Zenker's diverticulum (patient information): Difference between revisions
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''' | {{Template:Zenker's Diverticulum (patient information)}} | ||
{{CMG}}; {{AE}} {{Ajay}} | |||
==Overview== | |||
Patients with small [[Zenker's diverticulum]] are usually [[asymptomatic]], the severity of the symptoms is proportional to the size of the [[diverticulum]]. The most common symptoms include difficulty in swallowing, local pain, food [[regurgitation]], bad breath, coughing, change in voice, [[bronchitis]]; less common symptoms include difficulty in swallowing the pills, drooling, choking, food stuck on sensation, weight loss, gurgling sounds in the throat, Bloody sputum and vomit. | |||
==What are the Symptoms of (Disease name)?== | |||
The hallmark of ZD is difficulty in swallowing. The most common symptoms of ZD include bad breath, reflux of food into the mouth, coughing. | |||
[[Asymptomatic]] in patients with small [[Zenker's diverticulum|Zenker's]] [[diverticulum]], the severity of the symptoms is proportional to the size of the diverticulum.<ref name="urlZenkers diverticulum: exploring treatment options">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773964/ |title=Zenker's diverticulum: exploring treatment options |format= |work= |accessdate=}}</ref><ref name="urlZenkers diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/18197932 |title=Zenker's diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlZenkers Diverticulum. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/24055983 |title=Zenker's Diverticulum. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="url[Hypopharyngeal Zenkers diverticulum as a clinical and surgical problem]. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/16989439 |title=[Hypopharyngeal Zenker's diverticulum as a clinical and surgical problem]. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlSimultaneously occurring Zenkers diverticulum and Killian-Jamieson diverticulum: case report and literature review. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/28625183 |title=Simultaneously occurring Zenker's diverticulum and Killian-Jamieson diverticulum: case report and literature review. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="pmid18197932">{{cite journal |vauthors=Ferreira LE, Simmons DT, Baron TH |title=Zenker's diverticula: pathophysiology, clinical presentation, and flexible endoscopic management |journal=Dis. Esophagus |volume=21 |issue=1 |pages=1–8 |year=2008 |pmid=18197932 |doi=10.1111/j.1442-2050.2007.00795.x |url=}}</ref> | |||
'''Common symptoms''' | |||
[[Dysphagia|Difficulty in swallowing]] | |||
Local pain | |||
Food [[regurgitation|reflux]] | |||
[[Halitosis|Bad breath]] | |||
[[Coughing]] | |||
[[Hoarseness|Hoarseness- Change in voice]] | |||
Infection of the lungs | |||
'''Less common symptoms''' | |||
Pills stuck in the throat | |||
[[Drooling]] of the [[saliva]] | |||
[[Choking]] on the food | |||
[[Globus sensation]] | |||
Weight loss | |||
Gurgling sounds in the throat | |||
[[Hemoptysis]]- Blood in the Phlem | |||
[[Hematemesis]]- Bloody vomitings | |||
==What Causes (disease name)?== | |||
*Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers originating from the food pipe.Since it involves only the mucosa and submucosa it is a false diverticulum. | |||
*Killian's dehiscence- the point of weakness over the food pipe, which eventually develops a sac-like projection. | |||
*ZD occurs due to increased pressure within the food pipe. | |||
*A subsequent incomplete opening of the sphincter of the food pipe, causing the protrusion of the muscles of the food pipe. | |||
*ZD causes the disorder of the swallowing, affecting the functions such as chewing, initiating the swallowing. | |||
==Who is at Highest Risk?== | |||
The people at risk of developing [[Zenker's diverticulum]] are | |||
*Middle-aged and elderly individuals | |||
*Men are commonly affected than females | |||
*People of northern Europe are more prone for developing the [[Zenker's Diverticulum|ZD]] | |||
==Diagnosis== | |||
===History and Symptoms=== | |||
