Esophagus

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esophagus it is the channel muscle-membranoso ofdigesting apparatus that allonge from pharynx passing for cardias until stomach. Its function is to carry the alimentary bolus from mouth until the stomach, where it will come digested.

Index

Human anatomy

The esophagus has one length of approximately 25 cm and one width of 2-3 cm. The passage of the bolus does not happen for gravita, but thanks to energetic peristaltic waves.
It begins to a next level to cricoidea cartilage and it finishes low with a circular orifice (cardias) with which it communicates with stomach.
The esophagus occupies initially the inferior feature of neck and it comes down therefore in thorax, arranging itself deeply in mediastino, the classified space to heart. To the beginning it is situated behind trachea, when this is divided in the two bronchi, the esophagus s' intercrosses in front of the left bronchus, while more low it isaorta that it is intercrossed. Therefore the esophagus enters in relationship with the posterior face of the heart. It crosses diaphragm, penetrating therefore inabdomen and it is continued with the stomach.
In its to come down towards the bottom, the esophagus follows vertebral column, but it is not maintained along the median line of the body: to the beginning it is situated in means, but, coming down, door before light on the left therefore to right, in order to make place the aorta, passing to the left side of the vertebral column, in proximity of the diaphragm door newly on the left, intercrossing the aorta newly.
The esophagus is dilatabile and therefore its shape is various in filled up function that is or less from the food. When it is empty is flattened and its lume is only one fissure; when it is filled up assumes a irregular cylindrical shape, with a sure number of narrow points: the four narrowing natural of the esophagus. The first one (cricoideo) and the last one (diaframmatico) they are constituted from the points in which the esophagus it begins and it finishes, the others two are in the points in which it intercrosses with the left bronchus (bronchial) and with the aorta (aortico).

Structure

The internal surface is covered from one epithelium more layers. The frock inner mucosa is whitish, with a thickness of 0,8-1 milimeter and it is raised from folds that come down longitudinally from the pharynx to the esophagus.
The mucosa of the esophagus is constituted from three layers, that they are found also in the other segments of the digesting tube:

  • epithelium
  • own frock, much thin one and supported externally to muscolaris mucosae
  • muscolaris mucosae, formed from a thin muscular fiber layer.

Epithelium

Pluristratificato is of pavimentoso type, constituted from overlapping layers of cells. Those most superficial ones have flattened cells, above all in the advanced feature. In proximity of the cardias, they stretch to disporsi on an only layer, assuming one greater thickness, until becoming cylindrical epiteliali cells in the passage with the stomach.

Glands mucosae of the esophagus

The glands mucosae of the esophagus are inserted in the sottomucosa and are of ramificato composed acinoso type. They are many ghiandolari small acini that pour their secretion in lead small, that they meet in a main culvert, that it crosses the mucosa, riversando the product of the glands in the lume of the esophagus. This secreto allows to maintain the esophagus humid.

Bodies strangers in the esophagus

In all the cases in which too much large an alimentary bolus or a not alimentary substance it comes to bloccarsi to the height of the esophagus, one speaks about bodies strangers in the esophagus. To these they come associates also the "not drinkable liquids to you", that they turn out harmful, beyond that to the organism, to the same esophagus.
First to being hit from this problem they are the children, with their tendency to put in mouth whichever object, you follow yourself from the old ones that, not being able to chew well, they swallow large or too much too much hard mouthfuls. Other subjects to this type of problem are alienate mental and i to you suicides.

Tipologia of the introduced objects

If the ingested objects have edges dull to you, like as an example one currency, the problems, at least to the beginning, they can not be serious. The object will provoke pain and be able to be of impediment to the swallowing. If the clogging will be complete, it salted verra swallowed and ristagnerà in mouth.
More serious the case than ingestion of appuntiti or cutting objects. To it disturbs from clogging, the dangers of lesions to cargo of the walls of the esophagus will join, from the simple scalfittura until the perforation. The lesion can be complicated from one infection of hurt, that it will be able to extend to the organs and the near regions.
A body stranger in the esophagus, it does not determine dramatic situations like those of a body stranger in the aerial ways, but it will have however to be proceeded more quickly possible to its identification, to its localization and its extraction.

