Zenker's diverticulum (patient information)

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.

Common symptoms

Difficulty in swallowing

Local pain

Food reflux

Bad breath

Coughing

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 ZD

Diagnosis

History and Symptoms

While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as the following:

• 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

Template:WH Template:WS