Oesophageal Atresia & Congenial Diaphragmatic Hernia

Question 1

what the incidence rate of the esophageal atresia ?

Answer 1

is 1 every 2500 or 3000

about 0.5-2%

Question 2

whats the embryology of the oesophagus ?

Answer 2

at the 4th week the foregut will start to differentiate into ventral respirtatory part and dorsal oesopheagal part
then at the 6-7 week there will be complete separation of the trachea and the oesophagus

Question 3

the type of muscle in the esophageal sphincter ?

Answer 3

proximal___the muscle is started

the distal ___ the muscle is smooth

Question 4

what’re the most common type of the oesophageal atresia ?

Answer 4

type C is 85 % (Oesophageal atresia with distal fistula )
and type A is 7% (Pure oesophageal atresia without fistula)
type E
type B
type D

Question 5

whats type A ?

Answer 5

its 2nd most common around 7 %

its pure esophageal atresia with no fistula

Question 6

type B ?

Answer 6

its 2%

and its called (atresia with proximal fistula )

Question 7

type c?

Answer 7

most common around 85% (atresia with distal fistula )

Question 8

type d?

Answer 8

its less 1% rare

atresia with two fistula

Question 9

type E or H type ?

Answer 9

4%

no atresia just pure fistula

Question 10

whatre the associated anomalies with esophageal atresia ?

Answer 10

1- cardiac
2- renal
3-skeletal
4- Anorectal

Question 11

how to diagnosis the fetus with esophageal atresia ?

Answer 11

• we could diagnosis it early before labor by the US
  if there is polyhdraminous and no gastric shadow

-or after birth by
1-frothy saliva and cyanotic episodes
2- chocking on the first feed
3- history of polyhydraminous

-then confirm the diagnosis by
1- failure to pass 10 FR nasogastric or orogatric to the stomach

2- if used soft tube with x-ray the tube will coil within the upper esophageal pouch + also give an idea is there abdominal gases or not

• then we should see if there is associated anomalies bu using echocardiography or abdominal u/s

Question 12

what’re the general measurement for esophageal atresia ?

Answer 12

1- put the fetus in the incubator 
2- NOP( nothing by mouth ) and give IVF 
3- elevate the head of the fetus  and frequent suction of the fluid and saliva 
4- antibiotic 
5- vit k

Question 13

what’re the special measurements of the esophageal atresia ?

Answer 13

depending on the gap between the esophagus end we decide wither there is primary repair or delay primary delay or gastrostomy or cervical esophagostomy

Question 14

How to treat the type C atresia with fistula

Answer 14

_an incision made in the right thoracotomy and retro plural
we dived and ligate the trachea -esophageal fistula

then anastomosis the two ends of the esophagus

Question 15

whats the embryology of the diaphragm?

Answer 15

derived from

• thoracic intercostal muscle
• pleuro-peritoneal membrane
• septum transversum
• • oesophageal mesentery

and the Rt side closed just before the left side

Question 16

what’s the cause of the diaphragmatic hernia?

Answer 16

its delay of failure of the closure that leads to weak area then hernia

Question 17

what’s the origin of the diaphragmatic muscle?

Answer 17

-its costal, sternal and vertebral
periphery is muscle while the center is the tendon

• its has 3 openings for the esophagus, aorta and inf vena cava
• supply by right and left phrenic nerve (3,4,5 keep the diaphragm alive )

Question 18

whats the incidence of the congenital diaphragmatic hernia?

Answer 18

it 1 every 2000

Question 19

how would U estimate the morbidity and mortality for the

congenital diaphragmatic hernia?

Answer 19

is largely associated with 
-pulmonary hypoplasia (30% of babies die from respiratory failure )
-other congenital anomalies 
1- intestinal malformation
2- patent ductus artersus 
3-cardiac  
4- urinary 
5- muscular 
5- CNS

Question 20

what the types of congenital diaphragmatic hernia?

Answer 20

1- Boch-Dalek hernia (posterolateral congenital diaphragmatic hernia?) 90%
2- Morgan-gni Hernia (Anterior congenital diaphragmatic hernia?)

Question 21

how to diagnosis congenital diaphragmatic hernia?

Answer 21

1- plain chest x ray
2- contrast study
3-chest CT scan

we can dignosis CDH in the 18th week of gestation (نص الشهر الرابع )
by the ultarsound we can see the following :
1-lung heart ratio (normal 1;3)
2- liver in the chest

Question 22

dose the Boch-dalk hernia majority right or left?

Answer 22

it’s left 85%
right 13%
bilaterl 2%

Question 23

how and when to diagnosis the CDH in the prenatal period?

Answer 23

by the US in the 18th week (نص الرابع)

• liver in the chest
• lung heart ratio (normally 1:3)

Question 24

what’s the clinical presentations of the neonate with CDH?

Answer 24

neonate will have a stable state for 1 or 2 days
then he will have :
1- respiratory distress (tachypnea, cyanosis, chest retraction low Apgar score)

2- scaphoid abdomen
3- Apex beat shifted to the right (aberrant dextrocardia ) with bowel sounds

Question 25

dose the CDH only present in the neonate life?

Answer 25

no, 20% of cases present with CDH outside the neonate life present with a mild respiratory problem, feeding intolerance, gastric malformation

older pt with better prognosis no or mild complications (no hypoplasia or hypertension )

Question 26

what the initial resuscitation of the CDH?

Answer 26

1- intensive monitoring
2- no oral feed but nasogastric tune to compress the stomach
3- IV fluid
4- vit k and antibiotic
50- endotracheal intubation and mechanical ventilator

Question 27

surgical correction of the CDH?

Answer 27

1- first should give pt initial  resuscitation for stabilization 
2-subcostal incision by thoracotomy and 
other options 
as 1- laparoscopy 
2- *thoracoscopy 
3- robot surgery