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Surgical Anatomy

The oesophagus begins at the lower margin of the cricopharyngeous muscle and is approximately 25 cm  long.

  1. It has striated muscle in upper third, smooth muscle in the lower two thirds, and is lined throughout by   squamous epithelium.
  2. In the mediastinum, the oesophagus is closely related to the two trunks of the vagus nerve, the trachea, the aorta and the heart.
  3. The oesophagus enters the stomach approximately 45 cm from the incisor teeth.
  4. The barrier functions of the oesophagus depend on the upper cricopharyngeal and lower oesophageal sphincters, a zone of high pressure (15- 30 mmHg) extending over lowest 3-4cm of the esophagus; it has no anatomical counterpart.
  5. The pH within the oesophagus is usually 5-7. A pH of less than 4 is normally considered pathological;   assessment is best made by continuous 24 hour pH monitoring   Q.
  6. At the gastro-oesophageal junction, the transition from oesophageal to gastric mucosa is easily seen as an irregular circumferential line known as the ora serrata, gastric rosette, or Z-line.
  7. Speed of Peristalsis is 2 cm/s, Swallow-induced peristalsis is called primary peristalsis Q, and the peristalsis elicited by esophageal distention is called secondary peristalsis. Q
  8. Tertiary contractionsQ are simultaneous, isolated, dysfunctional contractions. These contractions are nonperistaltic, have no known physiologic role.

Barium swallow may show a constriction at three site :

  1. QCricopharyngeal junction – Narrowest point (15 cm from incisor)
  2. QMiddle narrowing – crossing of the left main stem bronchus and aortic arch (25 cm from incisor).
  3. QLower most narrowing – At the hiatus of the diaphragm (40 cm from incisor) 

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