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23 Cards in this Set

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supplied by the inferior thyroid artery
Cervical esophagus
supplied by the left gastric artery and inferior phrenic
arteries
Abdominal esophagus
Lymphatic drainage of the Esophagus
upper 2/3 drains cephalad , lower 1/3 drains caudad
Type of muscle in the upper esophagus?
striated muscle
Type of muscle in the lower esophagus?
smooth muscle
travels on posterior portion of stomach as it exits chest;
becomes celiac plexus; also has the criminal nerve of Grassi, can cause persistently
high acid levels post operatively if left undivided
Right vagus nerve
travels on anterior portion of stomach; goes to liver and biliary tree
Left vagus nerve
travels from right to left in chest at upper 1/3 of mediastinum; inserts
into left subclavian vein
Thoracic duct
most common site of esophageal perforation
Cricopharyngeus muscle
How far is the upper esophageal sphincter from incisors
15cm
Upper esophageal sphincter,
what is the inervation and muscle?
cricopharyngeus muscle
(circular muscle, prevents air swallowing); has recurrent laryngeal nerve innervation
Lower esophageal sphincter distance from incisors
40cm
Normal LES pressure at rest
10-20 mm Hg
Anatomic areas of narrowing of the Esophagus
1. Cricopharyngeus muscle
2. Compression by the left mainstem bronchus and aortic arch
3. Diaphragm
Surgical approach to the esophagus
-Cervical esophagus
left thorocotomy
Procedure of choice for dysphagia and odynophagia (better at picking up masses)
Barium swallow
Procedure of choice for heartburn
Endoscopy
Tx and Dx for Meat impaction
Dx and Tx: endoscopy
Possible etiology and tx Cervical esophageal dysphagia
Plummer-Vinson syndrome; usually due to web;
Fe-deficient anemia.
Tx: dilation, Fe; need to screen for oral CA
caused by increased pressure during swallowing
Zenker's diverticulum
a false diverticulum - posterior
• Occurs between the cricopharyngeus and pharyngeal constrictors
• Symptoms: upper esophageal dysphagia, choking, halitosis
Zenker's diverticulum
Dx: for Zenker's diverticulum
barium swallow studies, manometry; risk for perforation with EGD and Zenker's
Tx: for Zenker's diverticulum
cricopharyngeal myotomy (key point); Zenker's itself can either be resected or
suspended (removal of diverticula not necessary)
• Left cervical incision; leave drains in; esophagogram POD #1