Esophagus
Lecture 21-22
PATHOLOGY OF THE ESOPHAGUS ( Anatomy ) :
A) Function:
1) passage for ingested food
2) emesis
3) Conduit for endoscopic evaluation
4) Evaluation of aorta and heart (TEE)
B) Anatomy:
Muscular tube - Conduit from the pharynx to the stomach
Length is defined anatomically, from cricoid cartilage to the gastric orifice
Distance from the incisors 40-45 cm (actual length: M 22-28cm F 2cm shorter)
Arterial Supply
Upper → superior and inferior thyroid artery
Middle → Bronchial arteries and esophageal branches directly from aorta
Lower → L inferior phrenic and gastric
Venous Supply
Upper → esophageal venous plexus to azygos vein
Lower → esophageal branches of the coronary vein, a tributary of the portal vein
1
, Mucosa and 2 muscular layers
- mucosa is stratified squamous epithelium
- 2 muscular layers, inner layer is circular outer layer is longitudinal. There is not serosal
layer
- Musculature of upper 1/3 is skeletal and musculature of the lower 2/3 is smooth muscle.
2 sphincters: one is physiological one in the neck call upper esophageal sphincter, the
other is located at the diaphragm called lower esophageal sphincter
Physiology and Pathophysiology
Physiology:
food is propelled down the esophagus by a peristaltic wave.
-LES relaxes in anticipation of food, allows food enter stomach then returns to its high
resting pressure, to prevent reflux.
Pathophysiology:
- LES is to prevent reflux of gastric content.
1) Alteration of the mechanism of LES allows reflux of acid content, on an epithelial
surface that is rich in sensory innervation
2) Failure of LES to relax, causes proximal dilation with contractile disorders
2
Lecture 21-22
PATHOLOGY OF THE ESOPHAGUS ( Anatomy ) :
A) Function:
1) passage for ingested food
2) emesis
3) Conduit for endoscopic evaluation
4) Evaluation of aorta and heart (TEE)
B) Anatomy:
Muscular tube - Conduit from the pharynx to the stomach
Length is defined anatomically, from cricoid cartilage to the gastric orifice
Distance from the incisors 40-45 cm (actual length: M 22-28cm F 2cm shorter)
Arterial Supply
Upper → superior and inferior thyroid artery
Middle → Bronchial arteries and esophageal branches directly from aorta
Lower → L inferior phrenic and gastric
Venous Supply
Upper → esophageal venous plexus to azygos vein
Lower → esophageal branches of the coronary vein, a tributary of the portal vein
1
, Mucosa and 2 muscular layers
- mucosa is stratified squamous epithelium
- 2 muscular layers, inner layer is circular outer layer is longitudinal. There is not serosal
layer
- Musculature of upper 1/3 is skeletal and musculature of the lower 2/3 is smooth muscle.
2 sphincters: one is physiological one in the neck call upper esophageal sphincter, the
other is located at the diaphragm called lower esophageal sphincter
Physiology and Pathophysiology
Physiology:
food is propelled down the esophagus by a peristaltic wave.
-LES relaxes in anticipation of food, allows food enter stomach then returns to its high
resting pressure, to prevent reflux.
Pathophysiology:
- LES is to prevent reflux of gastric content.
1) Alteration of the mechanism of LES allows reflux of acid content, on an epithelial
surface that is rich in sensory innervation
2) Failure of LES to relax, causes proximal dilation with contractile disorders
2
