK YOU.