Osephageas

Question 1

Describe?

Answer 1

Fibromuscler tube that transports food from pharynx to stomach

Question 2

Beginning, ending , length ?

Answer 2

• end of pharynx at the cricoid cartilage level C6
• joins the stomach through cardiac orifice level T10
• 25 cm ( 10 inch )

Question 3

Parts of it ?

Answer 3

1- cervical : at the neck
2- thoracic : at the superiror, posterior mediastinum
3- abdominal: once it goes through diaphragmtic opening (T10) till the stomach

Question 4

Relations of each part ?

Answer 4

1- cervical part
Ant: trachea , recurrent laryngeal n
Post: vertebral column
Lateral: lobes of thyroid gland

2- thoracic part
*Ant : pericardium, left atrium , trachea in the superior mediastinum
Post: descending thoracic aorta

*Gets crossed by left main bronhus and arch of aorta

3- abdominal part

*Ant : left lobe of liver
Post: left crus of diaphragm

*Right crus surrounds the osephageas forming a sling to make some sort of sphincter ( pinch like action)

*Passing with esophageas in diaphragmtic opening 2 vagi , left gastric vessels , lymphatic vessels

Question 5

Clinical application of osephageas related to heart ❤️

Answer 5

Due to the close relationship between the heart , osephageas :-
- using barium swallow helps doctors to detect the size of left atrium and see if its dilated like in HF and long standing mitral stenosis

• using transpsephageal echo

Question 6

Constrictions of it ?

Answer 6

1- upper osephageal sphincter
-Beginning of it
-Between pharynx , osephageas level c6
-By cricopharngeas muscle

2- crossing with arch , left main bronchus
( sometimes it is divided )

3- lower oesophageal sphincter
-Ending of it
-Between stomach , osephageas

Question 7

Site of each constriction?

Answer 7

In males
• 1st is 15 cm from lower central incisors
• 2nd is 26 cm from ….
• 3rd is 40 cm from ….

In females
• 1st is 14 cm from ….
• 2nd is 24cm from …
• 3rd is 38 cm from ….

Question 8

Clinical importance of these constrictions ?

Answer 8

1- the most common site for stricture

2- swallowed object is most likely to lodge in it

3- they present problems when passage of instruments eg indoscopy

Question 9

Arterial supply ?

Answer 9

•Upper third by the inferior thyroid artery.

• The middle third by the thoracic aorta by osephageal artery

• The lower third by the left gastric artery.

Question 10

Veinous drainage ?

Answer 10

The upper third drains in into the inferior thyroid veins.

• The middle third into the azygos veins ~> svc ( systemic circulation )

• The lower third into the left gastric vein, which is a tributary of the portal vein ( portal circulation)

They form a porto systemic anastomosis

Question 11

What is the significance of porto systemic anastomosis ?

Answer 11

• when portal hypertension eg in liver cirrhosis, the anastomosis is then opened and blood from portal circulation goes to systemic circulation

• it causes dilation , elongation and tortious veins in osophages causing osephageal varices that may results in haematemsis ( 60% death)
(مرض عبدالحليم حافظ )

Question 12

Lymphatic drainage?

Answer 12

•Superior third: deep cervical lymph nodes.
• Middle third: superior and posterior mediastinal nodes.
• Lower third : celiac nodes.

Question 13

Nerve supply ?

Answer 13

• is supplied by sympathetic fibers from the sympathetic trunks.
• The parasympathetic supply comes form the vagus nerves.
• Inferior to the roots of the lungs, the vagus nerves join the sympathetic nerves to form the esophageal plexus.
• The left vagus lies anterior to the esophagus.
• The right vagus lies posterior to it.