L1: Esophageal Atresia

Question 1

Synonyms & Def of Congenital malformations

Answer 1

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”.

Question 2

Epidemeology of Congenital malformations

Answer 2

Question 3

Etiology of Congenital malformations

Answer 3

Question 4

Congenital malformations of Digestice Systems

• Esophageal

Answer 4

Question 5

Congenital malformations of Digestice Systems

• Intestinal

Answer 5

Question 6

Congenital malformations of Digestice Systems

• Abdominal Wall

Answer 6

Question 7

Congenital malformations of Digestice Systems

• Ano-Rectal in Males

Answer 7

Question 8

Congenital malformations of Digestice Systems

• Ano-Rectal in Females

Answer 8

Question 9

Def of Esophageal Atresia

Answer 9

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

Question 10

Embryological Backgroud of Esophageal Atresia

Answer 10

Question 11

Incidence of Esophageal Atresia

Answer 11

One in 3000 births

Question 12

Sex in Esophageal Atresia

Answer 12

Slight Male Predominance MCQ

Question 13

Esophageal Atresia is associated with ……

Answer 13

Associated malformations: 50% of cases.

Question 14

Types of Esophageal Atresia

Question 15

Types of Esophageal Atresia

• Type A

Answer 15

Pure esophageal atresia without TEF.

Question 16

Types of Esophageal Atresia

• Type B

Answer 16

Esophageal atresia with proximal TEF.

Question 17

Types of Esophageal Atresia

• Type C

Answer 17

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

Question 18

Types of Esophageal Atresia

• Type D

Answer 18

Esophageal atresia with proximal and distal TEF.

Question 19

Types of Esophageal Atresia

• Type E

Answer 19

TEF without esophageal atresia (H-shaped Fistula)

Question 20

Pathophysiology of Esophageal Atresia

Answer 20

Question 21

CP of Esophageal Atresia

• Prenatal

Answer 21

Question 22

CP of Esophageal Atresia

Answer 22

• Pre-natal
• Post-natal

Question 23

CP of Esophageal Atresia

• Post-Natal

Answer 23

Question 24

Dx of Esophageal Atresia

Answer 24

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

Question 25

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

Answer 25

Question 26

Dx of **Esophageal Atresia** - Plain X-Ray With Feeding Tube

Answer 26

Question 27

Dx of **Esophageal Atresia** - Endoscopy & Bronchoscopy

Answer 27

Question 28

Dx of **Esophageal Atresia** - Dx of Associated Anomalies

Answer 28

Question 29

TTT of **Esophageal Atresia**

Answer 29

- Pre-Operative - Operative - Post-Operative

Question 30

TTT of **Esophageal Atresia** - Pre-operative

Answer 30

- Minimize Complications - Antibiotics - No Oral Feeding - Baby Stabilization

Question 31

Pre-Operative TTT of **Esophageal Atresia** - Minimize Complications

Answer 31

Minimize complications from aspiration by - Continuous suction of the blind pouch with Replogle tube. - Maintain the child in upright or prone position.

Question 32

Pre-Operative TTT of **Esophageal Atresia** - Antibiotics

Answer 32

in case of aspiration pneumonia

Question 33

Pre-Operative TTT of **Esophageal Atresia** - Feeding?

Answer 33

- No oral feeding - start IV fluids or total parenteral nutrition (TPN).

Question 34

Pre-Operative TTT of **Esophageal Atresia** - Baby Stabilization

Answer 34

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

Question 35

Operative TTT of **Esophageal Atresia**

Answer 35

- Short Gap Atresia (Type C) - Long GAp Atresia (Type A)

Question 36

Operative TTT of **Esophageal Atresia** - Short Gap Atresia (Type C)

Answer 36

Question 37

Operative TTT of **Esophageal Atresia** - Long Gap Atresia (Type A)

Answer 37

Question 38

Post-Operative TTT of **Esophageal Atresia**

Answer 38

- Fluids - Antibiotics - Mechanical Ventilation - NGT & Feeding - Chest Tube - GERD TTT

Question 39

Post-Operative TTT of **Esophageal Atresia** - Fluids

Answer 39

Adequate fluid resuscitation

Question 40

Post-Operative TTT of **Esophageal Atresia** - Antibiotics

Answer 40

Continue broad-spectrum antibiotics

Question 41

Post-Operative TTT of **Esophageal Atresia** - Mechanical Ventilation

Answer 41

- 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**

Question 42

Post-Operative TTT of **Esophageal Atresia** - NGT & Feeding?

Answer 42

- **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.**

Question 43

Post-Operative TTT of **Esophageal Atresia** - Chest Tube

Answer 43

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

Question 44

Post-Operative TTT of **Esophageal Atresia** - GERD

Answer 44

- 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**.

Question 45

Done