While it may be [[asymptomatic]], [[Zenker's diverticulum|Zenker diverticulum]] often causes clinical manifestations such as the following:<ref name="pmid27933354">{{cite journal |vauthors=Hussain T, Maurer JT, Lang S, Stuck BA |title=[Pathophysiology, diagnosis and treatment of Zenker's diverticulum] |language=German |journal=HNO |volume=65 |issue=2 |pages=167–176 |year=2017 |pmid=27933354 |doi=10.1007/s00106-016-0302-z |url=}}</ref><ref name="pmid16989439">{{cite journal |vauthors=Stankiewicz C |title=[Hypopharyngeal Zenker's diverticulum as a clinical and surgical problem] |language=Polish |journal=Otolaryngol Pol |volume=60 |issue=3 |pages=295–303 |year=2006 |pmid=16989439 |doi= |url=}}</ref><ref name="pmid18197932">{{cite journal |vauthors=Ferreira LE, Simmons DT, Baron TH |title=Zenker's diverticula: pathophysiology, clinical presentation, and flexible endoscopic management |journal=Dis. Esophagus |volume=21 |issue=1 |pages=1–8 |year=2008 |pmid=18197932 |doi=10.1111/j.1442-2050.2007.00795.x |url=}}</ref><ref name="pmid24055983">{{cite journal |vauthors=Law R, Katzka DA, Baron TH |title=Zenker's Diverticulum |journal=Clin. Gastroenterol. Hepatol. |volume=12 |issue=11 |pages=1773–82; quiz e111–2 |year=2014 |pmid=24055983 |doi=10.1016/j.cgh.2013.09.016 |url=}}</ref><ref name="pmid25309667">{{cite journal |vauthors=Elbalal M, Mohamed AB, Hamdoun A, Yassin K, Miskeen E, Alla OK |title=Zenker's diverticulum: a case report and literature review |journal=Pan Afr Med J |volume=17 |issue= |pages=267 |year=2014 |pmid=25309667 |pmc=4191700 |doi=10.11604/pamj.2014.17.267.4173 |url=}}</ref><ref name="pmid23299166">{{cite journal |vauthors=Al-Juboori AN, Al-Essawi SH |title=Zenker's diverticulum. A rare cause of dysphagia |journal=Saudi Med J |volume=34 |issue=1 |pages=91–3 |year=2013 |pmid=23299166 |doi= |url=}}</ref> | |||
* [[Dysphagia]]: [[difficulty swallowing]] | |||
* [[Globus]]: a [[sense of a lump in the neck]] | |||
* [[Regurgitation]]: [[reappearance of ingested food in the mouth]] due to the pouch filling up | |||
* [[Cough]]: as some food may be [[regurgitated]] into the airways | |||
* [[Halitosis]]: [[smelly breath]], as stagnant food is digested by microrganisms | |||
* [[Odynophagia]] or [[pain with swallowing]] is generally not present | |||
===Laboratory findings=== | |||
Laboratory studies are not helpful in the diagnosis of the Zenker's Diverticulum (ZD), whereas they are used for the upper esophageal webs associated with iron deficiency anemia. The laboratory tests is done to differentiate the ZD from Plummer- Vinson syndrome. Laboratory findings consistent with the diagnosis of Plummer-Vinson syndrome include presence of iron deficiency anemia | |||
===X-ray=== | |||
An x-ray (barium esophagogram) is the best initial imaging study in a patient suspected with Zenker's Diverticulum (ZD). Findings on an x-ray (barium esophagogram) suggestive of esophageal diverticulum associated with ZD appear as thin projections on the anterior esophageal wall over the Killian's triangle. | |||
===CT scan=== | |||
Zenker's diverticulum (ZD) appears as an out-pouching sac on the CT scan over the posterior esophagus in the Killian's triangle, a point of weakness in the muscular wall of the hypopharynx surrounded by the cricopharyngeal sphincter and oblique fibers of the inferior constrictor of the pharyngeal muscle. | |||
===MRI=== | |||
Zenker's diverticulum (ZD) appears as an out-pouching sac on the MRI scan over the posterior esophagus in the Killian's triangle, a point of weakness in the muscular wall of the hypopharynx surrounded by the cricopharyngeal sphincter and oblique fibers of the inferior constrictor of the pharyngeal muscle. The sac is filled with, fluid, food, contrast materials. | |||
===Ultrasound=== | |||
The ultrasonographic findings of Zenker's divericulum (ZD) includes iso-echoic or hypo-echoic mass with internal or peripheral echogenic foci and a boundary hypo-echoic zone at the posterior portion of the thyroid gland.High-frequency USG identifies multi-layered appearance, continuous with the esophageal wall. Internal echogenic foci within ZD were often misdiagnosed as punctuate micro-calcifications associated with papillary cancer. Boundary hypo-echoic zone or echogenic line on a sonogram with a connection to the esophagus is associated with ZD. Thyroid USG is done to avoid unnecessary aspiration as it is often misdiagnosed for ZD as a thyroid nodule. | |||
==When to Seek Urgent Medical Care?== | |||
Call the doctor when you have the following symptoms | |||
Difficulty swallowing | |||
Sense of a lump in the neck | |||
Reappearance of ingested food in the mouth due to the pouch filling up | |||
Cough | |||
Smelly breath | |||
Pain with swallowing | |||
==Treatment Options== | |||
