Thorax Esophageal Pathway Notes

1. Esophagus Pathway 
1. Blood Supply 
1. Aorta  Aortic arch  
1. Left subclavian or brachiocephalic to right subclavian  thyrocervical  esophageal branches 
2. Aorta  bronchial arteries  esophageal branches 
3. Thoracic aorta  aortic esophageal arteries 
4. Descending aorta  celiac trunk  left gastric  esophageal branches 
2. Blood Drainage 
1. Esophageal venous plexus 
1. Upper esophagus 
1. Inferior thyroid  brachiocephalic  SVC 
2. Right side 
1. Highest intercostal  azygous  SVC
2. Azygous  SVC 
3. Left side 
1. Highest intercostal  brachiocephalic  SVC 
2. Accessory hemiazygos  
1. Highest intercostal  brachiocephalic  SVC 
2. Azygous  SVC 
3. Hemiazygos  azygous  SVC 
2. Lower esophagus 
1. Esophageal branches  left gastric  hepatic portal  liver  central veins  hepatic veins  IVC
3. Nerve Supply 
1. Afferent 
1. Somatic 
1. N/A
2. Autonomic 
1. Parasympathetic 
1. Stretch and pain receptors  vagal fibers  ascend parallel to efferent parasympathetic fibers  jugular foramen  medulla 
2. Sympathetic 
1. N/A
2. Efferent 
1. Somatic 
1. N/A
2. Autonomic 
1. Parasympathetic 
1. Medulla  jugular foramen  
1. Recurrent laryngeal  upper esophagus plexus for swallowing 
2. Anterior posterior vagal trunks  lower esophagus plexus 
2. Sympathetic 
1. IML  ventral root  thoracic spinal nerves  white rami  sympathetic ganglion  
1. Cervical ganglia (upper esophagus)  Ach synapse  esophageal plexus 
2. Thoracic ganglia  Ach synapse  esophageal plexus 
3. Greater thoracic splanchnic nerve  ach synapse  esophageal plexus