5 Esophageal Diseases
• Fibromuscular tube (~25 cm) running from the pharynx in the neck, through the thorax and diaphragm, to the stomach in the abdomen
• Runs just posterior to the trachea and anterior to vertebral bodies in the neck and superior mediastinum
• Tends to run to the left below T4 but is pushed to the center by the arch of the aorta and the root of the left lung
• Upper esophageal sphincter: circular muscle of the superior esophagus, including the cricopharyngeus, the first region of anatomical constriction
• Also compressed in its course by 3 structures, as seen on barium swallow (when expanded)
• Retropharyngeal danger space: possibility of infection spreading retroesophageally into the thorax
• Highly folded stratified squamous epithelium, with walls in apposition unless distended by swallowing
• Inner circular: continuous superiorly with the circumferential fibers of the inferior pharyngeal constrictor
• The esophageal nerve plexus is composed of vagal afferent and efferent, sympathetic efferent, and segmental sensory components.
• Parasympathetic preganglionic fibers
• Sympathetic postganglionic fibers
• Extensive submucosal vascular plexuses allow mobilization of large extents of the esophagus with reduced risk of ischemia.
• Cervical portion is supplied by branches of the inferior thyroid arteries from thyrocervical trunks of the right and left subclavian arteries.
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