Esophagus

the structure of the esophagus
Fig. 1. Topography of esophagus: 1 - cervical part of the esophagus; 2 - left bronchus; 3 - thoracic aorta; 4 - stomach; 5 - abdominal part of the esophagus; 6-the spine; 7 - thoracic part of the esophagus; 8 - the right bronchus; 9 - arch of the aorta; 10 - the trachea.

The esophagus is the digestive tract between the throat and stomach length on average 22-26 see Begins the esophagus at the level of the lower edge of VI cervical vertebra neck, down through the posterior mediastinum along the spine into the chest (thoracic), through hiatal penetrates into the cavity of the abdomen (abdominal part) and goes into cardiac Department of the stomach. In front of the esophagus are larynx, trachea and arch of the aorta (Fig. 1). The esophagus has three narrowing: when deviating from the pharynx, in place of dividing the trachea to the bronchi and passing through the aperture. The wall of the esophagus consists of an outer layer that represents the loose connective tissue; located underneath the muscle layer, consisting of external located longitudinal fibers and internal circular; submucosal layer and mucous membranes, lined with multi-layer flat epithelium. Cervical part P. receives blood from the lower thyroid and partially subclavian arteries; breast - through esophageal branch of the thoracic aorta, abdominal from the left gastric artery. The outflow of blood from the esophagus occurs through the veins, the relevant arteries. Thoracic main venous highways are unmatched and polurama of Vienna, in the abdominal part of the system of portal vein. Lymph outflow directed to the lymph nodes throat, mediastinum, stomach. Innerviruetsya P. wandering nerves forming on his wall plexus receiving branches from the sympathetic trunk and splanchnic nerves. For study of the esophagus have a value of: history, revealing pain, dysphagia (see); esophagoscopy (see), fluoroscopy and radiography, which allows to determine the level and degree of narrowing of the esophagus, the location, shape and size of the possible diverticulum (see), foreign body (see) or tumor.
To congenital malformations include: atresia (see), tracheo-esophageal and broncho-esophageal fistula. With them are often combined such defectsas atresia anus, ectopia of the bladder (see the bladder).
The esophageal atresia is detected from the first minutes of life of the newborn by leakage of mucus and saliva from the mouth and nose, regurgitation of milk when trying feeding.
If there fistula between the esophagus and the trachea or bronchus saliva and food content when feeding flow in the Airways of the child. There coughing, cyanosis, in light appear wheezing, quickly developing, aspiration pneumonia, which can lead to death of the newborn.
Crucial diagnostic value in these cases has fluoroscopy and radiography with the use of contrast agents (yodolipola). In rare cases, the use esophagoscopy. Early diagnosis and prompt treatment can save the life of the newborn.

The esophagus (esophagus) - the part of the digestive tract between the throat and stomach; muscular canal that begins on the level of the lower edge of VI cervical vertebra and ending with a transition into the cardiac portion of the stomach at the level of XI thoracal vertebra.

Embryology
In embryo man length 4-5 mm esophagus has the form of a short, wide tube, consisting of two rows of epithelial cells. The epithelium P. comes from material prechordal plate. From a single layer of prismatic it develops in a flat laminated; the cells of his are concentric rows. The lowering of the heart and the formation of the diaphragm accompanied by faster growth of P. in length, width, it decreases. On the 8th week in the epithelium P. appear vacuoles, which leads to increased clearance or crease formed a mucous membrane. The inner surface acquires a star shape because of folds and convergence of the walls of Petrograd In the embryo 12.5 mm appears circular muscle layer. Longitudinal varies greatly in the embryo 17 mm long, which is the formation of intramuscular and submucosal plexus; become visible and the choroid plexus.
By the time of birth the esophagus is a tube that is flattened at dorso-ventrally. In children due to insufficient development of the pharynx P. begins one vertebra above. In newborns length P. equals 11-16 cm, width 7-8 mm Total length P. in the adult about 25 cm in Width spasams state 15-20 mm


