|
|
Line 7: |
Line 7: |
| The differential diagnosis of the Zenker's diverticulum (ZD) are as follows Plummer-Vinson syndrome, reflux esophagitis, esophageal carcinoma, systemic sclerosis, achalasia, psuedoachalasia, chagas disease, esophageal candidiasis, pharyingitis and stoke. | | The differential diagnosis of the Zenker's diverticulum (ZD) are as follows Plummer-Vinson syndrome, reflux esophagitis, esophageal carcinoma, systemic sclerosis, achalasia, psuedoachalasia, chagas disease, esophageal candidiasis, pharyingitis and stoke. |
| ==Differential Diagnosis== | | ==Differential Diagnosis== |
| {| class="wikitable"
| |
| !Disease
| |
| !Signs & Symptoms
| |
| !Findings on barium swallow
| |
| !Endoscopy
| |
| !Other findings
| |
| |-
| |
| |Reflux esophagitis
| |
| |Dysphagia (from peptic stricture)
| |
| Heartburn
| |
|
| |
| Hoarseness
| |
| |
| |
| * Poor clearance
| |
|
| |
| * Free reflux of barium
| |
| |
| |
| * peptic stricture (advanced cases)
| |
| |A hiatus hernia may be present below the stricture
| |
| Lower esophageal pH studies will demonstrate pathologic gastroesophageal reflux
| |
| |-
| |
| |Plummer Vinson syndrome
| |
| |Dysphagia
| |
| Glossitis
| |
|
| |
| Brittle nails
| |
| |
| |
| * Esophageal webs
| |
| * Esophageal stricture
| |
| |
| |
| * Esophageal web and stricture
| |
| |Iron deficiency anemia
| |
| |-
| |
| |Esophageal carcinoma
| |
| |Dysphagia (initially for solids, liquids develops with advanced disease.)
| |
| Weight loss
| |
|
| |
| Lymphadenopathy
| |
|
| |
| Appetite changes
| |
|
| |
| Cachexia
| |
| |
| |
| * irregular stricture
| |
| * pre-stricture dilatation
| |
| |
| |
| * Most accurate test for diagnosis
| |
| * esophageal obstruction
| |
| * staging of disease
| |
| |Biopsy: for definite diagnosis and tumor histology
| |
| |-
| |
| |Systemic sclerosis
| |
| |Dysphagia
| |
| Muscle and joint pain
| |
|
| |
| Raynaud's phenomenon
| |
|
| |
| skin changes (e.g., rash, skin swelling or thickening).
| |
| |
| |
| * Dysmotility
| |
|
| |
| * Patulous esophagus
| |
| |Mucosal damage
| |
|
| |
| Peptic stricture (advanced cases)
| |
| |Serology for
| |
| Antinuclear antibodies
| |
|
| |
| Rheumatoid factor
| |
|
| |
| creatine kinase
| |
|
| |
| ESR
| |
| |-
| |
| |Esophageal spasm
| |
| |Chest pain (more prominent)
| |
| Dysphagia (intermittent)
| |
| |
| |
| * Corkscrew or
| |
| rosary bead esophagus
| |
| * nonperistaltic contractions
| |
| |Inconclusive
| |
| |Manometry: high-amplitude esophageal contractions
| |
| |-
| |
| |Pseudoachalasia
| |
| |Dysphagia
| |
|
| |
| Weight loss
| |
|
| |
| Lymphadenopathy
| |
|
| |
| Appetite changes
| |
|
| |
| Cachexia
| |
|
| |
| Older patients
| |
|
| |
| Underlying malignancy that mimics idiopathic achalasia.
| |
|
| |
| Patients tend to be older, duration of symptoms shorter, and weight loss greater and more rapid.
| |
| |
| |
| * More marked mucosal irregularity
| |
|
| |
| * Temporary patency of LES
| |
| |
| |
| * Most accurate test for diagnosis
| |
| * esophageal obstruction
| |
| * staging of disease
| |
| |Gastroscopic biopsy of gastroesophageal junction and cardia may demonstrate malignancy.
| |
|
| |
| Findings at endoscopy, barium swallow, and manometry may be indistinguishable from achalasia.
| |
| |-
| |
| |Chagas disease
| |
| |Dysphagia
| |
|
| |
| myocarditis
| |
|
| |
| Blepharitis
| |
|
| |
| Toxic megacolon
| |
| |
| |
| * oesophageal dilatation
| |
| * stasis of barium
| |
| |
| |
| * dilated esophagus
| |
|
| |
| * thickened LES (muscular ring)
| |
| |Giemsa stain: ''Trypanosoma cruzi''.
| |
|
| |
| PCR for trypanosome subtype
| |
| |-
| |
| |Pharyngitis
| |
| |Dysphagia
| |
|
| |
| Fever
| |
|
| |
| Throat pain
| |
| |Normal
| |
| |Inconclusive
| |
| |erythema, edema and/or exudates of the pharynx; tonsillar hypertrophy may cause severe narrowing of the pharynx; lymphadenopathy of the neck is often present
| |
| |-
| |
| |Esophageal candidiasis
| |
| |Dysphagia
| |
| Immunocompromised
| |
|
| |
| History of corticosteroid
| |
| |
| |
| * shaggy" appearance (plaques)
| |
|
| |
| * irregular contours in the lower third
| |
| |
| |
| * ulceration
| |
|
| |
| * plaques and pseudomembranes
| |
| * tiny nodules, polypoid folds (advanced cases)
| |
| |creamy white or yellowish plaques (thrush) in oropharynx or hypopharynx; may be normal exam
| |
| |-
| |
| |Stroke
| |
| |progressive dysphagia;
| |
| dysarthria;
| |
|
| |
| limb weakness
| |
|
| |
| Fatigue
| |
| |
| |
| * pooling of contrast in the pharynx
| |
| * aspiration of the barium contrast into the airway.
| |
| |
| |
| * reduced opening of upper esophageal sphincter
| |
| * reduced larynx elevation
| |
| |paraplegia, aphasia, dysarthria, vertigo, staggering, diplopia, deafness
| |
| |}
| |
|
| |
|
| ==References== | | ==References== |