Esophageal Diverticula Flashcards

1
Q

Definition of esophageal diverticula

A

Outpouching of esophageal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Defintion of true (vs. false) esophageal diverticulum

A
  • True esophageal diverticulum: involves all 3 layers of esophagus
  • False esophageal diverticulum: outpouching of mucosa and submucosa between displaced muscle fibers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Categories of esophageal diverticulum

A
  • Pulsion diverticulum (false diverticuli)
    • Results from increased pressure gradient across muscular sphincter
    • Associated wtih esophageal motility disorder
    • Zenker and Epiphrenic diverticuli
  • Traction diverticulum
    • extra-esophageal inflammatory process draws all three layers of esophagus into a true diverticulum
    • most common in mid esophagus (d/t chronic lymphadenitis)
    • no relationship with esophageal dysmotility
    • associated with fistuals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MC esophageal diverticulum

A

Zenker’s diverticulum

  • False diverticulum
  • Above cricopharyngeus muscle (Killian’s triangle)
  • Lateral projection near C6-7 vertebral body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pathophysiology of Zenker’s diverticulum

A

Hypertonicity of criciopharyngeaus muscle

(Lower esophageal motility and LES normal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pathophysiology of epiphrenic diverticulum

A
  • False diverticulum
  • Esophageal dysmotility disorder
  • Within 4 cm of GEJ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pathophysiology of mid-thoracic, diverticula

A
  • True diverticulm
  • Chronic inflammation (e.g. chronic lymphadenitis)
    • Posterior mediastinum
  • Usually within 4-5 cm of carina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical presentation of esophageal diverticulum

A
  • Dysphagia
  • Fetor and regurgitation of food
  • Neck mass (Zenker’s)
  • Risk of aspiration is high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Diagnostic w/u for esophageal diverticula

A
  • Barium esophagram
  • Endoscopy to characterize extent of diverticulum
    • Wide vs. narrow opeing
    • Mucosal abnormalities
    • Evaluate for malignancy
    • Must be careful not to perforate
  • ​Manometry (distal or epiphrenic diverticula d/t high association with motility disorder)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment of Zenker’s diverticulum

A

Cricopharyngeomyotomy + Diverticulectomy

  • Alternative Treatmetn:
    • Suspension and pexy of diverticulum (small, < 2cm diverticula) may be an option in addition to myotomy.
    • Transoral, endoscopic stapler
      • Opens diverticulum and divides cricopharyngeaus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Treatment of mid-esophageal, traction diverticula

A
  • Right thoracotomy
  • Diverticulectomy
  • Contralateral esophagomytomy if motility disorder suspected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment of epiphrenic diverticula

A
  • Low left thoracotomy
  • Diverticulectomy (mucosa oversewn)
  • Esophagomyotomy (high association with motility disorder)
  • Partial fundoplications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly