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Clinical anatomy and physiology of the esophagus
The esophagus (oesophagus) is a continuation of the pharynx from the level of the lower edge of the cricoid cartilage (CV) and is a flattened anteroposterior muscle tube 24-25 cm long.
The esophagus passes into the stomach at the Thxi level, which corresponds to the site of attachment of the VII costal cartilage to the sternum.
The total distance from the front teeth (through the mouth, pharynx, and esophagus) to the stomach in adults is 38–42 cm. In the upper section, the esophagus is located on the front surface of the body of the lower cervical vertebra. This section of the esophagus is called the cervical. In the chest cavity at the Thlx level, the esophagus is pushed anteriorly by the aorta. It should be noted that the course of the esophagus is not straightforward. In the cervical region, located behind the trachea, it protrudes from under its left edge, therefore, if necessary, cervical esophagotomy is performed from this side. In the cervical region and at the beginning of the thoracic esophagus, it is located in front of the spine and behind the trachea, then passes behind the left main bronchus and heart, which are to the left. The aorta in its upper part is located to the left of the esophagus, and in the area of the diaphragm - behind it. The length of the esophagus is not the same: cervical 4-4.5 cm, thoracic 14-16 cm, abdominal 2-4 cm.
The esophagus has three anatomical (stored on the corpse) and two physiological (only in living) narrowing. Anatomic constrictions include: I - narrowing at the beginning of the esophagus, called the "mouth"; II - bronchial - at the level of bifurcation of the trachea; III - diaphragmatic - in the esophageal opening of the diaphragm. Physiological narrowing: aortic - at the intersection of the esophagus with the aorta, cardiac - when it passes into the stomach. Constriction of the esophagus play a role in the development of the pathology of this organ. The cervical and abdominal parts of the esophagus are in a collapsed state, and the chest is gaping due to negative pressure in the chest cavity.
The wall of the esophagus is formed by three layers: the inner one is the mucous membrane, the middle one is muscular, the outer one is loose connective tissue (there is no fascial membrane or capsule, the esophagus). The mucous membrane is covered with stratified squamous epithelium and is collected in folds extending in the longitudinal direction. Due to the longitudinal folding, the loose submucosal layer and the loose connective tissue surrounding the esophagus, its lumen can expand with the passage of food.
The muscular layer of the wall of the esophagus is represented by a more pronounced external longitudinal and internal circular layers. In the upper sections of the muscle are composed of striated fibers, in the lower - from smooth. In the mucous membrane itself there are smooth muscle fibers that are involved in the formation of its longitudinal folds.
Numerous mucous glands and, rarely, lymph nodes are located in the submucosal layer. In the lower esophagus, also in the submucosal layer, glands of small sizes rarely reside, similar in structure to the cardiac glands located in the stomach. This explains the possibility of the formation of tumors in the esophagus that are identical in structure to tumors of the stomach.
The cervical esophagus is supplied with blood through the esophagus arteries (aa.oesophageae) from the lower thyroid artery (a.thyreoidea inferior), the thoracic branch with branches extending from the thoracic aorta, the abdominal part from the lower diaphragmatic (a. Phenica inferior) and left gastric ( a.gastrica sinistra) arteries. The outflow of blood from the esophagus is carried out in the cervical region to the lower thyroid veins, in the thoracic region - to the unpaired (v.azygos) and semi-unpaired (v.hemiazygos) veins, in the abdominal veins are connected with the portal vein system (v.portae).
The lymphatic system of the esophagus is represented by a superficial and deep network. The surface network originates in the thickness of the muscle wall, and the deep is located in the mucous membrane and submucosal layer. The outflow of lymph in the cervical region occurs in the upper paratracheal and deep cervical nodes, in the thoracic and abdominal regions - in the paratracheal and parabronchial nodes of the cardial part of the stomach.
The innervation of the esophagus is carried out by the branches of the vagus and sympathetic nerves.
The main function of the esophagus is the active passage of food into the stomach. At the time of swallowing, the “mouth” of the esophagus opens and the muscles of the pharynx advance the food lump into the initial section of the esophagus, then the muscles of the esophagus, by peristaltic contraction, push the food lump into the stomach.
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