Esophageal Diseases

Published on 16/04/2015 by admin

Filed under Surgery

Last modified 16/04/2015

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5 Esophageal Diseases

Anatomy of the Esophagus

image

Esophagus in Situ

• Fibromuscular tube (~25 cm) running from the pharynx in the neck, through the thorax and diaphragm, to the stomach in the abdomen
• Runs just posterior to the trachea and anterior to vertebral bodies in the neck and superior mediastinum
• Runs just posterior to the heart (left atrium and left ventricle) in the posterior mediastinum
• Tends to run to the left below T4 but is pushed to the center by the arch of the aorta and the root of the left lung
• Esophageal hiatus of the diaphragm is to the left of midline, at the level of the T10 vertebra.
• Upper esophageal sphincter: circular muscle of the superior esophagus, including the cricopharyngeus, the first region of anatomical constriction
• Also compressed in its course by 3 structures, as seen on barium swallow (when expanded)

image Arch of the aorta
image Left main bronchus
image Diaphragm: passes between the superior fibers of the right crus

• Ends at the cardial orifice of the stomach, left of midline
• Retropharyngeal danger space: possibility of infection spreading retroesophageally into the thorax

Microscopic Anatomy

Mucosa

• Highly folded stratified squamous epithelium, with walls in apposition unless distended by swallowing
• Mucous glands more numerous inferiorly

Tunica Muscularis

• Inner circular: continuous superiorly with the circumferential fibers of the inferior pharyngeal constrictor
• Outer longitudinal

image Upper third is striated (voluntary muscle) like the pharynx.
image Middle third is a combination of striated and smooth muscle.
image Lowest third is smooth muscle.

Tunica Adventitia

• Fibrous, not serous
• Has embedded arterial, venous, and nerve plexuses
image

Nerves of Esophagus

Innervation

• The esophageal nerve plexus is composed of vagal afferent and efferent, sympathetic efferent, and segmental sensory components.
• Parasympathetic preganglionic fibers

image Upper (cervical) portion from the recurrent laryngeal nerve
image Thoracic portion from the vagus via the pulmonary plexus (peribronchial)
image Ganglion cells located in myenteric plexuses

• Sympathetic postganglionic fibers

image Via nerves from cervical and thoracic chains
image From cervical ganglia and thoracic ganglia

• Sensory fibers (visceral afferent)

image Vagus: stretch, chemoreceptor, nociceptor; to vagal ganglia
image Segmental (parallel to sympathetics) with spinal nerves; to cervical and thoracic dorsal root ganglia

Vessels and Lymphatics

• Extensive submucosal vascular plexuses allow mobilization of large extents of the esophagus with reduced risk of ischemia.
image

Arteries of Esophagus

Arterial Supply

• Cervical portion is supplied by branches of the inferior thyroid arteries from thyrocervical trunks of the right and left subclavian arteries.
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