1229 Exam 5: TE Fistula

Question 1

Atresia

Answer 1

congenital absence or closure of normal body opening or tubular structure

Question 2

Esophageal Atresia with/without Tracheoesophageal Fistula

Answer 2

Congenital (before birth): hereditary, injury, infection, drugs
Failure of the esophagus and tract to seperate
Failure of the esophagus to develop as continous passage

Question 3

Fistula

Answer 3

abnormal tube like passage from a normal cavity or tube to a free surface or another cavity or tube

Question 4

Esophageal Atresia

Answer 4

The esophagus ends in a blind pouch

Nothing the baby swallows goes to the stomach

Question 5

Fistula Etiology

Answer 5

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

Question 6

VACTERL or VATER Syndrome

Answer 6

V- Vertebral
A- Anorectal
C- Cardiovascular
T- Tracheo
E- Esophageal
R- Renal
L- Limb

Question 7

Types

Answer 7

Out of the 5 types of fistulas 86% are Type C

Question 8

S&S

Answer 8

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

Question 9

Complications

Answer 9

Aspiration
Respiratory Distress
Laryngospasms

Question 10

Clinical Manifestations

Answer 10

Abdomen distention/vomiting
Feeding intolerance-choking & cyanotic episodes that worsen with feedings
Excessive drooling/ sneezing

Question 11

Diagnostics

Answer 11

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

Question 12

Pre Op

Answer 12

O2/ No ventilator
Respiratory distress: breath sounds, retractions, cyanosis
Resuscitation Equipment available
Teaching/Coping: Explain, reassurance, encouragement

Question 13

Surgery

Answer 13

General anesthesia
Thoracotomy, division & ligation of TEF, end to end anastamosis of the esophagus
Post op will go to NICU

Question 14

Post Op

Answer 14

Airway:
endotracheal intubation suction
position
o2, turn
Nutrition
IV/TPN/Gastrostomy tube
I&O, Wt, abdominal girth, diet progress
Oral feedings 10-14 days

Question 15

D/C Teaching

Answer 15

Suction
Respiratory Distress
Tube care
Esophagus structure
CPR

Question 16

Hypertrophic Pyloric Stenosis (HPS)

Answer 16

thickening of the muscle of the pyloric sphincter, at the junction of stomach & duodenum

Question 17

Pyloric Stenosis

Answer 17

Most common cause of gastric outlet obstruction in infants

Question 18

Etiology of Pyloric Stenosis

Answer 18

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

Question 19

Pyloric Stenosis: “Narrowing”

Answer 19

Hypertrophy/Hyperplasia

Question 20

S/S of pyloric stenosis

Answer 20

Regurgitation
Vomiting, no bile, projectile
Hungry
Olive shaped mass to rt of umbilicus
Visible peristaltic waves that move left to right

Question 21

Complications of pyloric stenosis

Answer 21

Dehydration

Vomiting

Question 22

Diagnostics

Answer 22

PE
HX
Lab-electrolytes, ABG, BUN, Hct, Hgb
Ultrasound-preferred
Barium swallow

Question 23

Pre Op

Answer 23

NPO
NGT
Positioning
Antibiotics
Dehydration
Bonding
Document any emesis
IVF's- IV therapy to correct any electrolyte imbalance

Question 24

Surgical treatment

Answer 24

Pyloromyotomy:
longitundinal
incision through the muscle

Question 25

Post Op

Answer 25

Op Site
Anagesics
Feed q4-6 hrs
Progressive diet
Discharge
Complications

Question 26

Feeding Post Op

Answer 26

Oral electrolyte solution
Progressive diet
Feeding record
Assess vomiting