Identification and localization of the body stranger

The answers of the patient or, in the case of small children, of the parents of the patient, they are in sufficient kind to identify the ingested object, describing of to the nature and the dimensions.
A radiografico examination will be able to confirm the presence of the object in the esophagus: the case is not rare in which the object it is passed through the esophagus arriving to stomach, also remaining feeling of its presence. If the substance is radio-opaque it will be sufficient one simple x-ray to i beams X, if the object is transparent to i beams X, the examination will be carried out with a contrast medium (as an example barium sulfate).
The confirmation of the presence of the object could be executed also throughesofagoscopia, that it will allow also a better acknowledgment of the object.

Extraction of the body stranger

In a generalized manner, to an object that has arrived in the esophagus, it can be made to follow the inverse road in order to let out it. Exceptions can be constituted from the particular shape of the object or from its position in the esophagus. The extraction of appuntiti or cutting bodies is from avoiding. The damage of a body stranger who obstructs the esophagus is always inferior to what accidental laceration of the esophagus can derive from one.
Throughesofagoscopio, the possibility can be judged also to push the object until the stomach, from which it will be able to continue throughintestine or extracted through one gastroscopia, little rischiosa than one esofagoscopica extraction.
If the body can easy be extracted through the mouth, the operation verra executed orienting R-al.meglio the extracted object and through I affixed pliers from taken to you. Before the extraction, the object can be reduced in smaller pieces through uses it of introduced scissors or tenagliette with the esofagoscopio.
If the participation is put into effect for time, the prognosis is always good, a lot that nel.giro.di little days all the problems are resolved.

Not drinkable liquids

In the greater part of the cases, the ingestion of "not drinkable liquids" has a harmful action to level of the stomach and the intestine, but family of liquids exists one, caustic sayings, that they produce the maximum damage just to level of the esophagus. Between these we find the solutions of hard, ammonia orsulfuric acid, substances that are found normally in the houses of the Italians to domestic use.
The ingestion of these substances can quickly carry the dead women, the ulcerations can extend also to the mouth and the stomach.
Knowing the ingested substance, a first participation can be that one of ridurne the effects. In the case of an alkaline liquid (hard) solution acida like water and vinegar or water and lemon could be somministrata one. In presence of an acid, one will be used alkaline substance, like sodium bicarbonate. Sara well, before every participation, to consult Center poisons and to follow of scrupulously the suggestions. If it disables to you or in the case of although minimal doubt is well to postpone and to carry the injured person to a ready aid, carrying with if an example of the substance that is supposed has been ingested.
In any case, every successive treatment will be to medical level, that it will have, beyond to the immediate damage, to prevent the consequences, like the narrowing or stenosis late of the esophagus. It is necessary ribadire that, in case of ingestion of caustic substance, it does not have to be induced vomito.

Pathology

Tumors of the esophagus

I tumors they are the more serious pathology for the esophagus. They are manifested in particular way after the 50 years, with one greater incidence in the male sex.
It can rebel in any drawn of the esophagus, even if centers subject to the tumors exist. More frequent it is in the third inferior, they follow the thoracic feature and therefore the feature begins them, where the insorgence of the disease is somewhat rare.

Diverticoli esofagei

I esofagei diverticoli they are estroflessioni of the mucosa and sottomucosa or all the wall of the esophagus.
In the first case they are said diverticoli from pulsione and they rebel on one preesistente malformation, in the second they are said diverticoli from traction and they derive from retraction of some linfonodo periesofageo.
They interest the part above all begins them of the esophagus, they have tendency to increase of volume.

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