4. ESOPHAGOUS A muscular collapsible tube Measures about 10inch long Joins the pharynx to stomach

5. Anatomically it is divided into three parts Cervical Thoracic Abdominal ESOPHAGOUS

7. ABDOMINAL ESOPHAGOUS CONSTRICTIONS OF ESOPHAGOUS, At three sites esophagous is constricted, 1.Behind the cricoid cartilage 2.Where aorta and left bronchus crosses it 3.Enterance into the stomach

9. It enters the abdomen through an opening in the diaphragm called ‘’ESOPHAGEAL HIATUS’’ to the left of midline. Cross the diaphragm at the level of T10 ABDOMINAL ESOPHAGOUS

10. ESOPHAGOUS

11. After crossing a short distance of o.5inch It enters the stomach on its right. ABDOMINAL ESOPHAGOUS

13. RELATIONS ANTERIORLY; Related to the posterior surface of left lobe of liver and left vagus nerve. POSTERIORLY; Related to the left crus of the diaphragm and right vagus nerve ABDOMINAL ESOPHAGOUS

16. SPHINCTERS OF ESOPHAGOUS; 2 in number  UPPER ESOPHAGEAL SPHINCTER; Made up of skeleton muscle. Between the pharnyx and esophagous.  LOWER ESOPHAGEAL SPHINTER; Made up of smooth muscle. Between the esophagous and stomach. ABDOMINAL ESOPHAGOUS

18. LOWER ESOPHAGEAL SPHINCTER/CARDIAC SPHINCHTER/GASTROESOPHAGEAL SPHINCTER No anatomic sphincter exists at the lower end of esophagous. The circular layer of smooth muscle at this region serve as a ‘’PHYSIOLOGICAL SPHINCTER’’ Relax during swollowing. Its tonic contraction prevents the stomach contents from regurgitaion into the esophagous.Its closure is under VAGAL CONTROL augmented by GASTRIN and reduced by CCK,SECRETIN,GLUCAGON. ABDOMINAL ESOPHAGOUS

20. BLOOD SUPPLY; Branches from the LEFT GASTRIC ARTERY VEINS DRAINAGE ; Into the LEFT GASTRIC VEIN which is a tributary of the PORTAL VEIN. ANASTOMOSIS; Esophageal Branches of the LEFT GASTRIC VEIN with the esophageal branches of the AZYGOUS VEIN. LYMPH DRAINAGE ; Follow the arteries into the LEFT GASTRIC NODES NERVE SUPPLY ; PARASYMPATHETIC by the anterior and posterior gastric /VAGUS NERVE. SYMPATHETIC; by the thoracic part of the sympathetic trunk TOGETHER THEY FORM ESOPHAGEAL PLEXUS ABDOMINAL ESOPHAGOUS

24. ACHALASIA OF CARDIA; ’CLINICAL ANATOMY’’ A- Mean ‘without/ not’ + Greek word khalasis/chalais ‘loosening’ (from khalan ‘relax’) It is a condition in which the muscles of the lower part of the oesophagus fail to relax, preventing food from passing into the stomach. Cause is unknown although associated with the degeneration of the parasympathetic plx(auerbchs plx) Primary site is the cardioesophageal sphincter by the vagus nerve. DYSPHAGIA,REGURGITATION, DISTAL NAROWING,PROXIMAL DILATATION. Appears like a’’ BIRDS BEAK’’

27. ESOPHAGEAL VARICES; PORTAL-SYSTEMIC VENOUS ANASTOMOSIS If portal vein become obstructed e.g in cirrhosis of liver,portal hypertension. Resulting in dilation and varicosity. Varicosed esophageal veins rupture causing severe vomiting of blood(HEMATEMESIS) ‘’CLINICAL ANATOMY’’

29. GASTROESOPHAGEAL REFLUX DISEASE; It is a reflux of acid stomach contents into the esophagous producing the symptoms of heartburn. Occurs at least 2 occasions per week. If continous esophageal mucous membrane becomes inflammed. Esophageal lining changes from squammous to columnar (BARRETTS ESOPHAGOUS). Risk of adenocarcinoma at LE of esophagous Causes include failure of LES,hiatus hernia of diaphragm,Abd Obesity ‘’CLINICAL ANATOMY’’