Oesophageal Diverticulas

Question 1

What is the epidemiology of oesophageal diverticula?

Answer 1

Rare compared to other GI sites
Peak incidence - middle aged and older male individuals
Zenker diverticulum is the most common type

Question 2

What is the classification of oesophageal diverticula?

Answer 2

Localisation - upper, middle and lower oesophageal diverticulum

Question 3

Where is upper oesophageal diverticulum located?

Answer 3

Pharyngoesophageal diverticulum
Most common type is canker diverticulum at Killian triangle

Question 4

where is the killian triangle located?

Answer 4

A triangular weeks point in the dorsal muscular wall of the hypopharynx between thyropharyngeal and cricopharyngeal constrictor muscle

Question 5

Where is the middle oesophageal diverticulum located?

Answer 5

Diverticulum at the tracheal bifurcation

Question 6

Where is the lower oesophageal diverticulum located?

Answer 6

Epiphrenic diverticulum

Question 7

What is the histology of a true and false diverticulum?

Answer 7

True - all layers of the oesophageal wall protrude
False - increased intralumiunal pressure causes only the mucosa and submucosa to bulge through weak points in the muscularis propria

Question 8

What is the pathoiphysiology behind an oesophageal diverticulum?

Answer 8

Inadequate relaxation of oesophageal sphincter and increased intraluminal pressure -> outpouching of the oesophageal wall -> pulsing diverticulum (false diverticulum as only mucosal wall protrudes)

Question 9

What are some common sites for pulsion diverticulum

Answer 9

Upper oesophageal sphincter - pharyngoesophageal pulsion diverticulum
Lower oesophageal sphincter - epiphrenic pulsion diverticulum

Question 10

what is the cause of a traction diverticulum?

Answer 10

Inflammation of mediastinum weight scarring and retraction eg secondary to TB or fungal infection

Question 11

Is a traction diverticulum a true or false diverticulum?

Answer 11

Usually true

Question 12

What is a common site for a traction diverticulum?

Answer 12

Middle oesophagus

Question 13

what are the clinical features of oesophageal diverticulum?

Answer 13

Dysphagia (most common)
Regurgitation of undigested food
Halitosis
Aspiration
Coughing after food intake
Retrosternal pressure sensation and pain
Weight loss
Neck mass

Question 14

How do you diagnose oesophageal diverticulum?

Answer 14

Barium swallow
Enbdoscopy
Oesophageal manometry
Transcutaneous ultrasound

Question 15

What is the use of an endoscopy for oesophageal diverticulum?

Answer 15

To rule out any malignancy in the pouch sand exclude other causes of patient’s symptoms eg tumour

Question 16

What is the purpose of oesophageal manometry?

Answer 16

Useful for identifying underlying motor abnormalities in patients with Dysphagia

Question 17

What is the purpose of a transcutaneous ultrasound?

Answer 17

Detection of zenker diverticula

Question 18

Which test is the best to confirm oesophageal diverticulum?

Answer 18

Barium swallow

Question 19

What is the purpose of a barium swallow?

Answer 19

Helps visiualise the diverticula and allows detection of underlying motor abnormalities and diverticulum size

Question 20

What is the treatment of oesophageal diverticulum?

Answer 20

Medical treatment - PPI’s for GERD symptoms

Surgical treatment - endoscopy with diverticulotomy and myotomy, open surgery

Question 21

What are the indications for surgical treatment?

Answer 21

Symptomatic zenker diverticula

Question 22

What are the complications of oesophageal diverticula?

Answer 22

Aspiration pneumonia
Perforation with mediastinitis and fistfula formation (rare)
Oesophageal cancer