B4.034 Development of the Respiratory System Flashcards
physical exam findings consistent with TEF
excessive oral secretions/mucous feeding difficulty gagging/choking hyperventilation, dyspnea, tachypnea cyanosis rales on auscultation VACTERL
what is VACTERL
vertebral abnormalities anal atresia cardiac abnormalities trachea-esophageal fistula renal/radial issues limb dysfunction
why is abdominal distention present in TEF?
caused by swallowing air during feeding
what physical exam finding with TEF helps rule out other congenital abnormalities with similar presentation?
mucous secretions from both nose and mouth suggest and interconnecting GI and trachea
how to evaluate suspicion of TEF?
CXR with NG tube
KUB (plain supine film of the abdomen) to identify air in GI tract
bronchoscopy confirms narrowing or fistula in esophagus
treatment of TEF?
emergency surgical repair
prognosis good following surgery
what conditions may a mother have experienced during pregnancy if she gives birth to a baby w TEF?
polyhydramnios
inhibited swallowing of amniotic fluid
complications of TEF surgery
aspiration pneumonia
pneumonitis
choking
reflux or esophageal stricture post op
what is the first step in the respiratory system development?
respiratory diverticulum
when do the esophagus and trachea split?
tracheoesophageal septum forms from the tracheoesophageal ridges
etiology of TEF
1/3000 births
90% blind esophagus and developed trachea with a TEF attaching from just below the bifurcation to the distal part of the esophagus
4% common communication between trachea and esophagus at bifurcation
4% isolated esophageal atresia
what is the hallmark of hypertrophic pyloric stenosis
normal feeding with a sudden change after 4-8 weeks
non-bilious projectile vomiting following feeding
why is there an alkaline pH and low potassium levels?
starvation leads to altered metabolism, regurgitation/emesis causes progressive loss of fluids, kidneys retain H+ ions in favor of K+
what is hypertrophic pyloric stenosis
narrowing of the pylorus region of the stomach (where the stomach meets the duodenum)
etiology of hypertrophic pyloric stenosis
more common in males
4x more frequent in firstborn males
2.4/1000 Caucasian births
key findings in a child w a congenital diaphragmatic hernia
scaphoid abdomen carrel shaped chest respiratory distress (retractions, cyanosis, grunting respiration)
findings in left sided posterolateral CDH?
poor air entry on the left
shift of cardiac sounds over the right chest
signs of pneumothorax if severe
downstream pathophysiology of CDH
pulmonary hypoplasia
fewer dichotomous branches of respiratory tree
increased muscularization of pulmonary arteries leading to pulmonary hypertension
what leads to the increased muscularization of pulmonary arteries in CDH?
attempting to provide more air exchange
what is the most/least common place for a CDH?
80-90% on left side
uncommonly in center
what is neonatal respiratory distress syndrome
caused by surfactant deficiency in premature infants
surfactant deficiency causes the lungs to collapse (atelectacic lung) with each successive breath
lack of O2 impairs surfactant synthesis
when is surfactant typically synthesized?
made by type 2 alveolar cells after the 35th week of gestation
corticosteroids induce this synthesis
appearance of RDS on CXR
ground glass with air brochograms (darker bronchi due to opacity to alveoli)
treatment for RDS
early admin os surfactant CPAP for alveolar recruitment diagnosis of patent ductus arteriosus fluid and electrolyte management trophic feeding and nutrition use of prophylactic fluconazole
