ESOPHAGEAL

DISORDER
KAARTIKA SUBRAMANIAM
0317476
LEARNING OUTCOMES…

• Outline applied anatomy and applied physiology of

esophagus.
• List common causes of dysphagia.
Introduction…
▶ 25cm long muscular tube that connects pharynx to the stomach.
▶ The esophagus extends from the lower border of the cricoid
cartilage (at the level of the sixth cervical vertebra) to the cardiac
orifice of the stomach at the side of the body of the 11th thoracic
vertebra.
▶ The first constriction is at 15 cm from the upper incisor teeth,
where the esophagus commences at the cricopharyngeal
sphincter; this is the narrowest portion of the esophagus.
▶ The second constriction is at 23 cm from the upper incisor teeth,
where it is crossed by the aortic arch and left main bronchus.
▶ The third constriction is at 40 cm from the upper incisor teeth,
where it pierces the diaphragm; the lower esophageal
(physiological) sphincter (LES) is situated at this level.
Continue…

Venous blood from the esophagus drains into a submucosal plexus. From this plexus, blood
drains to the periesophageal venous plexus. Esophageal veins arise from this plexus and
drain in a segmental way similar to the arterial supply.
Continue….
▶ Swallowing (deglutition) is a reflex response that is triggered by
afferent impulses in the trigeminal, glossopharyngeal and vagus nerve.
▶ Two physiological sphincters:-
▶ Upper esophageal sphincter.
▶ Lower esophageal sphincter
Tonically active but relax on swallowing.
Tonic activity of LES between meals.
prevents reflux of gastric contents into esophagus.
Made up of 3 component:-
▶ Sling fibers of the stomach wall create a flap valve that helps close off
esophagogastric junction and prevent regurgitation when intragastric pressure
rises.
Continue..

▶ Esophageal constrictions
- They are the sites where swallowed foreign bodies can lodge or through
which it may difficult to pass an esophagoscope.
- Due to slight delay in the passage of foods and fluids occurs at that levels
strictures may develop after drinking of caustic fluids.
- These measurements of each constrictors are clinically important for
endoscopy and endoscopic surgeries of the esophagus.
FIGURE 39-1 Blunt esophageal foreign
bodies are most commonly lodged at
one of three anatomic areas of
narrowing: the cricopharyngeus
muscle, the level of the aortic
crossover, and the lower esophageal
sphincter.
 Continue..
▶ Porto-systemic venous anastomosis
- At lower third of esophagus is Porto-systemic anastomosis area.
- Esophageal tributaries of azygos vein (systemic vein) anastomose with
esophageal tributaries of the left gastric vein ( which drains to portal vein). E.g:
in cirrhosis of liver, portal hypertension develops resulting in dilation and
varicosity of the porto-systemic anastomosis.
- Varicosed esophageal veins may rupture during the passage of foods
causing hematemesis.
Continue…

▶ The esophagus and the left atrium of the heart

▶ A barium swallow may help a physician assess the size of the left atrium in
cases of left sided heart failure in which the left atrium becomes distended
due to back pressure of venous blood.
▶ Carcinoma of lower third of esophagus
▶ The lymph drainage of the lower third of the esophagus descends through
the esophageal opening in the diaphragm and ends in celiac nodes around
the celiac artery.
▶ A malignant tumor in this area ( adenocarcinoma) tend to spread below the
diaphragm along this route.
▶ Surgical approaches to esophagus
- Cervical : Left side preferred because esophagus runs slightly to the left of
the trachea.
▶ Upper 1/3 thoracic : Right side, avoids aorta.
▶ Lower 1/3 thoracic: Left side, because esophagus typically lies to the left of
midline.
 Continue…
▶ Motor disorder of the esophagus
Achalasia
▶ Is a condition in which food accumulates in the esophagus due to increased
LES tone and incomplete relaxation of LES on swallowing that cause
dilation of esophagus and diverticula.
▶ The myenteric plexus of the esophagus is deficient at the LES.
GERD
▶ LES incompetence which permits reflux of acid gastric contents into
esophagus.
▶ This condition causes heartburn and esophagitis and can lead to
esophagitis and can lead to ulceration and strictures of the esophagus due
to scarring.
Causes of dysphagia…

▶ Dysphagia is defined as difficulty in swallowing.

▶ Causes can be due to intraluminal, luminal and extra -luminal.
References..
▶ https://books.google.com.my/books?id=VyqpCwAAQBAJ&pg=PA115&dq=anatom
y+of+esophagus++netter&hl=en&sa=X&redir_esc=y#v=onepage&q=anatomy%20
of%20esophagus%20%20netter&f=false
▶ http://emedicine.medscape.com/article/1948973-overview
▶ https://books.google.com.my/books?id=z6JPBQAAQBAJ&pg=PA261&dq=3+CON
STRICTORS+OF+ESOPHAGUS&hl=en&sa=X&redir_esc=y#v=onepage&q=3%20
CONSTRICTORS%20OF%20ESOPHAGUS&f=false
▶ http://www.instantanatomy.net/thorax/areas/oesophagus/muscles.html
▶ https://books.google.com.my/books?id=7SZWRe2OBlgC&pg=PA129&dq=3+CON
STRICTIONS+OF+ESOPHAGUS&hl=en&sa=X&redir_esc=y#v=onepage&q=3%2
0CONSTRICTIONS%20OF%20ESOPHAGUS&f=false