{"id":1795,"date":"2020-08-17T13:29:06","date_gmt":"2020-08-17T13:29:06","guid":{"rendered":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/thorax\/mediastinum\/esophagus\/"},"modified":"2021-10-09T10:27:13","modified_gmt":"2021-10-09T08:27:13","slug":"esophagus","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/thorax\/mediastinum\/esophagus\/","title":{"rendered":"Esophagus"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">\n<p class=\"wp-block-paragraph\"><div class=\"intro\">The esophagus is a ~25cm-long fixed muscular tube lined by mucosa connecting the pharynx to the stomach.<\/div><\/p>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Description<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">The esophagus extends from the&nbsp;<strong>pharyngoesophageal<\/strong> junction&nbsp;at the level of the C6 vertebra down to where it meets the stomach below the level of the T10 vertebra.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Generally, the esophagus is located posterior to the trachea and heart, and anterior to the vertebral column.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Path<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">Its location, relation to its surroundings, and the nearby structures vary greatly through its path.<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>Initially, the esophagus deviates to the left, and along the way, down the neck, the esophagus will deviate slightly to the right<\/li><li>At the level of the aorta, it crosses it anteriorly behind the left atrium<\/li><li>Next, the esophagus deviates to the left, passing through the esophageal hiatus in the diaphragm at T9-10, meeting the stomach at the&nbsp;<strong>esophagogastric junction<\/strong>&nbsp;at the level of T10-11 vertebra, 2 cm to the left of the midline<\/li><\/ol>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Parts<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">The esophagus can be divided into three parts, from top to bottom, based on its muscular structure:<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><strong>Skeletal muscle<\/strong>&nbsp;\u2014 At the cervical level<\/li><li><strong>Mixed skeletal and smooth muscles<\/strong>&nbsp;\u2014 At the thoracic level<\/li><li><strong>Smooth muscle<\/strong>&nbsp;\u2014 At the lower thoracic and abdominal level<\/li><\/ol>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Constrictions<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">Along its path, the esophagus is pressed by other structures as it passes down; these structures create so-called&nbsp;<strong>constrictions<\/strong>&nbsp;<em>(or&nbsp;<strong>angustia<\/strong>, from the Latin word&nbsp;<strong>ang\u014d&nbsp;<\/strong>which means to press together)<\/em>&nbsp;in the esophagus:<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><strong>Cervical constriction<\/strong><\/li><li><strong>Thoracic constrictions<\/strong><ol><li><strong>Aortic constriction<\/strong><\/li><li><strong>Bronchial constriction<\/strong><\/li><\/ol><\/li><li><strong>Diaphragmatic constriction<\/strong><\/li><\/ol>\n\n\n\n<div class=\"wp-block-columns are-vertically-aligned-top is-layout-flex wp-container-core-columns-is-layout-8f761849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-vertically-aligned-top is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\"><\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Cervical constriction<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Also called the&nbsp;<strong>cricoid constriction<\/strong>&nbsp;(or angustia)&nbsp;since it\u2019s located at the level of the cricoid cartilage, and the pharyngoesophageal junction (right at the beginning of the esophagus)&nbsp;<strong>C6<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is formed by the&nbsp;<strong>cricopharyngeus muscle<\/strong>&nbsp;which creates the&nbsp;<strong>upper&nbsp;esophageal sphincter<\/strong>.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Thoracic constrictions<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">Sometimes referred to as a single group constriction&nbsp;which is located at T3-T4:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Aortic constriction<\/strong>&nbsp;\u2014 As the esophagus is crossed by the aorta around T3 vertebra, pushing the esophagus to the right.<\/li><li><strong>Bronchial constriction<\/strong>&nbsp;\u2014 As the esophagus is crossed by the left main bronchus around T4 vertebra, pushing the esophagus to the left.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diaphragmatic constriction<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">As the esophagus passes through the&nbsp;<strong>esophageal hiatus&nbsp;<\/strong>in the diaphragm at the level of T9\/10, or 7th left costal cartilage, 2 cm from the midline. The&nbsp;<strong>pharyngoesophageal ligament&nbsp;<\/strong>will tether it to the diaphragm, with the subhiatal fat ring acting as an anchor.