PEDIATRIC Section 7: LUMINAL GI

Question 1

What are the subtypes of TracheoEsophageal fisule (TEF)

Answer 1

N-Type (Type C)
Esophageal Atresia (Type A)
H-Type (Type E)

Question 2

Classic TEF scenario?

Answer 2

frontal CXR with an NG tube stopped in the upper neck,

or a fluoro study (shown lateral) with a blind ending sac or communication with the tracheal tree.

Question 3

TEF diagnosis is made with?

Answer 3

Diagnosis is made with a Fluoro swallow exam

Question 4

What are the associated conditions in TEF?

Answer 4

VACTERL

Question 5

What is the most common subtype of TEF?

Describe?

Answer 5

N type (Type C)

blind ended esophagus, with distal esophagus hooked up to trachea

Question 6

TEF with Excessive Air in the Stomach

Answer 6

H Type (Type E)

Question 7

TEF with NO air in the stomach?

Answer 7

Esophageal Atresia (Type A)

Question 8

What must be described in TEF prior to surgery?

Answer 8

Presence of a right arch (4%)

Question 9

This is a way of remembering that certain associations are seen more commonly when together (when you see one, look for the others).

Answer 9

VACTERL

Question 10

What is VACTERL?

Answer 10

V - Vertebral Anomalies (37%)
A - Anal (imperforate anus) (63%)
C - Cardiac (77%)
T- Tracheoesophageal Fistula
E - sophageal Atresia (40%)
R- Renal (72%)
L - Limb (radial ray) - 58%

Question 11

VACTERAL association is diagnes when?

Answer 11

or more of the defined anomalies affect a patient.

Question 12

What iare the most common organs affected in VACTERL?

Answer 12

Heart and kidneys

Question 13

In VACTERL/When both kidneys tend to be involved?

Answer 13

If both limbs are involved, then both kidneys tend to be involved. If one limb is involved, then one kidney tends to be involved.

Question 14

a repaired esophageal atresia will end up in what complication?

Answer 14

Stricure in 30%

Question 15

When can you see strictures?

Answer 15

Caustic ingestion - long segment
Reflux (chronic and severe)

Question 16

The esophagus will accommodate the coin so it can be turned in any direction. The trachea is rigid and will force the coin to rotate into the posterior membrane — so what will the coin look like on AP?

Answer 16

Skinny

Question 17

Diagnosis?

Answer 17

Pulmonary SLing

Question 18

The only variant in vascular impressions that goes between the esophagus and the trachea.

Answer 18

Pulmonary sling

Question 19

Vascular impressions associated with tracheal stenosis

Answer 19

Pulmonary sling (which is actually primary and not secondary to compression)

Question 20

Associated cadiopulmonary and systemic anomalies in Pulmonary Sling

Answer 20

hypoplastic right lung,
horseshoe lung,
TE-fistula,
imperforate anus
complete tracheal rings.

Question 21

What is the treatment of choice in Pulmonary sling?

Answer 21

Treatment is controversial but typically involves surgical repositioning of theartery

Question 22

MOST common SYMPTOMATIC Vascular ring anomaly

Answer 22

Double aortic Arch

Question 23

Diagnosis?

Answer 23

Double Aortic arch

Question 24

Most common Aortic arch anomaly - not necessarilty symptomatic

Answer 24

Left Arch with Aberrant Right Subclavian Artery

Question 25

Trouble swallowing Left Arch with Aberrant Right Subclavian Artery

Answer 25

“Dysphagia Lusoria”

Question 26

pouch like aneurysmal dilatation of the proximal portion of an aberrant right subclavian artery

Answer 26

Diverticulum of Kommerell

Question 27

Diagnosis?

Answer 27

Diverticulum of Kommerell