Clinical features

1 For oesophagoscopy, measurements are made from the upper incisor teeth; the three important levels 7in (17cm), 11in (28cm) and 17in (43 cm) corresponding to the commencement of the oesophagus, the point at which it is crossed by the left bronchus and its termination respectively.

2 These three points also indicate the narrowest parts of the oesophagus: the sites at which, as might be expected, swallowed foreign bodies are most likely to become impacted and strictures to occur after swallowing corrosive fluids.

3 The anastomosis between the azygos (systemic) and left gastric (portal) venous tributaries in the oesophageal veins is of great importance. In portal hypertension these veins distend into large collateral channels, oesophageal varices, which may then rupture with severe haemorrhage (probably as a result of peptic ulceration of the overlying mucosa).

4 Use is made of the close relationship between the oesophagus and the left atrium in determining the degree of left atrial enlargement in mitral stenosis; a barium swallow may show marked backward displacement of the oesophagus caused by the dilated atrium.

5 The oesophagus is crossed solely by the vena azygos on the right side. This is therefore the side of election to approach the oesophagus surgically.

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