Oesophageal Atresia Flashcards
Oesophageal atresia (EA) is a variety of congenital anatomic defects that are caused by?
abnormal embryological development of the oesophagus.
EA is anatomically characterised by what developmental defect?
characterised by continuity of the oesophageal wall. oesophagus is divided into 2 pouch, an cooer and lower, which may/may-not communicate with the tracheobronchial tress, through fistula.
In how many live births does EA occur?
1/4,000 live births
The presence of EA is suspected during infancy. What are the signs that indicate EA in infancy?
Presence is detected during infant with excessive salvation + bubbles and in new-born with drooling, frequently accompanied by choking, coughing and sneezing. When fed, infants swallow normally but begins to cough and struggle- fluid returns through mouth and nose as it’s not able to reach the stomach. The infant can become cyanotic due to lack of O2 and stop breathing as over-flow of fluid from upper E pouch makes way to lungs. During ventilation fluid can be sucked into trachea -> lungs -> choking
Cyanosis is a result of laryngospasm. Explain what this is and over time what it can lead to?
Cyanosis is a result of laryngospasm (protective mechanism that the body uses to prevent aspiration into trachea). Over time respiratory distress will develop.
Catheters are used to confirm the presence of EA, how?
If any of the above signs/symptoms are notices, a catheter is gently passes into oesophagus to check for resistance. If resistance is noted, other studies will be done to confirm the diagnosis. A catherter can be inserted and will show up as a white on regular X-ray film to demonstrate the blind pouch ending. Sometimes a small amount of barium (chalk-like liquid) is placed through the mouth to diagnose the problem
what are the treatments of EA?
Treatment of EA and TEF is surgery to repair the defect, If EA or TEF is suspected, all oral feeding is stopped and IV fluids are started. The infant will be positioned to help drain secretion and decrease the likelihood of aspiration. Babies with EA may sometimes have other problems. Surgery to fix EA is rarely emergency. Once the baby is in condition for surgery, an incision is made on the side of the chest. The oesophagus can usually be sewn together- anastomosis of upper and lower part.
What types of EA and trachea-oesophageal fistula are there?
Type A Type B Type C Type D Type E Type F
What type of EA is most common? How is this type detected?
Type C Most Common type (~85% of affected babies will have lower fistula) Oesophagus Atresia with distal (lower) TEF Lower part of oesophagus goes straight to trachea Can lead to air in stomach Air is helpful indicator in X-rays + catheter are gold standard test If no air in abdomen => Not lower fistula (confirms presence of NOT type C)
At which week of fetal development does defect in the development of Oesophagus and Trachea become disrupted leading to EA?
In 4th fetal week, when trachea and Oesophagus should begin to separate from each-other, birth defects lead to EA.
what other birth defects can EA be associated with?
Other birth defects EA is associated with can occurs in: Heart, but sometimes also in the anus, spinal column or kidney – Known as Vacterl syndrome (because it involves vertebral column). Anorectal, cardiac, tracheal, oesophageal, renal and limbs is associated with polyhydramnios in the 3rd trimester.
At how many weeks can the condition be visible? What signs help direct to EA diagnosis?
This condition is visible, after 26 wks on ultrasound. On antenatal USG, the finding of an absent or small stomach is the setting of polyhydramnios used to be considered suspicious of oesophageal atresia. Infant unable to swallow its own saliva. New born may have- gastric distention, cough, apnea, tachypnea and cyanosis.
What is the Gold standard diagnosis for EA?
Gold standard- Catheter 5cm into oesophagus + X-rays w/ contrast dye showing air in lower GI In many types of oesophageal atresia, a feeding tube will not pass though oesophagus as its not developed into a long continuous tube itself.
Complication which can occur due to presence of EA are?
Any attempt at feeding could cause aspiration (chemical) pneumonia as the milk collects in the blind pouch and overflows into the trachea and lung. A fistula between lower oesophagus and trachea allows stomach acid to flow into lungs -> damage of trachea and lung tissue (vital for respiration). Because of these dangers, the condition must be treated as soon as possible after birth Tracheomalacia- softening of the trachea, usually above the crania, but sometimes extensive in the lower bronchial tress as-well is another possible serious complication.
Surgical repair is the most immediate and effective form of treatment in most cases why. Why can’t this method of treatment be applied to all types of EA?
Surgery is effective as it immediately close the fistula(s) and reconnect the 2 ends of the oesophagus to each-other. However it’s not possible in all cases, since the gap between upper and lower oesophageal segments may be too longs to bridge.
