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Esophageal Diverticula 
Diverticulum Esophageal

Presentation

TEDs usually present with dysphagia or recurrent aspiration. We describe here a rare presentation of upper gastro-intestinal bleeding resulting from ulceration and fistulization of the TED. [springerplus.springeropen.com]

Giant cell formation is rare, but fused histiocytes are present. [acgcasereports.gi.org]

The clinical presentation varies with pouch size and localization, with the most common symptoms being dysphagia, regurgitation, retrosternal pain, and pulmonary symptoms secondary to aspiration. [amboss.com]

Presenting symptoms of Epiphrenic esophageal diverticula depends on the underlying disease process and they mostly present with alarming symptoms. [omicsonline.org]

However, lipomas of the esophagus commonly present with dysphagia when they grow in size [ 2 ]. [karger.com]

Gastrointestinal

  • Dysphagia

    Esophagram for Patient 2, 75-year-old woman with regurgitation, dysphagia, pain, and odynophagia. Figure 2. Esophagram for Patient 2, 75-year-old woman with regurgitation, dysphagia, pain, and odynophagia. Figure 3. [jaoa.org]

    […] esophagus Cause of Zenker's diverticulum and pulsion diverticula ↑ pressure during swallowing Location of Zenker's diverticulum Between cricopharyngeus (UES) and thyropharyngeus portion of inferior pharyngeal constrictors SSx of Zenker's diverticulum Dysphagia [quizlet.com]

    Clinicians should be aware of the possibility of traction mid-esophageal diverticulum in sarcoidosis patients with progressive dysphagia. [acgcasereports.gi.org]

    Epidemiology Rare diverticula compared to other gastrointestinal sites (prompting < 1% of all barium swallows and accounting for < 5% of all cases of dysphagia ). [amboss.com]

    Rarely, the pouch becomes large, causing dysphagia and sometimes a palpable neck mass. Traction and epiphrenic diverticula are rarely symptomatic, although their underlying cause may be. [merckmanuals.com]

  • Regurgitation of Undigested Food

    […] of undigested food, dysphagia Tx for Traction diverticulum Excision w 1° closure, palliative XRT if 2/2 invasive CA Location of epiphrenic diverticulum Cause of epiphrenic diverticulum SSx of epiphrenic diverticulum ASx, dysphagia, regurgitation Dx of [quizlet.com]

    Zenker's diverticula are often found in older patients who present with dysphagia, regurgitation of undigested food, choking, hoarseness, halitosis or even a neck mass. [med-ed.virginia.edu]

    Regurgitation of undigested foods is primary seen when the lipoma is located in the cervical part of the esophagus, with intraluminal growing and obstruction. [karger.com]

    Surgical treatments are indicated in the patients with symptoms such as dysphagia or regurgitation of undigested food ( 3, 5 ). Traditionally, thoracotomy has been the preferred surgical approach ( 3 ). [jtd.amegroups.com]

    Patients complain of regurgitation of undigested food in to the mouth. [explainmedicine.com]

Jaw & Teeth

  • Halitosis

    Zenker's diverticulum and pulsion diverticula ↑ pressure during swallowing Location of Zenker's diverticulum Between cricopharyngeus (UES) and thyropharyngeus portion of inferior pharyngeal constrictors SSx of Zenker's diverticulum Dysphagia, choking, halitosis [quizlet.com]

    Note halitosis, a common sign of esophageal diverticula. Inspect the patient’s neck for visible signs of esophageal distention that has been caused by food trapped in the diverticula. [medical-dictionary.thefreedictionary.com]

    Zenker's diverticula are often found in older patients who present with dysphagia, regurgitation of undigested food, choking, hoarseness, halitosis or even a neck mass. [med-ed.virginia.edu]

    References: [1] [2] [5] [3] Clinical features Clinical presentation depends on diverticulum size and localization Dysphagia (most common) Regurgitation of undigested food Aspiration Coughing after food intake Retrosternal pressure sensation and pain Halitosis [amboss.com]

    Symptoms may include difficulty swallowing ( dysphagia ), chronic coughing, regurgitation, or bad breath (halitosis). [everydayhealth.com]

Treatment

The patient underwent a surgical treatment and recovered completely. [ncbi.nlm.nih.gov]

Conservative treatment still holds a place of promise for treatment of epiphrenic esophageal diverticulum [ 6 ]. [npplweb.com]

Transoral, endoscopic stapler Opens diverticulum and divides cricopharyngeaus Treatment of mid-esophageal, traction diverticula Right thoracotomy Diverticulectomy Contralateral esophagomytomy if motility disorder suspected Treatment of epiphrenic diverticula [brainscape.com]

Usually no treatment Sometimes surgery Treatment of diverticula is not usually needed. If symptoms are severe or the pouch is large, however, the pouch can be removed surgically. [msdmanuals.com]

