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The Esophagus
Tube-like structure
Portion of the upper digestive tract
Conducts food from the pharynxstomach via
rhythmic contractions (peristalsis)
Mucous glands lubricate the bolus
25 cm (10 inch) in length, 2.5 cm (20.5mm, 1 inch)
in diameter
~C5/6- T11
Left of midline
Cricoid cartilage to thoracic inlet
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(Zimbio.com)
Areas of Natural
Esophageal Narrowing
1.
2.
3.
http://www.sts.org/
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Innervation
Motor innervation is via vagus CNX
UES/ proximal esophagus- striated cell bodies arise in
nucleus ambiguous
Distal esophagus/ LES- smooth fibers originate in the
dorsal motor nucleus also receive sympathetic nerve
supply (motor and sensory) from spinal segments T1-T10
Sensory innervation via vagus- cell bodies originate in
nodose ganglion project to brainstem
Local nervous system- Enteric Nervous System
Physiology
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Esophageal Stage
Primary peristalsis
contractile wave migrates toward stomach
Relaxation of the UES and LES
Induced by swallowing
Secondary Peristalsis
distention of the esophagus
LES relaxation only
Tertiary Contractions
Non- useful/ non- propulsive
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UES Function
LES Function
Pressure barrier that separates the
esophagus from the stomach
Serves to prevent reflux of gastric contents
into the esophagus
Poor LES pressure GERD
Relaxation of LES
LES promptly relaxes with:
Deglutition
Distention of the esophagus
Belching or vomiting
Swallow induced LES relaxation:
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Dysphagia
Odynophagia
Heartburn or pyrosis
Regurgitation
Nonheartburn chestpain
Waterbrash
Bleeding
Respiratory symptoms/ cough
Laryngeal symptoms
Disorders overview
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Disorders of the
Cervical Esophagus
Cricopharyngeus hypertension
Prominent cricopharyngeus/ CP bar/ pharyngeal bar
CP hypertrophy
CP fibrosis
Radiation
GERD
Zenkers Diverticulum
Cervical osteophytes
Anterior cervical esophageal web
Anatomic Variants
Hiatal Hernia
Most are acquired
Shortening secondary to GERD
Congenitally short esophagus
2 types
Sliding
Paraesophageal
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http://heartburn-home-remedies.net/hiatal-hernia-pictures/
GERD
Gastroesophageal reflux represents the
backflow of gastric contents from the
stomach into the esophagus. When it is
frequent or severe, it is considered GERD
Complicated GERD
1.Esophagitis
2.Peptic stricture
3.Barretts esophagus
4.LPR/ Respiratory
complications
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LPR Definition
Laryngopharyngeal reflux represents the
backflow of gastric contents from the
stomach through the esophagus and into
the laryngopharynx
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Non-Reflux Induced
Esophagitis
1. Infectious esophagitis
a. Candida esophagitis
b. Herpes simplex esophagitis
4. Radiation-induced esophagitis
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Motor Disorders
Primary motor disorders
Motor Disorders
Primary- (no known etiology)
Hypertensive peristaltic or nutcracker
esophagus
Diffuse esophageal spasm or corkscrew
esophagus
Achalasia
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Nutcracker Esophagus
Normally propagated, high amplitude
peristaltic waves in distal esophagus
Duration of contraction wave prolonged
LES relaxation normal, but resting LES pressure
is elevated
May progress to diffuse esophageal spasm or
achalasia
C/o:
Angina-like chest pain
Do not generally c/o dysphagia
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Achalasia
Aperistalsis in the body of the esophagus
Elevated LES pressure
Absent or incomplete LES relaxation in
response to swallowing
Progressive dilation of esophagus
bird beak appearance of LES
C/o: dysphagia for solids and liquids,
regurgitation, fullness, possible chest pain
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Motor Disorders
Secondary-(caused by systemic/ local
condition, age)
Acid-induced dysmotility
Related to neuropathy (diabetes or alcoholism)
Esophageal involvement in scleroderma or
other connective tissue disorders
presbyesophagus
Esophageal Rings
Schatzkis ring- a lower esophageal mucosal ring
Squamos epithelium on superior, columnar
inferior border
Common cause of dysphagia (lumen <13mm)
(intermittent 13-20mm)
Cause unknown
Intermittent solid-food dysphagia
Episodic food-bolus obstruction
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Esophageal Diverticula
Zenkers diverticulum
Midesophageal diverticulum
Lower esophageal or epiphrenic diverticulum
(Intramural diverticulosis)
Zenkers Diverticulum
Mucosal weakness
Arises posteriorly in the midline between the
oblique inferior pharyngeal constrictor muscles
and transverse cricopharyngeal fibers Killians
dehiscence
Enlarges shifts left of midline
Result of decreased compliance of the CP
muscle abnormally high pressures in the
hypopharynx during deglutition
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