Ch. 319 - Congenital Anomalies (Esophagus Only) Flashcards
MC congenital anomaly of the esophagus
Esophageal atresia (EA)
T/F Majority of EA have an associated TEF
T
MC form of EA
Type A: Proximal EA with distal TEF
Types of EA in order of frequency
A: Proximal pouch with distal TEF, B: Proximal and distal pouch with no TEF, C: TEF (H-type) D: Proximal TEF with distal pouch, E: Proximal and distal TEF
Associated features of EA
1) Advanced maternal age 2) European ethnicity 3) Obesity 4) Low socioeconomic status 5) Tobacco smoking
Highest risks for mortality in neonates with TEF
1) Less than 1500g at birth 2) Severe cardiac anomalies
___% of patients with EA are nonsyndromic
50%
MC anomaly associated with EA
VATER or VACTERL syndrome
T/F Aspiration of gastric contents via a distal fistula causes more damaging pneumonitis than aspiration of pharyngeal secretions from the blind upper pouch
T
Type of TEF that might come into medical attention later in life with chronic respiratory problems, including refractory bronchospasm and recurrent pneumonia
Type C or H-type fistula
Perinatal radiographic findings that might alert the physician to EA
Absence of the infant stomach bubble and maternal polyhydramnios
EA that can manifest as an air-distended stomach
Distal TEF
EA that can manifest as an airless scaphoid abdomen
Pure EA
Imaging modalities that can demonstrate an isolated TEF (H-type)
1) Esophagogram with contrast medium injected under pressure 2) Bronchoscopy 3) Methylene blue dye injected into the ET tube during endoscopy is observed in the esophagus during forced inspiration
Positioning that minimizes movement of gastric secretions into a distal fistula
Prone
T/F ET intubation with mech ventilation is to be avoided in patients with EA
T, it can worsen distention of abdominal viscera
Current standard surgical approach to an EA with TEF
Surgical ligation of TEF and primary end-to-end anastomosis of the esophagus via a right-sided thoracotomy
Temporizing surgical intervention for EA in patients who are premature or otherwise complicated
Fistula ligation and gastrostomy tube placement
Primary repair cannot be done if the gap between the atretic ends of the esophagus is
> 3-4cm
Options for repair of widely gapped EA
Using gastric, jejunal, or colonic segments interposed as a neoesophagus
___ contributes significantly to the respiratory disease (reactive airway disease) that often accompanies EA and TEF and also worsens the frequent anastomotic strictures after repair of EA
GERD
Pulmonary condition associated with EA with TEF that improves as the child grows
Tracheomalacia
