The Oesophagus (Esophagus) – Clinical Anatomy

hello in this video we're going to talk about the clinical anatomy of the esophagus the adult human esophagus is an 18 to 25 centimeter long muscular tube extending from the pharynx to the stomach here are your incisors your teeth and here is the pharynx the throat the pharynx continues to the esophagus the esophagus passes through the diaphragm and joins with the stomach the esophagus has cervical thoracic and abdominal parts the cervical esophagus from the fairing go esophageal Junction to the sub sternal notch the thoracic esophagus extends from the suprasternal notch to the diaphragmatic hiatus the abdominal esophagus extends from the diaphragmatic hiatus to the orifice of the cardia of the stomach three narrow points or anatomical constriction sites of the esophagus which is important to know I am drawing the larynx and trachea here running in front of the esophagus the upper esophageal sphincter which is the cricopharyngeal muscle is here this is the first narrow point second narrow point is the bifurcation of the trachea to the main bronchi and also where the aortic arches again here is the trachea and its bifurcation in the main bronchi and behind it continuing on is the esophagus the third anatomical constriction site is the lower esophageal sphincter where the esophagus passes through the diaphragm essentially if we look at these sites from a lateral view the cricopharyngeal muscle is the muscle attached to the trachea and which wraps around the esophagus located around the c5 c6 vertebral level sorry you cannot see the numbers clearly here the esophagus runs behind the respiratory tract the bifurcation of the trachea and where the aortic arch is located is the level of the sternal angle roughly which is between t4 and t5 vertebral level the last anatomical constriction site is where the esophagus passes through the diaphragm at level t10 two high pressure zones prevent the backflow of food these are the upper and lower esophageal sphincter these functional zones are located at the upper and lower ends of the esophagus these are physiological constriction sites as well as anatomical as we have learned some clinical Anatomy gastro esophageal reflux disease gourd also known as good is a condition in which reflux of the stomach content into the esophagus results in symptoms such as heartburn usually due to an incompetent or dysfunctional lower esophageal sphincter an example of what could cause reflux is alcohol because alcohol is known to relax the lower esophageal sphincter allowing food content and then the acid to flow backwards causing irritation of the esophagus again clinical anatomy the esophageal constriction sites as we talked about the site at which you might expect to swallow foreign bodies and these farmers can get impacted and strictures can occur after swallowing corrosive fluids for example not only that these sites can be potentially difficult sites for gastroscopy to pass through strictures as mentioned may develop after ingestion of corrosive agents and lastly as mentioned foreign bodies may get stuck in these locations clinical Anatomy xenca is diverticulum also known as the pharyngeal pouch is the out pouching of the hypopharynx so drawing it out the larynx and trachea here on the left you have the esophagus running behind it there are important muscles the cricopharyngeal and the inferior pharyngeal constrictor which wraps around the esophagus the cracker Ferengi is as we know is the upper esophageal sphincter if there is a weakened layer around the fairing fairing go esophageal Junction the mucosa and submucosa layers originating here can pop out resulting in an outpouching sac here is an image a barium swallowing study showing a pharyngeal pouch the clinical presentation of Jenkins diverticulum include a Globus sensation dysphagia halitosis and regurgitation the anatomical relationship of the esophagus we already learned a bit about it the trachea is anterior to the esophagus modification of the trachea a o attic arch anterior to the trachea level at the sternal angle not t4 and t5 vertebral level the arch of the aorta wraps over the left main bronchus and it travels posterior to the esophagus you have the right vagus nerve and the left vagus nerve on both sides of the esophagus which supplies the esophagus forming the esophageal plexus the thoracic ducts travel left of the esophagus imagine cutting a cross-section now of the thorax imagine this is a CT scan orientate ourselves here we have the right lung the sternum here is the esophagus at the back now this is where we introduce the mediastinum the mediastinum is the area of the thorax which can be divided into the superior and inferior compartments the inferior compartments can be further divided into the posterior compartment where we find the esophagus the middle media mediastinum where we can find the heart and then the anterior part of the mediastinum where we find the sternum let's zoom into this area here again here is the right lung and then you have your left lung this is about the t8a table level you have the esophagus and then you have the thoracic aorta to the left of the esophagus the thoracic aorta will have branches called the posterior intercostal arteries coming off that will supply the ribs and the spinal cord the azygos vein is posterior and to the right of the esophagus and will drain blood into the superior vena cava which leads us to the venous drainage of the esophagus you have the esophagus vein which drains the majority of the esophagus the Hemi azygos vein runs left of these Suffolk as it joins with the azygos