Diverticulum is resected by either an open surgery or by an endoscopic procedure. | |||
==Where to find Medical Care for (Disease name)?== | |||
Medical care for (disease name) can be found [https://www.google.com/maps/search/hospitals/ here]. | |||
==Prevention== | |||
There are no established measures for the primary prevention of Zenker's Diverticulum. | |||
==What to Expect (Outlook/Prognosis)?== | |||
Prognosis of Zenker's diverticulum after the intervention is good, the recurrence of the diverticulum is very rare. | |||
==Possible Complications== | |||
Complications of the Zenker's diverticulum include: | |||
Aspiration pneumonia- infection of the lungs | |||
Bleeding of the diverticulum | |||
Ulceration of the diverticulum | |||
Compression of the trachea and esophageal obstruction with large diverticula | |||
Very rarely Squamous cell carcinoma of the diverticulum | |||
Perforation of the diverticulum during the endoscopy and hence scopes with side viewing should be used to prevent perforation. | |||
==Sources== | |||
http://www.nlm.nih.gov/medlineplus/ency/article/000434.htm | |||
{{WH}} | |||
{{WS}} | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
<references /> | |||
Latest revision as of 02:02, 7 December 2017
Template:Zenker's Diverticulum (patient information)
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ajay Gade MD[2]]
Overview
Patients with small Zenker's diverticulum are usually asymptomatic, the severity of the symptoms is proportional to the size of the diverticulum. The most common symptoms include difficulty in swallowing, local pain, food regurgitation, bad breath, coughing, change in voice, bronchitis; less common symptoms include difficulty in swallowing the pills, drooling, choking, food stuck on sensation, weight loss, gurgling sounds in the throat, Bloody sputum and vomit.
What are the Symptoms of (Disease name)?
The hallmark of ZD is difficulty in swallowing. The most common symptoms of ZD include bad breath, reflux of food into the mouth, coughing.
Asymptomatic in patients with small Zenker's diverticulum, the severity of the symptoms is proportional to the size of the diverticulum.[1][2][3][4][5][6]
Common symptoms
Local pain
Food reflux
Infection of the lungs
Less common symptoms
Pills stuck in the throat
Choking on the food
Weight loss
Gurgling sounds in the throat
Hemoptysis- Blood in the Phlem
Hematemesis- Bloody vomitings
What Causes (disease name)?
- Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers originating from the food pipe.Since it involves only the mucosa and submucosa it is a false diverticulum.
- Killian's dehiscence- the point of weakness over the food pipe, which eventually develops a sac-like projection.
- ZD occurs due to increased pressure within the food pipe.
- A subsequent incomplete opening of the sphincter of the food pipe, causing the protrusion of the muscles of the food pipe.
- ZD causes the disorder of the swallowing, affecting the functions such as chewing, initiating the swallowing.
Who is at Highest Risk?
The people at risk of developing Zenker's diverticulum are
- Middle-aged and elderly individuals
- Men are commonly affected than females
- People of northern Europe are more prone for developing the ZD
Diagnosis
History and Symptoms
While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as the following:[7][8][6][9][10][11]
- Dysphagia: difficulty swallowing
- Globus: a sense of a lump in the neck
- Regurgitation: reappearance of ingested food in the mouth due to the pouch filling up
- Cough: as some food may be regurgitated into the airways
- Halitosis: smelly breath, as stagnant food is digested by microrganisms
- Odynophagia or pain with swallowing is generally not present
Laboratory findings
Laboratory studies are not helpful in the diagnosis of the Zenker's Diverticulum (ZD), whereas they are used for the upper esophageal webs associated with iron deficiency anemia. The laboratory tests is done to differentiate the ZD from Plummer- Vinson syndrome. Laboratory findings consistent with the diagnosis of Plummer-Vinson syndrome include presence of iron deficiency anemia
X-ray
An x-ray (barium esophagogram) is the best initial imaging study in a patient suspected with Zenker's Diverticulum (ZD). Findings on an x-ray (barium esophagogram) suggestive of esophageal diverticulum associated with ZD appear as thin projections on the anterior esophageal wall over the Killian's triangle.
