Esophagus

The esophagus is a tubular

structure that is continuous
above with the laryngeal
part of the pharynx
opposite the sixth cervical
vertebra

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Esophagus
Begins at the lower border
of the cricoid cartilage (C6)
and descends posterior to
the trachea

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Esophagus
Begins at the lower border of the
cricoid cartilage (C6) and
descends posterior to the trachea

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Esophagus
Distance from
teeth to stomach:
40-45cm
A muscular tube
(approximately 25
cm long)
Average diameter
of 2 cm
Conveys food from
the pharynx to the
stomach
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 It passes through the
diaphragm at the level of
the 10th thoracic vertebra
to join the stomach

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 Esophagus
Terminates by
entering the
stomach at the
cardial orifice of
the stomach to the
left of the midline
at the level of the
7th left costal
cartilage and T11
vertebra.

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 In the neck, the
esophagus lies in front
of the vertebral
column; laterally, it is
related to the lobes of
the thyroid gland; and
anteriorly, it is in
contact with the
trachea and the
recurrent laryngeal
nerves. 7
Passes from
Esophagus
superior and
posterior
mediastinum

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 In the posterior mediastinum
the esophagus related to a
number of important structures

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 The relations of the
thoracic part of the
esophagus from above
downward:
 Anteriorly: The trachea
and the left recurrent
laryngeal nerve; the left
principal bronchus, which
constricts it; and the
pericardium, which
separates the esophagus
from the left atrium.

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 Posteriorly: The bodies
of the thoracic
vertebrae; the thoracic
duct; the azygos veins;
the right posterior
intercostal arteries;
and, at its lower end,
the descending
thoracic aorta

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 Right side: The mediastinal
pleura and the terminal part of
the azygos vein
 Left side: The left subclavian
artery, the aortic arch, the
thoracic duct, and the
mediastinal pleura

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 Inferiorly to the level of
the roots of the lungs, the
vagus nerves leave the
pulmonary plexus and join
with sympathetic nerves
to form the esophageal
plexus. The left vagus lies
anterior to the esophagus
and the right vagus lies
posterior
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 At the opening in the
diaphragm, the esophagus
is accompanied by the two
vagi, branches of the left
gastric blood vessels, and
lymphatic vessels.

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 In the abdomen, the esophagus
descends for about (1.3 cm)
and then enters the stomach. It
is related to the left lobe of the
liver anteriorly and to the left
crus of the diaphragm
posteriorly.

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Esophagus
Can be
compressed or
narrowed by
surrounding
structures at
three locations
Or has three
constriction

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Cervical constriction (upper
esophageal sphincter): at its
beginning at the pharyngo-
esophageal junction, approximately
15 cm from the
incisor teeth; formed by the
cricopharyngeus muscle Thoracic
(broncho-aortic) constriction: a
compound constriction where it is
first crossed by the arch of the
aorta, 22.5 cm from the incisor
teeth, and then where it is crossed
by the left main bronchus, 27.5 cm
from the incisor teeth; the former is
seen in anteroposterior views, the
latter in lateral views.
Diaphragmatic constriction:
where it passes through the
esophageal hiatus of the
diaphragm, approximately 40 cm
from the incisor teeth
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18
Esophageal constrictions
These constrictions have
important clinical
consequences. A swallowed
object is most likely to lodge
at a constricted area.An
ingested corrosive substance
would move more slowly a
narrowed region ,causing
more damage at this site
than elsewhere along the
esophagus

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 The phrenicoesophagial ligament
Connects the esophagus flexibly to the diaphragm
Limits upward movement of the esophagus while
permitting some movement during swallowing
and respiration

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 Muscular layer of esophagus
Internal circular and
external longitudinal
layers of muscle
Superior third, the
external layer consists of
voluntary striated
muscle;
Inferior third is
composed of smooth
muscle,
Middle third is made up
of both types of muscle
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Muscular layer of esophagus
Longitudinal layers begin
as two seperate bundles of
muscle fibers from the
posterior surface of cricoid
cartilage
When it descends, it
covers the whole
esophagus
Until the two bundles
combine, 3 cm distance is
only covered by mucosa
and circular fibers… weak
point….. Diverticulum may
form
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Esophageal
diverticulum

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The esophagogastric junction
Lies to the left of the T11 vertebra
on the horizontal plane that passes
through the tip of the xiphoid
process.
Surgeons and endoscopists
designate the Z-line, a jagged line
where the mucosa abruptly changes
from esophageal to gastric mucosa
Immediately superior to this
junction, the musculature of the
right crus of the diaphragm forming
the esophageal hiatus functions as
an extrinsic physiological inferior
esophageal sphincter that contracts
and relaxes

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 The esophagogastric junction

Radiologic studies show that food stops

here momentarily and that the
sphincter mechanism is normally
efficient in preventing reflux of gastric
contents into the esophagus.  
Reflux: condition in
which liquid from
the stomach moves upwards into
the oesophagus 

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Hiatal hernia

A hiatal hernia occurs

when the upper part
of the stomach
pushes up through
the esophageal hiatus
and into thorax

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Arteries of esophagus

 The upper third of the esophagus is supplied

by the inferior thyroid artery
 the middle third by branches from the
descending thoracic aorta and bronchial
arteries
 the lower third by branches from the left
gastric artery.

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Veins of esophagus
 The veins from the upper third
drain into the inferior thyroid
veins,
 from the middle third into the
azygos veins,hemiazygos
vein
 from the lower third into the
left gastric vein

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 The lymphatic of esophagus

 Lymph vessels from the

upper third of the
esophagus drain into the
deep cervical nodes, from
the middle third into the
superior and posterior
mediastinal nodes, and from
the lower third into nodes
along the left gastric blood
vessels and the celiac nodes
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Nerve Supply of the Esophagus

 The esophagus is supplied by

parasympathetic and sympathetic fibers

 Both side’s vagus nerves unit with the

sympathetic fibers coming from the
sympathetic trunk and form esophageal
plexus

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 Vagus nerve
At the lower levels of
esophagus, the branches
of the esophageal
branches unit
Anterior to esophagus,
anterior vagal trunk is
formed
Posterior to esophagus,
posterior vagal trunk is
formed
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32
 Vagus nerve

Anterior & posterior vagal trunks,

pass to abdominal cavity with the
esophagus

In abdomen, they give off anterior

gastric , posterior gastric, hepatic,
coeliac, and renal branches

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