vein on the right the azygos vein as mentioned drains into the superior vena cava I have not drawn the heart but imagine it is sitting on the diaphragm in the middle now the esophageal vein also Anasta moses with the left gastric vein originating below the diaphragm the left gastric vein drains into the portal vein the portal vein as we know drains into the liver the portal vein is super important because it drains most of the gastrointestinal organs it drains the splenic vein in fear mesenteric vein and the superior mesenteric vein important to realize here the left gastric vein and esophageal vein and nasty Moises and is a connection between the portal and systemic venous system and is a potential site for the development of esophageal varices in portal hypertension so clinical Anatomy esophageal varices anastomosis between the azygous and left gastric vein may develop varices from portal hypertension so drawing this out here we have the portal vein you can imagine in liver cirrhosis where the liver becomes finebros this increases resistance in the portal vein causing portal hypertension this means that blood can get pushed back back to the splenic vein superior mesenteric vein and also the left gastric vein causing esophageal varices here is an endoscopic picture of the esophagus where you can see esophageal varices varices is an abnormal dilated vessel with a tortuous course and these varices can rupture hemorrhage you get bleeding this patient can eventually present with Melina which is black stool as well as hematemesis vomiting blood and this brings us to the blood supply to the esophagus there are three main ones and this also is good because you can divide the esophagus into three parts the first are the branches of the inferior thyroid artery which provides arterial supplier to the cervical esophagus the paid a aortic esophageal arteries supply the thoracic esophagus and then the left gastric artery supplies the abdominal esophagus when talking about the histology or the pathology of the esophagus it is good to divide the esophagus into the upper two-thirds and lower third by dividing it like this we can easily differentiate the cell types found in the esophagus let's focus on the upper two-thirds and zoom into this area and look at the layers of the esophagus from the most inner layer first which is the mucosa the upper two-thirds contains stratified squamous epithelial cells and these cells can develop into squamous carcinoma below it you have the submucosa which contains mucous glands goblet cells the muscle layers next and you have an inner striated circular voluntary muscle and then the external longitudinal muscle the outermost layer of the esophagus is the adventitia lymphatic drainage is to the neck and the mediastinal nodes unlike other areas of the GI tract the esophagus does not have a distinct cirrhosis or covering this allows the software geo tumors to spread more easily and makes them harder to treat surgically the lower third of the esophagus the mucosa layer you have transition from stratified squamous epithelium to columnar epithelium simple and these guys can actually develop into Adam no carcinomas the submucosa contain the mucous glands the goblet cells the muscle layer here we can find transition of the inner striated muscles to involuntary smooth muscles the external or the outer muscle layer is still the longitudinal muscle the most outer layer is the adventitia remember there is no serosa layer in the esophagus lymphatic drainage at the lower third is to the gastric and para a or tick nodes let's talk about some embryology of the oesophagus week four of gestation the respiratory tube and the esophageal tube are forming from the same bud they separate respiratory tube moving anteriorly forming the forming slowly the bronchi and its branches and then the esophagus is initially very short but elongates rapidly reaching its final relative length by about week seven by week five and six the respiratory tube and esophageal tube have separated now you can imagine that if the respiratory tube and the esophageal tube does not separate properly problems can arise some clinical Anatomy tracheal esophageal fistula it is a pathological connection between the esophagus and the chuckya it is a development abnormality and there are many types signs and symptoms of trickier fistula includes cyanosis difficulty breathing and also coughing and vomiting episodes for the infant because we talked about God GERD which is where you have an incompetent lower esophageal sphincter we need to talk about esophageal achalasia where the lower esophageal sphincter is too competent or stiff it doesn't allow things to pass through smoothly causing symptoms of regurgitation heartburn esophageal irked achalasia is where food accumulates in the esophagus and the esophagus becomes dilated it is due to increased tone to the lower esophageal sphincter failure to relax and whereas in gold remember it is to relaxed you can say here is a barium swallowing study of a patient with esophageal achalasia as you can see the barium stops at a tip of constriction this is where the lower esophageal sphincter is and you can see proximal to that tip the esophagus is dilated forming what is known as a bird beak appearance thank you for watching this video I hope you enjoyed it on the esophagus clinical anatomy you


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  4. Food getting lodged and having to be regurgitated in a regular basis as it won’t go down..drinking water doesn’t help as water just comes back up.. any ideas??

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