Eosophageal Atresia Flashcards
What is oesophageal atresia?
A genetic defect in which the upper oesophagus is not connected to the lower oesophagus, ending blindly instead.
What is it caused by?
The abnormal development of the tracheoesophageal septum
When does it present?
Immediately after birth
How does it present?
Cyanosis attacks
Foaming at mouth
Coughing
Inability to pass a feeding tube into stomach
What is necessary to classify the atresia?
X ray - shows an air filled pouch at the level of the third thoracic vertebrae
Why can infants with suspected oesophageal atresia not be fed orally?
There is a risk of aspiration pneumonia
Curative surgery must be performed when?
Within first 24 hours after birth
How many types are there?
Type A-E
Type A = oesophageal atresia without tracheoesophageal fistula (around 8%)
Type B = oesophageal atresia with tracheoesophageal fistula to the proximal oesophageal segment (3%)
Type C = oesophageal atresia with tracheoesophageal fistula to the distal oesophageal segment (84%)
Type D = eosophageal atresia with tracheoesophageal fistula to proximal and distal segments
Type E= tracheoesophageal fistula without atresia (4%)
What type of tissue differentiation is defective?
Defect in mesodermal differentiation
About 50% of cases are associated with other mesodermal defects such as…
VACTERL Vertebral anomaly Anal atresia Cardiac anomaly Tracheoesophageal fistula Oesophageal atresia Renal anomaly Limb malformation
What prenatal clinical features are associated?
Polyhydramnios- fetus unable to swallow amniotic fluid
Associated with increased risk of premature birth
Why do cyanosis attacks occur?
Due to reflex laryngospasms that prevent reflux aspiration
How is it diagnosed?
Inability to pass feeding tube
X ray of thorax/abdomen - oesophageal pouch (except with type E), large gastric bubble (gross types A and B present with gasless abdomen)
What differentials are there?
Status post C section - excessive secretions, but a reversible condition
Choanal atresia - cyanosis attacks which normalise after opening mouth
Oesophageal stenosis - dysphagia, regurgitation
Defective swallow reflex - CNS disorder or peripheral neuromuscular disorder
How is it managed pre operatively?
Placement of an oroesophageal or nasoesophageal tube for suctioning of secretions to prevent aspiration
Upper body elevated
Antibiotics in case of aspiration pneumonia
