ANATOMY OF upper ad middle OESOPHAGUS.pptx
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anatomy of esophagus
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ANATOMY OF upper ad middle OESOPHAGUS.pptx
- 2. • Fibromuscular tube 25cm,from C6 to T11 • a) mucosa • b) submucosa • c) musular layer • d) fibrous
- 3. • Nerve supply • Parasympathetic from vagus and • Sympathetic from the trunk. • Lymphatic Drainage- • cervical into deep cervical nodes • thoracic into posterior mediastinal • abdominal into gastric nodes.
- 4. Applied anatomy • 1. at pharyngo-oesophageal junction(C6)- 15cm from upper incisors. • 2. at the crossing of arch of aorta and left main bronchus(T4)-25cm from the upper incisors. • 3. as it pierces the diaphragm(T10)-40 cm from upper incisors.
- 5. Foreign bodies in food passage • Commonly ingested F B – • fish bone, • chicken bone, • needle, • denture, • coin or • safety pin.
- 6. Aetiology • AGE • Loss of protective mechanism-dentuers • unconsciousness • epileptic seizures • alcoholic intoxication • Narrowed passage-stricture or CA • psychotics
- 7. Clinical features • History of choking or gagging • Discomfort • Dysphagia • Drooling of saliva • Respiratory distresss • Substernal or epigastric pain due to spasm • Tenderness • Pooling in pyriform fossa
- 8. management • Plain X-rays- PA of neck and lateral view • Children screened from nasopharynx to rectum for multiple foreign bodies • Fluroscopy for radiolucent foreign bodies • Oesophagoscopic removal
- 9. Indications • Dignostic- • cause of dysphagia as CA achalasia cardia stricture or diverticula • Cause of retrosternal burning as hiatus hernia or reflux oesophagitis • Cause of haemetmesis-oesophageal varices • As a part of panendoscopy- to know the primary
- 10. Therapeutic • Removal of foreign body • Dilatation of strictures • Removal of benign lesions as cyst or fibroma • Injection of varices • Insertion of tube for palliative treatment of CA
- 11. contraindications • Trismus • Diseases of cervical spinesas spondylosis tuberculous spine, kyphosis • Receding mandible • Aneurism of aorta • Advanced heart, liver or kidney diseases.
- 12. Steps for procedure • Identification of arytenoids • Passing cricopharyngeal sphincter • Crossing the aortic arch and left main bronchus • Passing the cardia
- 13. complications • Injury to lips and teeth • Injury to arytenoids • Injury to pharynx • Perforation of oesophagus-at the Killians dehiscence-pain in interscapular region,raised temperature, surgical emphysema may develpe, may get complicated by abscess in retropharyngeal space or mediastinum.