Anatomy
There are 3 Department P.: cervical, thoracic and abdominal (Fig. 1). Cervical vertebrae (pars cervicalis), length of 5-6 cm, is located at a height of VII cervical vertebra behind and slightly to the left from the initial part of the trachea, between the throat, ending at the level of the cricoid cartilage throat, and upper opening of the chest. The topography of this esophagus - see Neck.
From the level of the upper holes of the chest to f (inclusive continues thoracic vertebrae (pars thoracica P., the biggest on the whole (17-19 cm). It is located in the posterior mediastinum (see).
Abdominal Department (pars abdominalis) P., length, 1-3 cm, takes a cut between the diaphragm and the stomach. The movement of the diaphragm and the displacement of the stomach affect the length and thickness of P. in this Department. The degree of filling of the stomach food, bloating it also resize the abdominal P.
When passing through the esophageal opening of the esophagus is connected with medial legs diaphragm muscle bundles m. phrenicooesophageus and fibroelastosis membrane. The final part P. touches left lobes. The transition P. in the stomach is projected from a living person on the anterior abdominal wall at the level of cartilage YII left ribs near the sternum.
The thickness of the esophagus and its width clearance during vary. Natural contractions P. practical value are the following. First, the narrow, is located in the transition area of the throat in Petrograd Here cricoid cartilage is putting pressure on the front wall P. Itself wall is slightly thickened due circle muscle bundles. The second narrowing occurs on a place fit to P. the left bronchus and the aortic arch. Third, expressed more distinctly,- diaphragmatic sphincter P. - corresponds to the boundary between the IX and X of the thoracic vertebrae. Rentgenograficheskie stated physiological narrowing P. at the entrance to the stomach area cardiac sphincter. Above the diaphragm, and below it is possible to allocate portions of expansion P. newborns esophagus is more straight tube, the narrowing and bends it is not expressed.
Lumen., in normal conditions is a series of narrow longitudinal cracks that with the passage of food lump expanded. The cross section clearance P. has a star-shaped form. Wall thickness P. an average of 7-8 mm, while tension is reduced to 4 mm
The blood supply. In the cervical spine sources of blood supply P. serve esophageal branches inferior thyroid artery (rami oesophagei a. thyroideae inf.) and in 50% of cases is a direct branch of the left subclavian artery. The ramifications of these arteries in the thoracic esophagus 2-3 cm from the level of bifurcation of the trachea meet with esophageal branches (rami oesophagei) of the thoracic aorta (Fig. 2). Small collateral branches intercostal arteries also sometimes reach P. Abdominal Department P. receives blood from the left gastric artery (rami oesophagei a. gastricae sin.) and sometimes from the branches to the lower left diaphragmatic artery. Roundabout arterial road weakly developed. Well supplied with blood wall P. covered serous membrane.
The outflow of blood from the esophagus is done through the veins, the relevant supply P. arteries. Thoracic main venous highways on, are unmatched and polurama Vienna. In caudal thirds P. the direction of the current venous blood is changed to descending. Here peripheral blood is collected origins of the portal venous system - Porto-kavalenya anastomoses through the veins P.
The lymphatic system. The network of lymphatic capillaries are deposited in the mucous membrane, submucosal and muscle layers. Lymph outflow directed either towards
lymph nodes, stomach, or to the lymph nodes throat. For the upper third P. regional serve deep lymphatic nodes of the neck, to the middle third - tracheobronchial and rear mediastinal. From caudal thirds P. lymph going to lymph nodes in the abdomen is primarily stomach.
Innervation. Many branches of the right and left stray nerves form a surface plexus and penetrate into intermuscular (horbachevska) and submucosa (masherovski) plexus. In the cervical esophagus nerve fibers come in the composition of recurrent nerves. Below the root of the lungs right vagus nerve runs behind P., the left is located in the front. Plexus P. also receive branches from the sympathetic trunk, and from large splanchnic nerves. The mucous membrane P. has heat, pain and tactile sensitivity, and the most sensitive area of Peterhof is the transition region in the stomach.

Fig. 1. The esophagus (front): 1 - top narrowing; 2 - average narrowing; 3-bottom narrowing; 4 - diaphragma; 5 pars cardiaca ventriculi; 6 - pars abdominalis oesophagi; 1 - pars thoracica oesophagi; 8 - pars cervicalis oesophagi; 9 - pharynx (pars laryngeal
Fig. 2. View of the esophagus rear and front (b):
1 - trachea; 2 - truncus brachiocephalicus; 3 - arcus aortae; 4 - esophagus.

Research methods
Method study of the esophagus are key esophagoscopy (see) and x-ray P. (see below).