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TEST TAKING TIPS

Test Taking Tips

Some of the more common scenarios on the esophagus involve perforations: both iatrogenic and from cancer. Err on the side of being conservative: wide drainage, surgical diversion, and antibiotics being the cornerstone. Only consider a repair in low-risk situations such as early diagnosis of an iatrogenic perforation.

Benign esophageal disease is also frequently tested. The most common scenarios will involve chronic reflux, and how to manage iatrogenic perforations.

ANATOMY

Name the layers of the esophagus:

  • Mucosa and muscularis propria (esophagus has no serosa)

FIGURE 18-1.

Arterial blood supply of the esophagus. (Reproduced with permission from Rothberg M, DeMeester TR. Surgical anatomy of the esophagus. In: Shields TW, ed. General Thoracic Surgery. 3rd ed. Philadelphia: Lea & Febiger; 1989:84.)

What is the arterial blood supply to the cervical esophagus?

  • Inferior thyroid arteries (branch of thyrocervical trunk on left and subclavian artery on right)

What is the arterial supply to the thoracic esophagus?

  • Direct blood supply from 4 to 6 esophageal arteries off of the aorta; esophageal branches off of right (R) and left (L) bronchial arteries; supplemented by descending branches off the inferior thyroid arteries, intercostal arteries, and ascending branches of the paired inferior phrenic arteries

What is the arterial blood supply to the abdominal esophagus?

  • Left gastric artery and the paired inferior phrenic arteries

Describe the venous drainage for the cervical esophagus:

  • The submucosal venous plexus drains into the inferior thyroid veins (tributaries of L subclavian vein and R brachiocephalic vein)

Describe the venous drainage for the thoracic esophagus:

  • The submucosal venous plexus of the thoracic esophagus joins with the more superficial esophageal venous plexus and the venae comitantes that surround the esophagus at this level. This plexus then drains into the azygos veins on the right and the hemiazygous veins on the left.

FIGURE 18-2.

Venous drainage of the esophagus. (Reproduced with permission from Rothberg M, DeMeester TR. Surgical anatomy of the esophagus. In: Shields TW, ed. General Thoracic Surgery. 3rd ed. Philadelphia: Lea & Febiger; 1989:85.)

Describe the venous drainage of the abdominal esophagus?

  • Drains into both the systemic and portal venous systems through the L and R phrenic veins, and the L gastric (coronary) vein and short gastrics

In what direction is the lymphatic flow in the upper two-thirds of the esophagus?

  • Cephalad

In what direction is the lymphatic flow in the distal third of the esophagus?

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