Oesophageal Atresia & Congenial Diaphragmatic Hernia Flashcards
what the incidence rate of the esophageal atresia ?
is 1 every 2500 or 3000
about 0.5-2%
whats the embryology of the oesophagus ?
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
the type of muscle in the esophageal sphincter ?
proximal___the muscle is started
the distal ___ the muscle is smooth
what’re the most common type of the oesophageal atresia ?
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
whats type A ?
its 2nd most common around 7 %
its pure esophageal atresia with no fistula
type B ?
its 2%
and its called (atresia with proximal fistula )
type c?
most common around 85% (atresia with distal fistula )
type d?
its less 1% rare
atresia with two fistula
type E or H type ?
4%
no atresia just pure fistula
whatre the associated anomalies with esophageal atresia ?
1- cardiac
2- renal
3-skeletal
4- Anorectal
how to diagnosis the fetus with esophageal atresia ?
- 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
what’re the general measurement for esophageal atresia ?
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
what’re the special measurements of the esophageal atresia ?
depending on the gap between the esophagus end we decide wither there is primary repair or delay primary delay or gastrostomy or cervical esophagostomy
How to treat the type C atresia with fistula
_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
whats the embryology of the diaphragm?
derived from
- thoracic intercostal muscle
- pleuro-peritoneal membrane
- septum transversum
- oesophageal mesentery
and the Rt side closed just before the left side
what’s the cause of the diaphragmatic hernia?
its delay of failure of the closure that leads to weak area then hernia
what’s the origin of the diaphragmatic muscle?
-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 )
whats the incidence of the congenital diaphragmatic hernia?
it 1 every 2000
how would U estimate the morbidity and mortality for the
congenital diaphragmatic hernia?
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
what the types of congenital diaphragmatic hernia?
1- Boch-Dalek hernia (posterolateral congenital diaphragmatic hernia?) 90%
2- Morgan-gni Hernia (Anterior congenital diaphragmatic hernia?)
how to diagnosis congenital diaphragmatic hernia?
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
dose the Boch-dalk hernia majority right or left?
it’s left 85%
right 13%
bilaterl 2%
how and when to diagnosis the CDH in the prenatal period?
by the US in the 18th week (نص الرابع)
- liver in the chest
- lung heart ratio (normally 1:3)
what’s the clinical presentations of the neonate with CDH?
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
dose the CDH only present in the neonate life?
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 )
what the initial resuscitation of the CDH?
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
surgical correction of the CDH?
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
