Zenker diverticulum

Define: Zenker's diverticulum

aka pharyngeal pouchMucosal out-pouching in a weak area known as Killian's triangleBetween the thyropharyngeus and cricopharyngeas (∴ just above the UES)

Pathogenesis

Lack of proper of relaxation of the cricopharyngeus (UES) → ↑ pressure on direct tissues above during swallowing

Associations

- elderly - motor neuron disease- previous CVA

Clinical features

Upper cervical dysphagia"Lump" appearing on the SIDE of the neck when SWALLOWINGRegurgitationNocturnal aspiration - "waking up coughing

Diagnosis

Lump" appearing on the SIDE of the neck when SWALLOWINGBarium swallow

Treatment

Endoscopic stapling - diverticulotomy with staplesNeck surgery - resection + incision of cricopharyngeus

5 key questions to ask in patients with dysphagia

- Solids and liquids from the start?Yes; susp. motility disorder (achalasia, CNS, pharyngeal)No; solids then liquids; (stricture)- Difficult INITIATING swallowing movement?Yes; bulbar palsy (esp. if patient coughs on swallowing)- Painful swallowing?Yes; suspect ulceration (cancer, esophagitis...)- Intermittent or constant/getting worseIntermittent; diffuse esophageal spasmConstant and worsening; malignant stricture - Neck bulge on gurgle/drinking?Yes; pharyngeal pouch

Tests/exams for dysphagia

Examine mouthFeel the supraclavicular nodes (Virchow's)Signs of systemic disease/CNS Upper GI endoscopy +/- biopsyManometry (dysmotility)Barium swallow