CT scan
Zenker's diverticulum (ZD) appears as an out-pouching sac on the CT scan over the posterior esophagus in the Killian's triangle, a point of weakness in the muscular wall of the hypopharynx surrounded by the cricopharyngeal sphincter and oblique fibers of the inferior constrictor of the pharyngeal muscle.
MRI
Zenker's diverticulum (ZD) appears as an out-pouching sac on the MRI scan over the posterior esophagus in the Killian's triangle, a point of weakness in the muscular wall of the hypopharynx surrounded by the cricopharyngeal sphincter and oblique fibers of the inferior constrictor of the pharyngeal muscle. The sac is filled with, fluid, food, contrast materials.
Ultrasound
The ultrasonographic findings of Zenker's divericulum (ZD) includes iso-echoic or hypo-echoic mass with internal or peripheral echogenic foci and a boundary hypo-echoic zone at the posterior portion of the thyroid gland.High-frequency USG identifies multi-layered appearance, continuous with the esophageal wall. Internal echogenic foci within ZD were often misdiagnosed as punctuate micro-calcifications associated with papillary cancer. Boundary hypo-echoic zone or echogenic line on a sonogram with a connection to the esophagus is associated with ZD. Thyroid USG is done to avoid unnecessary aspiration as it is often misdiagnosed for ZD as a thyroid nodule.
When to Seek Urgent Medical Care?
Call the doctor when you have the following symptoms Difficulty swallowing Sense of a lump in the neck Reappearance of ingested food in the mouth due to the pouch filling up Cough Smelly breath Pain with swallowing
Treatment Options
Diverticulum is resected by either an open surgery or by an endoscopic procedure.
Where to find Medical Care for (Disease name)?
Medical care for (disease name) can be found here.
Prevention
There are no established measures for the primary prevention of Zenker's Diverticulum.
What to Expect (Outlook/Prognosis)?
Prognosis of Zenker's diverticulum after the intervention is good, the recurrence of the diverticulum is very rare.
Possible Complications
Complications of the Zenker's diverticulum include: Aspiration pneumonia- infection of the lungs Bleeding of the diverticulum Ulceration of the diverticulum Compression of the trachea and esophageal obstruction with large diverticula Very rarely Squamous cell carcinoma of the diverticulum Perforation of the diverticulum during the endoscopy and hence scopes with side viewing should be used to prevent perforation.
Sources
http://www.nlm.nih.gov/medlineplus/ency/article/000434.htm
- ↑ "Zenker's diverticulum: exploring treatment options".
- ↑ "Zenker's diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. - PubMed - NCBI".
- ↑ "Zenker's Diverticulum. - PubMed - NCBI".
- ↑ "[Hypopharyngeal Zenker's diverticulum as a clinical and surgical problem]. - PubMed - NCBI".
- ↑ "Simultaneously occurring Zenker's diverticulum and Killian-Jamieson diverticulum: case report and literature review. - PubMed - NCBI".
- ↑ 6.0 6.1 Ferreira LE, Simmons DT, Baron TH (2008). "Zenker's diverticula: pathophysiology, clinical presentation, and flexible endoscopic management". Dis. Esophagus. 21 (1): 1–8. doi:10.1111/j.1442-2050.2007.00795.x. PMID 18197932.
- ↑ Hussain T, Maurer JT, Lang S, Stuck BA (2017). "[Pathophysiology, diagnosis and treatment of Zenker's diverticulum]". HNO (in German). 65 (2): 167–176. doi:10.1007/s00106-016-0302-z. PMID 27933354.
- ↑ Stankiewicz C (2006). "[Hypopharyngeal Zenker's diverticulum as a clinical and surgical problem]". Otolaryngol Pol (in Polish). 60 (3): 295–303. PMID 16989439.
- ↑ Law R, Katzka DA, Baron TH (2014). "Zenker's Diverticulum". Clin. Gastroenterol. Hepatol. 12 (11): 1773–82, quiz e111–2. doi:10.1016/j.cgh.2013.09.016. PMID 24055983.
- ↑ Elbalal M, Mohamed AB, Hamdoun A, Yassin K, Miskeen E, Alla OK (2014). "Zenker's diverticulum: a case report and literature review". Pan Afr Med J. 17: 267. doi:10.11604/pamj.2014.17.267.4173. PMC 4191700. PMID 25309667.
- ↑ Al-Juboori AN, Al-Essawi SH (2013). "Zenker's diverticulum. A rare cause of dysphagia". Saudi Med J. 34 (1): 91–3. PMID 23299166.