1229 Exam 5: TE Fistula Flashcards
Atresia
congenital absence or closure of normal body opening or tubular structure
Esophageal Atresia with/without Tracheoesophageal Fistula
Congenital (before birth): hereditary, injury, infection, drugs
Failure of the esophagus and tract to seperate
Failure of the esophagus to develop as continous passage
Fistula
abnormal tube like passage from a normal cavity or tube to a free surface or another cavity or tube
Esophageal Atresia
The esophagus ends in a blind pouch
Nothing the baby swallows goes to the stomach
Fistula Etiology
Rare- 1 in 4000 live births
Low birthweight & preterm babies
**Polyhydramnios-is the excessive accumulation of anmiotic fluid
Associated with other anomalities/defects
No hereditary factor
Equal sexes
Occurs 4th-5th week of gestation
VACTERL or VATER Syndrome
V- Vertebral A- Anorectal C- Cardiovascular T- Tracheo E- Esophageal R- Renal L- Limb
Types
Out of the 5 types of fistulas 86% are Type C
S&S
Symptoms occur soon after birth
Classic or Hallmark signs- 3 C’s: Choke, Cough, Cyanosis
May stop breathing
Copious fine white frothy bubbles of mucous in mouth & sometimes nose
Excess salivation
Nasal secretions
Clears with aggressive suction but returns
Complications
Aspiration
Respiratory Distress
Laryngospasms
Clinical Manifestations
Abdomen distention/vomiting
Feeding intolerance-choking & cyanotic episodes that worsen with feedings
Excessive drooling/ sneezing
Diagnostics
Can’t pass feeding tube or NG to stomach
Chest & abdomen x-rays to identify air in the stomach
Hx of polyhydramnios
No stomach bubble on prenatal ultrasound
Pre Op
O2/ No ventilator
Respiratory distress: breath sounds, retractions, cyanosis
Resuscitation Equipment available
Teaching/Coping: Explain, reassurance, encouragement
Surgery
General anesthesia
Thoracotomy, division & ligation of TEF, end to end anastamosis of the esophagus
Post op will go to NICU
Post Op
Airway: endotracheal intubation suction position o2, turn Nutrition IV/TPN/Gastrostomy tube I&O, Wt, abdominal girth, diet progress Oral feedings 10-14 days
D/C Teaching
Suction Respiratory Distress Tube care Esophagus structure CPR
Hypertrophic Pyloric Stenosis (HPS)
thickening of the muscle of the pyloric sphincter, at the junction of stomach & duodenum
Pyloric Stenosis
Most common cause of gastric outlet obstruction in infants
Etiology of Pyloric Stenosis
1 in 500 Full term infants 3 weeks to 2 months of age Hx of regurgitation & non-bilious vomiting shortly after feeding Vomiting becomes projectile
Pyloric Stenosis: “Narrowing”
Hypertrophy/Hyperplasia
S/S of pyloric stenosis
Regurgitation Vomiting, no bile, projectile Hungry Olive shaped mass to rt of umbilicus Visible peristaltic waves that move left to right
Complications of pyloric stenosis
Dehydration
Vomiting
Diagnostics
PE HX Lab-electrolytes, ABG, BUN, Hct, Hgb Ultrasound-preferred Barium swallow
Pre Op
NPO NGT Positioning Antibiotics Dehydration Bonding Document any emesis IVF's- IV therapy to correct any electrolyte imbalance
Surgical treatment
Pyloromyotomy:
longitundinal
incision through the muscle
Post Op
Op Site Anagesics Feed q4-6 hrs Progressive diet Discharge Complications
Feeding Post Op
Oral electrolyte solution
Progressive diet
Feeding record
Assess vomiting