<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-vertically-aligned-top is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<div class=\"wp-block-image is-style-default\"><figure class=\"aligncenter size-medium\"><a href=\"https:\/\/meddists.com\/learn\/wp-content\/uploads\/2021\/10\/esophagus-lateral-view.png\" target=\"_blank\" title=\"Esophagus\"><img loading=\"lazy\" decoding=\"async\" width=\"253\" height=\"300\" src=\"https:\/\/meddists.com\/learn\/wp-content\/uploads\/2021\/10\/esophagus-lateral-view-253x300.png\" alt=\"\" class=\"wp-image-7316\" srcset=\"https:\/\/meddists.com\/learn\/wp-content\/uploads\/2021\/10\/esophagus-lateral-view-253x300.png 253w, https:\/\/meddists.com\/learn\/wp-content\/uploads\/2021\/10\/esophagus-lateral-view-863x1024.png 863w, https:\/\/meddists.com\/learn\/wp-content\/uploads\/2021\/10\/esophagus-lateral-view-768x911.png 768w, https:\/\/meddists.com\/learn\/wp-content\/uploads\/2021\/10\/esophagus-lateral-view.png 1088w\" sizes=\"auto, (max-width: 253px) 100vw, 253px\" \/><\/a><figcaption><strong>Figure 1. <\/strong>The esophagus and its constrictors (left lateral view)&nbsp;<\/figcaption><\/figure><\/div>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/meddists.com\/wp-content\/uploads\/2018\/09\/phrenoesophageal-ligament.png\" target=\"_blank\" title=\"Esophagus\"><img decoding=\"async\" src=\"https:\/\/meddists.com\/wp-content\/uploads\/2018\/09\/phrenoesophageal-ligament-600x345.png\" alt=\"\" class=\"wp-image-18307\"\/><\/a><figcaption><strong>Figure 2. <\/strong>The esophagogastric junction&nbsp;(Credit: Elsevier,&nbsp;<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA 4.0<\/a>)<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Sphincters<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<p class=\"wp-block-paragraph\">The esophagus is equipped with two sphincters found at both of its ends. They are the <strong>upper <\/strong>and <strong>lower esophageal sphincters<\/strong> (UES and LES).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The UES is formed by the <a href=\"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/head-and-neck\/head\/muscles-head\/muscles-of-the-pharynx\/\">cricopharyngeus muscle<\/a>, and is under <strong>voluntary control<\/strong>. It protects against the aspiration of fluids and food to the trachea, as well as prevents the entry of air into the digestive tract.<\/li><li>The LES is <strong>involuntary<\/strong> and it prevents the reflux of gastric juice from the stomach. <\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Neurovasculature<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"pure-table\"><tbody><tr><td><strong>Blood supply<\/strong><\/td><td>The cervical part is supplied by the&nbsp;inferior thyroid artery<br>The thoracic part is supplied by the&nbsp;esophageal branches&nbsp;of the&nbsp;thoracic aorta<br>The abdominal &nbsp;part is supplied by the&nbsp;esophageal branches&nbsp;of the&nbsp;left gastric artery&nbsp;(a branch of the celiac trunk)<\/td><\/tr><tr><td><strong>Venous drainage<\/strong><\/td><td>The cervical part is drained by the&nbsp;inferior thyroid veins<br>The thoracic part is drained by the&nbsp;hemiazygos vein<br>The abdominal part is drained by the&nbsp;left gastric vein, which reaches the portal circulation<\/td><\/tr><tr><td><strong>Innervation<\/strong><\/td><td>Esophageal plexus<br>Carries fibers from the Vagus nerve, sympathetic ganglia, and from the greater splanchnic nerve.<br>The Vagal and sympathetic fibers innervate the smooth muscle and glands of the inferior two-thirds of the esophagus<\/td><\/tr><tr><td><strong>Lymphatic drainage<\/strong><\/td><td>The cervical part is drained by the&nbsp;deep cervical nodes<br>The thoracic esophagus is drained by the&nbsp;superior and inferior mediastinal nodes<br>The abdominal part is drained by the&nbsp;celiac nodes<\/td><\/tr><\/tbody><\/table><figcaption><strong>Table 1. Neurovasculature of the esophagus<\/strong><\/figcaption><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Clinical information<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Esophageal motility disorders<\/strong> are a group of conditions in which the esophageal body or sphincters may lead to difficulty in swallowing and pain.<\/li><li><strong>Gastroesophageal reflux disease (GERD)<\/strong> is a condition in which the lower esophageal sphincter is incompetent, leading to the reflux of gastric juice.<\/li><li><strong>Esophageal diverticulum<\/strong> is a condition in which a portion of the esophagus protrudes through the esophageal tissue or its surrounding structures, forming a sack-like protrusion.<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Description<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Path<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Parts<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Constrictions<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Cervical constriction<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Thoracic constrictions<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diaphragmatic constriction<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Sphincters<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Neurovasculature<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Clinical information<\/h3><\/div><\/p>\n<div id=\"the_titles\" style=\"display:none;\"><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":1775,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1795","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Esophagus &#8211; 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