anatomy of esophagus (p)

mc presenting esophageal symptom

dysphagia

describe surgical anatomy of esophagus

muscular tube 10 inches(25cm)

posterior to trachea and heart (spasm may mimic anginal pain)

pass through hiatus though right crus at T10

relations of both vagi to esophagus

after passing the haitus

the rt vagus deviate posteriorly

left vagus becomes anteriorly

character and relation of cervical esophagus

5 cm ,from C6-T1

verterbe is posterior and trachea anterior

lateraly carotid theath and thyroid lobes

RLN is situated between trachea and esophagus

side of exposure of esophagus in the neck

left cervicotomy

length and relation of thoracic part of esophagus

It is 20 cm long.

Above tracheal bifurcation; right of aortic arch, then anterior to descending aorta

at the upper part the vertebra lies posterior to it

deviation of esophagus in relation to hiatus

deviates left before diaphragm and slightly anterior .

describe thr course of throracic duct

ascending upward between desend arota (to its left ) and azygous vein (to its right )

then it cross behind esophagus and anterior to aorta to be in left chest

describe the anatomy of abdominal esophagus

it is 2-3 cm below diaphragm

Surrounded by phreno-esophageal ligaments(anti reflux)

passes through right crus at T10.(with vagi)

what are the Common sites for foreign body impaction & corrosive strictures in esophagus

Cricopharyngeus (start)

Arch of aorta/left main bronchus

Diaphragmatic hiatus/LES

histological layers of esophagus

Mucosa: Stratified squamous epithelium

submucosa

Muscularis: Upper 1/3 skeletal (voluntary), lower 2/3 smooth (involuntary)

No serosa (only adventitia)→ weak wall prone to diverticula & poor anastomosis

UES

Cricopharyngeus ms

Tonic at rest relaxes durig the pharyngeal phase

failure to relax → Zenker's diverticulum.

LES

Physiological sphincter,(not anatomical) normal pressure 15-25 mmHg

high in achalasia (>40 mmHg)

low in GERD(<10 mmHg)

if becomes Above diaphragm → sliding hiatal hernia.(normaly 2 cm below

types of prestalisis

Primary (entry of food), secondary (distension), tertiary (non propulsive pathologic).

abnormal patterns of body of esophagus

Abnormal patterns

1-incordinate and retrograde

2-Nutcracker esophagus( increase amplitude)

3-inc frequency diffuse spasm (corkscrew)

4-atonic/sigmoid esophagus (advanced achalasia.)

vascular supply of esophagus

in Neck: Thyroid vessels

chest: bronchial & aortic branches

abdomen: left & short gastric vessels.

* Lower veins drain to left gastric vein → varices in portal hypertension

benefit of having segmental and small vessels in esophagus

could be easily dissected without any major bleeding in transhiatal esophagectomy

nerve supply of esophagus

-Parasympathetic via vagus nerves to Meissner's & Auerbach's plexuses.(smooth ms involuntry)

-Right vagus posterior, left vagus anterior at lower esophagus.

lymph darinage

.

* Upper 1/3 → deep cervical LN

* Middle 1/3 → mediastinal LN

* Lower 1/3 → celiac LN

why radical esophagectomy entails lymphadenectomy in the 3 feilds

as one single submucosal plexus pass all through the esophagus (not each segment seperated from other

surgical esposure

* Neck: Left cervicotomy

* Chest: Right thoracotomy/thoracoscopy(to avoid aorta at left and ligate the azygos to expose esophagus)

* Abdomen: Laparotomy/laparoscopy