Prognosis

[…] mid esophagus at level of tracheal bifurcation; becoming uncommon; previously mostly due to tuberculosis, mediastinal lymphadenitis and scarring; may be due to motor dysfunction, congenital or alkali ingestion ( Med Hypotheses 2004;62:931 ); better prognosis [pathologyoutlines.com]

Prognosis : guarded to poor. Pathogenesis Etiology Congenital or acquired. [vetstream.com]

Treatment and Prognosis Patients with small asymptomatic or minimally symptomatic diverticula can be followed, because progressive enlargement is uncommon. 2 Patients with large and symptomatic Zenker’s diverticula should be offered treatment. [clinicalgate.com]

Prognosis and Patient Counseling. Both surgical and endoscopic modalities have high success rates for symptom improvement (>90%). Surgical intervention does have an associated perioperative mortality of approximately 1.8%. [clinicaladvisor.com]

Even in adenocarcinoma which is less sensitive to chemo and radiotherapy, combined treatment improves prognosis. [clevelandclinicmeded.com]

Etiology

A number of distinct types of esophageal diverticula are found clinically with distinct locations, etiologies, and clinical consequences. All are true diverticula and thus are surrounded by all histological layers of the esophageal wall. [pathwaymedicine.org]

Although its etiology has not been definitively established, ZD appears to be caused by the discoordination between the two muscle groups. [enttoday.org]

Tuberculosis and histoplasmosis are known etiologies of this condition. 2 Figure 2. Lung biopsy showing dense fibrosis encasing hard granulomata composed of epithelioid histiocytes. [acgcasereports.gi.org]

Pathogenesis Etiology Congenital or acquired. [vetstream.com]

This reason for the development of a diverticulum is not a familiar etiology for esophageal diverticula. The most common etiological factor for esophageal diverticula is pulsion diverticulum due to increased intraluminal pressure. [karger.com]

Epidemiology

Epidemiology Rare diverticula compared to other gastrointestinal sites (prompting < 1% of all barium swallows and accounting for < 5% of all cases of dysphagia ). [amboss.com]

Other methods include fibreoptic diverticular repair. [7] Other non-surgical treatment modalities also exist, such as endoscopic laser, which recent evidence suggests is less effective than stapling. [8] Epidemiology [ edit ] Zenker's diverticulum mainly [en.wikipedia.org]

Epidemiology Age Most esophageal diverticula occur in middle-aged adults and elderly people. Presentation in infants and children is rarely seen. [emedicine.medscape.com]

While there are differences between squamous cell carcinoma and adenocarcinoma in epidemiology, location and patterns of spread, both diseases tend to spread early outside the esophagus and both share a rather poor prognosis unless discovered early. [clevelandclinicmeded.com]

Pathophysiology

[…] of Zenker's diverticulum Hypertonicity of criciopharyngeaus muscle (Lower esophageal motility and LES normal) Pathophysiology of epiphrenic diverticulum False diverticulum Esophageal dysmotility disorder Within 4 cm of GEJ Pathophysiology of mid-thoracic [brainscape.com]

Pathophysiology (see “Pathophysiology” below) Pulsion Diverticula Traction Diverticula References: [1] [2] [4] [3] Pathophysiology Anatomy 3 constrictions of the esophagus The cervical constriction: beginning of the esophagus (upper esophageal opening [amboss.com]

Pathophysiology Esophageal diverticula are classified by location in the esophagus. Upper (pharyngoesophageal, Killian-Jamieson, or Zenker), middle, or lower (epiphrenic). [emedicine.medscape.com]

Pathophysiology Pulsion type (most common) - true diverticulum - circumscribed sac or pouch created by herniation of esophageal mucosa through defect in surrounding muscularis, most commonly cranial to thoracic inlet or just in front of diaphragm. [vetstream.com]

PATHOPHYSIOLOGY Virtually all mucosal injuries are accompanied by inflammation with various degrees of severity including from erythema, frank ulcers with potential scarring and bleeding and strictures. [clevelandclinicmeded.com]

Prevention

Teach the patient methods to reduce symptoms, prevent malnutrition and weight loss, and improve sleep and rest. [medical-dictionary.thefreedictionary.com]

Emphasize the need to chew food thoroughly to prevent food particles from becoming trapped in the diverticulum. Teach the patient how to perform massage or postural drainage to prevent aspiration. [nursingfile.com]

It may also help prevent food from becoming stuck in the diverticula pockets. [wikihow.com]

This procedure has been excogitated to control of symptoms due to esophageal motility disorders and to prevent postoperative symptoms due to reflux, stenosis, and leak. [symbiosisonlinepublishing.com]

Antibacterial therapy is nominated for prevention of infection complications. In first two days after the burn the patients get parenteral feeding. [intranet.tdmu.edu.ua]

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