Development of

Esophagus
Develops from the cranial
foregut
In week 4, a small
diverticulum appears at the
ventral wall of the foregut ,
the tracheobronchial
diverticulum.
It becomes separated from
the foregut by the
esophagotracheal septum.

Gross Anatomy - esophagus

Fibromuscular tube about
10/ 25 cm long: C6T10.
Esophageal Constrictions:
Superiorly: level of
cricoid cartilage, junction
with pharynx. 15 cm from IT
Middle: crossed by aorta
and left main bronchus. 23
cm. From IT
Inferiorly: diaphragmatic
Sphincter. 40 cm from IT

Esophageal
Histology

Inner circular & outer

longitudinal muscle coats
Not all smooth muscle
Inferior third smooth
Superior third skeletal
Middle third mixed
Mucosa
stratified squamous, nonkeratinizing
muscularis mucosae prominent
Submucosa: mucous glands
Muscularis externa
Adventitia: loose conn. tissue
no serosa

Esophageal Achalasia
esophageal motility
disorder involving the smooth
muscle layer of the lower
esophagus.
characterized by incomplete
LES relaxation, increased LES
tone, and lack of peristalsis,
difficulty in swallowing
& regurgitation.
Diagnosed by barium swallow.
Cause not know.

Hiatal hernia

Three types
1. Sliding
2. Rolling
3. Mixed
May lead to acid reflux
disease.

Esophagus- web, ring stricture and stenosis

Schatzki-Gary ring
narrowing is caused by a
ring of mucosal tissue.
Patient present with
Dysphasia

Narrowing of lower esophagus

Cause: GERD

Esophageal web:
shelf
like protrusion into
the lumen

Mallory Wiss syndrome

MalloryWeiss
syndrome refers to
bleeding from tears in
the mucosa at the
esophago-gastric
junction.

Esophageal verices
Esophageal varices
Commonly seen in cases of
portal hypertension
(usually as a result of
cirrhosis)
Veins of the lower part of
esophagus enlarge and
become varicose
May rupture and lead to
severe bleeding

Developmental anomaly
Atresia and fistula
Type A:
a missing mid-segment.
Type B:
Proximal esophageal
termination on the lower
trachea with distal
esophageal bud.
Type C:
Proximal esophageal
Atresia with distal TEF

A newborn male is noted to have difficulty feeding and turns blue

and chokes when drinking formula. The prenatal records reveal
that the amniotic fluid appeared normal on ultrasound. A pediatric
feeding tube is passed orally to 20 cm without difficulty, with gastric
secretions aspirated. Which of the following is the most likely
diagnosis?
A. Congenital heart disease
B. Floppy epiglottis
C. Respiratory distress syndrome
D. Tracheoesophageal fistula
E. Zenker diverticulum

 A 61-year-old man presents with a

chief complaint of difficulty
swallowing. To evaluate his
dysphagia, the physician orders a
barium swallow with fluoroscopy,
as well as an esophagogram. She
finds that the anterior wall of the
esophagus in the mid-thorax is
being compressed. Which of the
following structures is most likely
responsible for this compression?
(A) Left atrium
(B) Left ventricle
(C) Pulmonary trunk
(D) Right atrium
(E) Right ventricle

 Over the past 4 months,

a 50-year-old man has
had increasing difficulty
swallowing solids and
liquids. He also has had
regurgitation of
undigested solids and
liquids. Examination
shows no abnormalities.
A barium swallow shows
dilation of the distal
esophagus with loss of
peristalsis in the distal
two thirds.

(A)Achalasia
(B) Diffuse esophageal spasm
(C) Esophageal cancer
(D) Esophageal candidiasis
(E) Esophageal reflux
(F) Globus hystericus
(G) Herpetic esophagitis
(H) Lower esophageal web
(I) Paraesophageal hernia
(j)Peptic stricture of the esophagus
(K) Pharyngoesophageal (Zenker's)
diverticulum
(L) Plummer-Vinson syndrome
(M) Polymyositis
(N) Pseudobulbar palsy
(O) Systemic sclerosis (scleroderma)
(P) Tracheoesophageal fistula

 For 1 month, a 62-year-old

man has had difficulty and
pain when swallowing; he has
had a 4.5-kg (10-lb) weight
loss during this period. He has
smoked two packs of
cigarettes daily for 40 years.
Examination shows no
abnormalities. A barium
swallow shows a narrowing of
the distal esophageal lumen
with partial obstruction.

(A)Achalasia
(B) Diffuse esophageal
spasm
(C) Esophageal cancer
(D) Esophageal
candidiasis
(E) Esophageal reflux
(F) Globus hystericus
(G) Herpetic esophagitis
(H) Lower esophageal
web
(I) Paraesophageal
hernia
(j)Peptic stricture of the
esophagus

 Which of the following is NOT involved in swallowing?

A. Contraction of the upper esophageal sphincter.
B. Coordination by the swallowing center in the medulla
oblongata.
C. The approximation of the vocal cords to close the glottis.
D. The raising of the larynx to close its entrance.
E. The elevation of the soft palate to close the nasopharynx.