00:01
Now we're going to move on
to the esophagus.
00:05
The esophagus is
the long muscular tube
that connects the pharynx
to the stomach.
00:11
And it doesn't just
have thoracic parts.
00:14
It starts in the neck and
ends in the abdomen.
00:17
It's about 22 to 25
centimeters long.
00:21
And, like the trachea
starts around the C6 vertebra,
just after the pharynx
at something called
the pharyngoesophageal junction.
00:32
And it will terminate distally at
around the T11 vertebra,
where it joins the stomach at
the gastroesophageal junction.
00:43
So let's look at the esophagus
in relation to
some other structures here.
00:47
So here we have the esophagus.
00:49
And we see that a certain point
it's going to have
to go through the diaphragm.
00:54
And we saw in the diaphragm
lecture that there's an opening
called the esophageal hiatus
that allows the esophagus
to travel through the diaphragm
and briefly become
an abdominal portion
before joining the stomach.
01:09
So let's look at those parts.
01:10
So we start off in the neck.
01:13
And so we call that
the cervical part.
01:16
And it will terminate right about
the area we reach the thorax.
01:20
So right about at the
jugular suprasternal notch.
01:24
And there becomes the
thoracic part
until we hit the diaphragm
at the esophageal hiatus.
01:31
And then briefly,
we have the abdominal part
before entering into the stomach.
01:37
Now, the esophagus
is going to do its job
by moving food via involuntary
contractions called peristalsis.
01:45
However, most of the time
nothing's being swallowed.
01:48
So it's going to be closed off
by two sphincters,
one proximally,
and one distally.
01:54
Proximally, is going to be
the superior sphincter
at that pharyngeal
esophageal junction.
02:00
And it's also called the upper
esophageal sphincter or UES.
02:05
Distally, we're going to
have the inferior sphincter
at the gastroesophageal junction.
02:11
And that's often called the
lower esophageal sphincter or LES.
02:17
And it's really important for
the sphincters to open and close
only when they're supposed to.
02:21
So for example, here we see the
esophagus coming down to the stomach
and the LES the smooth muscle
in this area
should open and close
only with swallowing.
02:32
However, if for some reason,
the lower esophageal sphincter
can't relax and open up in
something called achalasia,
any food or liquids
that are swallowed
can't pass into the stomach.
02:46
And that will cause the esophagus
to start to dilate.
02:50
Conversely, closure of that
lower esophageal sphincter
also serves to keep acid in the
stomach where it belongs.
03:00
If it can't contract and
it stays open too much,
then that acid can go back up
into the esophagus, or reflux.
03:09
And this is something very
common called
gastroesophageal reflux disease.
03:14
And because the esophagus isn't
really meant to handle acid
like the stomach is,
it can cause damage
that over time can cause
some pretty severe consequences.
03:24
Just because the sphincters
open and close
when they're supposed to
doesn't mean that
it's smooth sailing for food
the rest of the way.
03:32
There are certain points
along the esophagus,
where that tube can get
a little bit narrower.
03:38
And we call these
areas constrictions.
03:41
And so if a large solid object
were to be swallowed,
it's going to be more likely
to lodge at these areas
of constriction.
03:51
The first one is the
pharyngoesophageal constriction.
03:55
And that's a constriction
because of the nearby cartilage,
the cricoid cartilage.
04:00
Because that's a pretty
intense cartilage,
it goes all the way around
and forms a complete circle
just in front of the esophagus.
04:09
Then we have the thoracic ones.
04:12
And these constructions are going
to be caused by the aortic arch
and the left bronchus.
04:20
And then finally inferiorly,
we have the
diaphragmatic constriction,
being caused by the presence of the
diaphragm at that esophageal hiatus.
04:30
Now let's look at how the esophagus
relates to some other structures
starting with what sits
anterior to it.
04:36
Well, in the trachea section,
we mentioned that
the trachea and esophagus
run together.
04:41
And the trachea indeed sits
just anterior to the esophagus
because it actually developed
from the primitive esophagus
very early in development.
04:51
At a certain point, it's going to
bifurcate and go into the lungs.
04:55
So then after that point, it's
going to be bounded anteriorly
by the pericardium.
05:01
And then finally,
it's going to hit the diaphragm.
05:05
Posteriorly, it's going to be
bounded by the vertebral column
all along its length.
05:11
Laterally, on the right side,
it's going to have
the right parietal pleura,
and the azygos vein.
05:19
And on the left, it's going to
have the left parietal pleura
and some arteries.
05:25
It's going to have the
left subclavian artery.
05:27
It's going to have
the aortic arch
and the descending aorta
to its left.
05:33
So what about the blood supply
to the esophagus itself?
Well, in the cervical esophagus,
we have the inferior thyroid artery.
05:43
For the thoracic part, it's coming
from branches off of the aorta.
05:50
But when we get to the
abdominal part,
which is pretty short,
it's getting some esophageal
branches of the left gastric artery,
which is actually a branch
of the celiac trunk
down in the abdominal aorta.
06:03
Similarly, the venous drainage
mirrors the arterial supply
so that it's drained in the
cervical region by
inferior thyroid vein
in the thoracic part by the azygos.
06:13
And then, abdominally,
by the left gastric vein.
06:16
In terms of innervation,
there is a plexus that sits
all along the surface
of the esophagus,
composed of parasympathetic
and sympathetic nerves
of the autonomic nervous system.
06:29
Where the parasympathetic portion
is coming from the vagus nerves.
06:33
And the sympathetic portion
is coming from the sympathetic trunk
that runs up and down on either side
of the vertebral column.