2. Tracheoesophageal anomalies

Question 1

types (MC)

Answer 1

1. Pure esophangeal atresia or stenosis
2. Pure tracheosophageal ( H- type)
3. Esophangeal atresia with distal tracheoesophageal fistula ( MC -85%)

Question 2

tracheosophageal anomalies - clinical presentation

Answer 2

1. Polyhydramnios in utero.
   2,Neonates drool, choke, and vomit with first feeding. 3.allows air to enter stomach (visible on CXR). 4.Cyanosis is 2° to laryngospasm (to avoid reflux-related aspiration).

Question 3

CXR of abdomen

Answer 3

1. Pure esophangeal atrsia or stenosis –. GASLESS ABDOMEN
2. Pure tracheosophageal –> air in stomach
3. Esophangeal atresia with distal tracheoesophageal fistula –> air in stomach

Question 4

clinical test

Answer 4

failure to pass nasograstric tube into stomach

Question 5

Interstinal atresia presents with

Answer 5

bilious vomiting ( with bile ) and abdominal distention within first 1-2 days of life. Proximal atresia is also presented with polyhydramnios

Question 6

Interstinal atresia - types

Answer 6

1. duodenal atresia

2. jejunal and ileal atresia

Question 7

duodenal atresia - mechanism / finding s

Answer 7

failure to recanalize –> dilation of stomach and proximal duodenum ( DOUBLE BUBBLE on x-ray)

Question 8

jejunal and ileal atresia - mechanism / findings

Answer 8

disruption of mesenteric vessels—> ischemic necrosis —> segmental resorption ( bowel discontinuity or ‘‘apple peel”)

Question 9

duodenal atresia is associated with

Answer 9

Down syndrome

Question 10

• What is the most common subtype of tracheoesophageal fistula?

Answer 10

Esophageal atresia (a blind-pouch upper esophagus with the lower esophagus connected to the trachea)

Question 11

• What are some symptoms seen with the most common subtype of tracheoesophageal fistula?

Answer 11

Cyanosis, choking, and vomiting with feeding, air bubble on x-ray of the chest (or polyhydramnios, if still in utero)

Question 12

• A patient’s CXR shows an airway stricture. He is drooling excessively. How do you confirm your suspected diagnosis?

Answer 12

Attempt to pass a nasogastric tube (in a tracheoesophageal fistula, the tube will not reach the stomach)

Question 13

• A newborn chokes and vomits with the first feeding, and she reportedly had polyhydramnios in utero. Why might this baby become cyanotic?

Answer 13

The newborn may develop cyanosis from laryngospasm (to avoid reflux-related aspiration) (this is a tracheoesophageal fistula)

Question 14

• A baby with esophageal atresia has a chest x-ray revealing a gasless abdomen. What type of esophageal atresia is this?

Answer 14

Pure atresia