InformationalPrivacy
| ... Read more of at Urban Myths.ca | Informational Privacy |
 |
Home |
Medical Articles |
Mother's Remedies |
Household Tips |
Medicine History |
Search |
Medical ArticlesFavorable Symptomsare the following: Absence of internal inflammation; a bright... Prostration Nervous The various articles under Nerves and Nervousness should be re... Fall A After a fall from a height, where there is no apparent outward... Polarization Of The Circuit I have said, in effect, a little above, that, while the curre... Inflammation Of The Lungs - Pneumonia This disease is often connected with Pleurisy, and consists o... Use Of The Long Cord It is often desirable to bring the entire parts of the patien... To Prevent Typhoid Fever When exposed, as in nursing the sick, take _Baptisia_ 2d, and... Erysipelas This troublesome disease is also known as St. Anthony's Fire, ... Prognosis If the foreign body be not removed, the resulting chronic se... Burns Case Xxxiv Mr. C. aged 51, scalded his leg ten days ago on the instep. H... Diagnosis From Measles In scarlatina the heat is much greater, and the pulse is much... Flannel Bands See Band, Flannel. ... Other Forms Of Rest DO you hold yourself on the chair, or does the chair ... The Half-bath The Sitz- Or Hip-bath Should the half-bath or shallow-bath (which are technical ter... Compression Stenosis Of The Trachea And Bronchi Compression of the trachea is most commonly caused by goiter... Testing For Electric Defects These tests should be made beforehand; not when about to com... Normal Blood Pressure For Adults Woley [Footnote: Woley, II. P.: The Normal Variation of the S... Fruits And Vegetables The Special Uses of Fruits and Vegetables. We come now to t... Cold Cloths See Towels, Cold Wet. ... Bruises Case Xix Robert Hill, aged 16, received a blow yesterday from a bone w... |
The EsophagusCategory: ANATOMY OF LARYNX, TRACHEA, BRONCHI AND ESOPHAGUS, ENDOSCOPICALLY CONSIDERED Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery A few of the anatomical details must be kept especially in mind when it is desired to introduce straight and rigid instruments down the lumen of the gullet. First and most important is the fact that the esophageal walls are exceedingly thin and delicate and require the most careful manipulation. Because of this delicacy of the walls and because the esophagus, being a constant passageway for bacteria from the mouth to the stomach, is never sterile, surgical procedures are associated with infective risks. For some other and not fully understood reason, the esophagus is, surgically speaking, one of the most intolerant of all human viscera. The anterior wall of the esophagus is in a part of its course, in close relation to the posterior wall of the trachea, and this portion is called the party wall. It is this party wall that contains the lymph drainage system of the posterior portion of the larynx, and it is largely by this route that posteriorly located malignant laryngeal neoplasms early metastasize to the mediastinum. [58] [FIG 46.--Esophagoscopic and Gastroscopic Chart BIRTH 1 yr. 3 yrs. 6 yrs. 10 yrs. 14 yrs.ADULTS 23 27 30 33 36 43 53 Cm. GREATER CURVATURE 18 20 22 25 27 34 40 Cm. CARDIA 19 21 23 24 25 31 36 Cm. HIATUS 13 15 16 18 20 24 27 Cm. LEFT BRONCHUS 12 14 15 16 17 21 23 Cm. AORTA 7 9 10 11 12 14 16 Cm. CRICOPHARYINGEUS 0 0 0 0 0 0 0 Cm. INCISORS FIG. 46.--The author's esophagoscopic chart of approximate distances of the esophageal narrowings from the upper incisor teeth, arranged for convenient reference during esophagoscopy in the dorsally recumbent patient.] The lengths of the esophagus at different ages are shown diagrammatically in Fig. 46. The diameter of the esophageal lumen varies greatly with the elasticity of the esophageal walls; its diameter at the four points of anatomical constriction is shown in the following table: Constriction Diameter Vertebra Cricopharyngeal Transverse 23 mm. (1 in.) Sixth cervical Antero-posterior 17 mm. (3/4 in.) Aortic Transverse 24 mm. (1 in.) Fourth thoracic Antero-posterior 19 mm. (3/4 in.) Left-bronchial Transverse 23 mm. (1 in.) Fifth thoracic Antero-posterior 17 mm. (3/4 in.) Diaphragmatic Transverse 23 mm. (1 in+) Tenth thoracic Antero-posterior 23 mm. (in.--) For practical endoscopic purposes it is only necessary to remember that in a normal esophagus, straight and rigid tubes of 7 mm. diameter should pass freely in infants, and in adults, tubes of 10 mm. The 4 demonstrable constrictions from above downward are at 1. The crico-pharyngeal fold. 2. The crossing of the aorta. 3. The crossing of the left bronchus. 4. The hiatus esophageus. There is a definite fifth narrowing of the esophageal lumen not easily demonstrated esophagoscopically and not seen during dissection, but readily shown functionally by the fact that almost all foreign bodies lodge at this point. This narrowing occurs at the superior aperture of the thorax and is probably produced by the crowding of the numerous organs which enter or leave the thorax through this orifice. The crico-pharyngeal constriction, as already mentioned, is produced by the tonic contraction of a specialized band of the orbicular fibers of the lowermost portion of the inferior pharyngeal constrictor muscle, called the cricopharyngeal muscle. As shown by the author it is this muscle and not the cricoid cartilage alone that causes the difficulty in the insertion of an esophagoscope. This muscle is attached laterally to the edges of the signet of the cricoid which it pulls with an incomprehensible power against the posterior wall of the hypopharynx, thus closing the mouth of the esophagus. Its other attachment is in the median posterior raphe. Between these circular fibers (the cricopharyngeal muscle) and the oblique fibers of the inferior constrictor muscle there is a weakly supported point through which the esophageal wall may herniate to form the so-called pulsion diverticulum. It is at this weak point that fatal esophagoscopic perforation by inexperienced operators is most likely to occur. The aortic narrowing of the esophagus may not be noticed at all if the patient is placed in the proper sequential high-low position. It is only when the tube-mouth is directed against the left anterior wall that the actively pulsating aorta is felt. The bronchial narrowing of the esophagus is due to backward displacement caused by the passage of the left bronchus over the anterior wall of the esophagus at about 27 cm. from the upper teeth in the adult. The ridge is quite prominent in some patients, especially those with dilatation from stenoses lower down. The hiatal narrowing is both anatomic and spasmodic. The peculiar arrangement of the tendinous and muscular structure of the diaphragm acts on this hiatal opening in a sphincter-like fashion. There are also special bundles of muscle fibers extending from the crura of the diaphragm and surrounding the esophagus, which contribute to tonic closure in the same way that a pinch-cock closes a rubber tube. The author has called the hiatal closure the diaphragmatic pinchcock. Next: Direction Of The Esophagus Previous: Dimensions Of The Trachea And Bronchi
Viewed 484 |
||||||||||||||||||||
