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Y4R4 - Surgery II 👨‍⚕️ > L1: Esophageal Atresia > Flashcards

L1: Esophageal Atresia Flashcards

1
Q

Synonyms & Def of Congenital malformations

A

Congenital anomalies = Congenital disorders = Birth defects

  • Structural or functional anomalies that occur during intrauterine life and can be identified prenatally, at birth or later in life “According to WHO”.
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2
Q

Epidemeology of Congenital malformations

A
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3
Q

Etiology of Congenital malformations

A
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4
Q

Congenital malformations of Digestice Systems

  • Esophageal
A
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5
Q

Congenital malformations of Digestice Systems

  • Intestinal
A
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6
Q

Congenital malformations of Digestice Systems

  • Abdominal Wall
A
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7
Q

Congenital malformations of Digestice Systems

  • Ano-Rectal in Males
A
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8
Q

Congenital malformations of Digestice Systems

  • Ano-Rectal in Females
A
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9
Q

Def of Esophageal Atresia

A
  • Interruption in the continuity of the esophagus with or without tracheal fistula.
  • Abnormal differentiation of the gastrointestinal and respiratory tracts.
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10
Q

Embryological Backgroud of Esophageal Atresia

A
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11
Q

Incidence of Esophageal Atresia

A

One in 3000 births

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12
Q

Sex in Esophageal Atresia

A

Slight Male Predominance MCQ

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13
Q

Esophageal Atresia is associated with ……

A

Associated malformations: 50% of cases.

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14
Q

Types of Esophageal Atresia

A
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15
Q

Types of Esophageal Atresia

  • Type A
A

Pure esophageal atresia without TEF.

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16
Q

Types of Esophageal Atresia

  • Type B
A

Esophageal atresia with proximal TEF.

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17
Q

Types of Esophageal Atresia

  • Type C
A

Esophageal atresia with distal TEF. (The most common type ~85%).

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18
Q

Types of Esophageal Atresia

  • Type D
A

Esophageal atresia with proximal and distal TEF.

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19
Q

Types of Esophageal Atresia

  • Type E
A

TEF without esophageal atresia (H-shaped Fistula)

20
Q

Pathophysiology of Esophageal Atresia

A
21
Q

CP of Esophageal Atresia

  • Prenatal
A
22
Q

CP of Esophageal Atresia

A
  • Pre-natal
  • Post-natal
23
Q

CP of Esophageal Atresia

  • Post-Natal
A
24
Q

Dx of Esophageal Atresia

A
  • Plain X-Ray with Feeding Tube
  • Endoscopy & Bronchoscopy
  • Dx of VACTREAL Associations
25
Q

About 50% of cases are associated with other ……….. defects Like ………

A
26
Q

Dx of Esophageal Atresia

  • Plain X-Ray With Feeding Tube
A
27
Q

Dx of Esophageal Atresia

  • Endoscopy & Bronchoscopy
A
28
Q

Dx of Esophageal Atresia

  • Dx of Associated Anomalies
A
29
Q

TTT of Esophageal Atresia

A
  • Pre-Operative
  • Operative
  • Post-Operative
30
Q

TTT of Esophageal Atresia

  • Pre-operative
A
  • Minimize Complications
  • Antibiotics
  • No Oral Feeding
  • Baby Stabilization
31
Q

Pre-Operative TTT of Esophageal Atresia

  • Minimize Complications
A

Minimize complications from aspiration by

  • Continuous suction of the blind pouch with Replogle tube.
  • Maintain the child in upright or prone position.
32
Q

Pre-Operative TTT of Esophageal Atresia

  • Antibiotics
A

in case of aspiration pneumonia

33
Q

Pre-Operative TTT of Esophageal Atresia

  • Feeding?
A
  • No oral feeding
  • start IV fluids or total parenteral nutrition (TPN).
34
Q

Pre-Operative TTT of Esophageal Atresia

  • Baby Stabilization
A

The baby should be stabilized, the diagnosis should be confirmed, and full assessment for associated anomalies should be performed before surgical intervention.

35
Q

Operative TTT of Esophageal Atresia

A
  • Short Gap Atresia (Type C)
  • Long GAp Atresia (Type A)
36
Q

Operative TTT of Esophageal Atresia

  • Short Gap Atresia (Type C)
A
37
Q

Operative TTT of Esophageal Atresia

  • Long Gap Atresia (Type A)
A
38
Q

Post-Operative TTT of Esophageal Atresia

A
  • Fluids
  • Antibiotics
  • Mechanical Ventilation
  • NGT & Feeding
  • Chest Tube
  • GERD TTT
39
Q

Post-Operative TTT of Esophageal Atresia

  • Fluids
A

Adequate fluid resuscitation

40
Q

Post-Operative TTT of Esophageal Atresia

  • Antibiotics
A

Continue broad-spectrum antibiotics

41
Q

Post-Operative TTT of Esophageal Atresia

  • Mechanical Ventilation
A
  • The patient is usually maintained on mechanical ventilation for a variable period postoperatively
  • Maintain intubation until the risk of extubation failure is low given the fisk of reintubation of a freshly postoperative trachea.
  • Postoperative Muscle paralysis is sometimes indicated upon surgical team recommendations when esophageal anastomosis is performed under significant tension.
  • Deep tracheal suctioning is avoided except if lifesaving.
  • If endotracheal tube has to be changed, AVOID neck extension
  • Avoid bag/mask ventilation
42
Q

Post-Operative TTT of Esophageal Atresia

  • NGT & Feeding?
A
  • Ryle tube remains in place for about 1 week and (Never reinsert it if slipped).
  • Minimize the volume of swallowed saliva by frequent oral suctioning, with care taken not to insert the suction catheter into the esophagus to the depth of the anastomotic site.
  • Feeding can begin through Ryle tube at the 5th day if no evidence of leak from anastomosis
  • Esophagram may be performed 1 week after the operation to confirm absence of anastomotic leak.
43
Q

Post-Operative TTT of Esophageal Atresia

  • Chest Tube
A

To be removed after developing oral feeding without evidence of anastomotic leak (about 1 week).

44
Q

Post-Operative TTT of Esophageal Atresia

  • GERD
A
  • All babies after EA repair** should be treated with anti gastrosophageal reflux (GER) medications including acid blockade +/- a promotility agent.**
  • The EA repair itself increases the risk of GER because of tension on the lower esophagus.
  • Furthermore, acidic gastric contents will irritate the anastomotic site and increase the risk of stricture.
45
Q

Done

A

Y4R4 - Surgery II 👨‍⚕️ (16 decks)

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