Respiratory Clinical Cases Flashcards
-Full-term male
-Pregnancy complicated with size greater than dates for the past 4 weeks
-Copious amounts of amniotic fluid
-Nasogastric tube inserted in nose and could not be advanced past 12 cm
-Difficulty breathing that seemed to improve with pharyngeal suctioning
-X-ray demonstrated nasogastric tube folded in the proximal esophagus
-Normal bowel game noted
What is the diagnosis?
Esophageal atresia with tracheoesophageal fistula.
What is the embryology behind Esophageal atresia with tracheoesophageal fistula?
Incomplete division of the cranial part of the foregut.
What type of TEF is most likely with the following symptoms:
- Nasogastric tube could not be advanced.
- Bowel gas seen on x-ray
Esophageal atresia with distal TEF. There must be a connection between the trachea and esophagus somewhere if bowel gas is present
What does bowel gas suggest in a patient with suspected esophageal atresia?
Esophageal fistula
What is the cause of “size greater than dates”?
Esophageal atresia led to polyhydramnios.
–> Urine recirculates through amniotic fluid, and is then swallowed. When there is an obstruction, the urine cannot re-enter the gastrointestinal system.
How do you know there is a distal fistula with the atretic esophagus?
Air in the bowel confirms a distal fistula
-Female, 1100 grams, emergent C section
-Mother is 14 yr old with seizures
—Pregnancy undiagnosed
—Blood pressure = 190/125 and severe proteinuria
—Eclampsia in mom
-Amniotic fluid volume normal, placenta unremarkable
-Severe retractions, intubation for cyanosis
-CXR showed ground glass appearance in lung fields
-Air-bronchogram formation and reduced lung volume
What is the diagnosis?
Respiratory distress syndrome (RDS)
- VERY SMALL baby
- Signs of respiratory distress
What causes respiratory distress syndrome?
Immature type II pneumocytes fail to produce adequate surfactant.
Where do Type II pneumocytes live?
They line the alveoli.
What is the therapy for respiratory distress syndrome?
Artificial surfactant administration will improve compliance of the lung.
How can respiratory distress syndrome (RDS) be ameliorated?
- Prenatal corticosteroids can reduce incidence of RDS
- Prolonging the pregnancy decreases the incidence of RDS
What other benefits can prenatal corticosteroids provide to unborn babies?
It improves outcomes in different organ systems as well (helps globally):
- Less cardiac failure
- Less renal dysfunction
When do corticosteroids not improve RDS statistically?
After 34 weeks. Most OBs don’t give corticosteroids after this date. (probably just don’t have the statistical power to study it at this stage in gestation)
When do you give corticosteroids to a pregnant woman?
When she has a high risk pregnancy.
–> high blood pressure (pre-eclampsia)
How quickly do corticosteroids work and when do you see their maximum effect?
Typically take 48 hours to see the maximum effect and this effect lasts up to 14 days.
