ESOPHAGUS
ESOPHAGUS
ESOPHAGUS
outline
Embryology
Congenital anomalies
Extent and structure
Clinical correlates
Course
Curvatures
Relations
Blood and nerve supply
Lymphatic drainage
Embryology
• The esophagus develops from the foregut immediately caudal to the
pharynx.
• During embryonic development, the esophagus and trachea initially share
a single-lumen tube at the anterior region of the foregut.
• As organogenesis proceeds, the anterior foregut separates and generates
the trachea ventrally and the esophagus dorsally. This tracheal-esophageal
separation occurs approximately 4-6 weeks of gestation in humans
• The foregut is divided into the esophagus dorsally and the trachea ventrally
by the tracheoesophageal folds, which fuse to form the tracheoesophageal
septum
• Initially, the esophagus is short, but it elongates rapidly, mainly
because of the growth and relocation of the heart and lungs
• The esophagus reaches its final relative length by the seventh week.
• Its epithelium and glands are derived from endoderm.
• The striated muscle forming the muscularis externa of the superior
third of the esophagus is derived from mesenchyme in the fourth and
sixth pharyngeal arches.
• The smooth muscle, mainly in the inferior third of the esophagus,
develops from the surrounding splanchnic mesenchyme
Congenital anomalies
Congenital anomalies of the esophagus are divided into three
categories:
• Or adenocarcinoma AC (glandular
cells) causes; smoking, acid reflux,
obesity. 7-10> males.
Cervical part
Anteriorly, it is related to:
(a) trachea
• Thoracic duct.
• Vertebral column
Laterally thoracic part- rt
Right lung and pleura.
Azygos vein.
Anteriorly posteriorly
• Left gastric nerve • Right gastric nerve
• Posterior surface of left lobe of • Left crus of the diapragm
liver
Esophageal constrictions
• Cricopharyngeal sphincter- 15cm
from incisor teeth- narrowest
part, c6
• Predilection to carcinoma
• High tendency to rupture, 25-40% in pts with cirrhosis, with 30% mortality
risk/ episode of active variceal bleeding and 70% risk of reccurent
hemorrhage.