L1: Esophageal Atresia Flashcards
Synonyms & Def of Congenital malformations
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”.
Epidemeology of Congenital malformations
Etiology of Congenital malformations
Congenital malformations of Digestice Systems
- Esophageal
Congenital malformations of Digestice Systems
- Intestinal
Congenital malformations of Digestice Systems
- Abdominal Wall
Congenital malformations of Digestice Systems
- Ano-Rectal in Males
Congenital malformations of Digestice Systems
- Ano-Rectal in Females
Def of Esophageal Atresia
- Interruption in the continuity of the esophagus with or without tracheal fistula.
- Abnormal differentiation of the gastrointestinal and respiratory tracts.
Embryological Backgroud of Esophageal Atresia
Incidence of Esophageal Atresia
One in 3000 births
Sex in Esophageal Atresia
Slight Male Predominance MCQ
Esophageal Atresia is associated with ……
Associated malformations: 50% of cases.
Types of Esophageal Atresia
Types of Esophageal Atresia
- Type A
Pure esophageal atresia without TEF.
Types of Esophageal Atresia
- Type B
Esophageal atresia with proximal TEF.
Types of Esophageal Atresia
- Type C
Esophageal atresia with distal TEF. (The most common type ~85%).
Types of Esophageal Atresia
- Type D
Esophageal atresia with proximal and distal TEF.
Types of Esophageal Atresia
- Type E
TEF without esophageal atresia (H-shaped Fistula)
Pathophysiology of Esophageal Atresia
CP of Esophageal Atresia
- Prenatal
CP of Esophageal Atresia
- Pre-natal
- Post-natal
CP of Esophageal Atresia
- Post-Natal
Dx of Esophageal Atresia
- Plain X-Ray with Feeding Tube
- Endoscopy & Bronchoscopy
- Dx of VACTREAL Associations
About 50% of cases are associated with other ……….. defects Like ………
Dx of Esophageal Atresia
- Plain X-Ray With Feeding Tube
Dx of Esophageal Atresia
- Endoscopy & Bronchoscopy
Dx of Esophageal Atresia
- Dx of Associated Anomalies
TTT of Esophageal Atresia
- Pre-Operative
- Operative
- Post-Operative
TTT of Esophageal Atresia
- Pre-operative
- Minimize Complications
- Antibiotics
- No Oral Feeding
- Baby Stabilization
Pre-Operative TTT of Esophageal Atresia
- Minimize Complications
Minimize complications from aspiration by
- Continuous suction of the blind pouch with Replogle tube.
- Maintain the child in upright or prone position.
Pre-Operative TTT of Esophageal Atresia
- Antibiotics
in case of aspiration pneumonia
Pre-Operative TTT of Esophageal Atresia
- Feeding?
- No oral feeding
- start IV fluids or total parenteral nutrition (TPN).
Pre-Operative TTT of Esophageal Atresia
- Baby Stabilization
The baby should be stabilized, the diagnosis should be confirmed, and full assessment for associated anomalies should be performed before surgical intervention.
Operative TTT of Esophageal Atresia
- Short Gap Atresia (Type C)
- Long GAp Atresia (Type A)
Operative TTT of Esophageal Atresia
- Short Gap Atresia (Type C)
Operative TTT of Esophageal Atresia
- Long Gap Atresia (Type A)
Post-Operative TTT of Esophageal Atresia
- Fluids
- Antibiotics
- Mechanical Ventilation
- NGT & Feeding
- Chest Tube
- GERD TTT
Post-Operative TTT of Esophageal Atresia
- Fluids
Adequate fluid resuscitation
Post-Operative TTT of Esophageal Atresia
- Antibiotics
Continue broad-spectrum antibiotics
Post-Operative TTT of Esophageal Atresia
- Mechanical Ventilation
- 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
Post-Operative TTT of Esophageal Atresia
- NGT & Feeding?
- 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.
Post-Operative TTT of Esophageal Atresia
- Chest Tube
To be removed after developing oral feeding without evidence of anastomotic leak (about 1 week).
Post-Operative TTT of Esophageal Atresia
- GERD
- 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.
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