DIVERTICULUM.pptx

1. Diverticulum
PRESENTED BY :
V.RAMYA,
TUTOR,
SRMTCON.

2. overview
 Introduction
 Types
 Zenker diverticulum
 Midesophageal diverticulum
 Epiphrenic diverticulum
 Clinical manifestations
 Assessment and diagnostic findings
 Management

3. INTRODUCTION
* An esophageal diverticulum is an out pouching of mucosa and
submucosa that protrudes a week portion of the musculature of the
esophagus.
• Diverticula may occur in one of three areas of the esophagus.
• Pharyngoesophageal ( upper )
• Midesophageal ( middle )
• Or epiphrenic ( lower)

4. diverticulum

5. types
 The most common type of diverticulum is zenker
diverticulum.
 Located in the Pharyngoesophageal area ,zenker
diverticula are caused by a dysfunctional sphincter that
fails to open, which leads to increased pressure that forces
the mucosa and submucosa to herniate through the
esophageal musculature ( called a pulsion diverticulum )
 Is usually seen in people older than 60 years of age.

6. Esophageal diverticulum

7. Zenker diverticulum

8. Midesophageal diverticulum
Midesophageal diverticula are
uncommon.
Symptoms are less acute , and
usually the condition does not
require surgery.

9. MIDESOPHAGEAL DIVERTICULUM

10. Epiphrenic diverticulum
 Epiphrenic diverticula are usually larger diverticula
in the lower esophagus just above the diaphragm.
 They may be related to the improper functioning
of the lower esophageal sphincter or to motor
disorders of the esophagus.

11. Intramural diverticulosis
Intramural diverticulosis is the
occurrence of the numerous small
diverticula associated with a
stricture in the upper esophagus.

12. Clinical manifestations
 Symptoms experienced by the patient with a
Pharyngoesophageal pulsion diverticulum include
dysphagia,
 fullness in the neck,
 Belching,
 Regurgitation of undigested food ,and
 Gurgling noises after eating.

13. Clinical manifestations
 When the patient assumes a recumbent position
,undigested food is regurgitated ,and coughing may be
caused by irritation of the trachea or aspiration.
 Halitosis ( bad breath ) and a sour taste in the mouth are
also common because of the decomposition of food
retained in the diverticulum.
 Although less acute, dysphagia is the primary symptom in
the other types of diverticula.

14. Assessment and diagnostic findings
 A barium swallow may determine the exact nature and location
of a diverticulum .
 Manometric studies may be performed for patients with
epiphrenic diverticula may rule out a motor disorder .
 Esophagoscopy usually is contraindicated because of the
danger of perforation of the diverticulum , with resulting
mediastinitis (inflammation of the organs and tissues that
separate the lungs ).
 Blind insertion of an NG tube should be avoided.

15. Surgical management
 Because zenker diverticulum is progressive ,the only
means of cure is surgical removal of the diverticulum.
 During surgery, care is taken to avoid trauma to the
common carotid artery and internal jugular veins.
 In addition to a diverticulectomy , a myotomy of the
cricopharyngeal muscle is often performed to relieve
spasticity of the musculature ,which seems to contribute to
a continuation of symptoms.

16. DIVERTICULECTOMY

17. Surgical management
 An ng tube may be inserted at the time of surgery.
 Postoperatively, the nurse observes the incision of evidence the
leakage from the esophagus and a developing fistula.
 Food and fluids are withheld until x –ray studies show no leakage at
the surgical site .
 The diet begins with liquids and is progressed as tolerated.
 Advances in technology include the minimally invasive endoscopic
stapler diverticulotomy, which expedites oral intake and discharge
,reduces the risk of fistula formation , and does not require an NG
tube.

18. Surgical management
 Patients who are not good candidates for this endoscopic
procedure those with a stiff or short neck ,poor mouth opening ,
prominent teeth , large tongue , and with a larger diverticula.
 Surgery is indicated for epiphrenic and Midesophageal
diverticula only if the symptoms are troublesome and
becoming worse.
 Treatment consists of diverticulectomy and long myotomy.
 Intramural diverticula usually regress after the esophageal
stricture is dilated.

19. bibliography
 Brunner and Suddarth’s Textbook of Medical- Surgical Nursing
,South Asian Edition , Volume 1 , Published by Wolters Kluwer .
Page reffered to 856-857.
 Ansari and Kaur, Textbook of Medical – Surgical Nursing 1 .
Published by Pee Vee 2011 Edition, Page reffered to 848 – 849.
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