tracheoesophageal fistula and/or atresia

Question 1

Esophageal Atresia and Tracheoesophageal Fistula etiology

Answer 1

Acronym VACTERL: condition of multiple anomalies sometimes associated with tracheoesophageal defects

V–vertebral defect
A–anorectal malformation
C–cardiac defects
T–tracheoesophageal fistula
E–esophageal atresia
R–renal anomalies
L–limb defects

Question 2

diagnosis of Esophageal Atresia and Tracheoesophageal Fistula

Answer 2

• history of maternal polyhydramnios
• prenatal sonogram
• radiographic studies

Question 3

Esophageal Atresia with Fistula;

what is fistula?

Answer 3

abnormal opening between two

if ends in blind pouch:

symptoms: drool, saliva will not have any place to go
- also cough and sputter
- laryngospams
- abdominal distention from air

If spits up, will go up trachea

• first priority: airway
• suction
• position head up so secretions will pool in pouch and can suction out
• head out

Question 4

Post-op for:

Esophageal Atresia and Tracheoesophageal Fistula

Answer 4

• dont want anything irritating
• barky cough post-op

risk for esophageal cancer after this repair:

• feed g-tube
• leave g-tube open to get rid of gas
• gradually begin introducing liquids and decrease G-tube feeds
• comfort measures (stimulate suck reflex with pacifier)

Question 5

Hypertrophic Pyloric Stenosis (HPS)

Answer 5

• a GI obstruction disorder
• usually occurs in the first few weeks of life
• incidence is 1:150 in males, and 1:750 in females
• familial
• predominant in white first-born males

Question 6

physical findings of HPS

Answer 6

• regurgitation and nonprojectile vomiting during the first few weeks of life
• projectile vomiting beginning 2-3 weeks of age
• loss of apetite with weight loss, dehydration, and constipation
• vomitus is nonbilious, can contain blood
• “Olive” mass palpated in epigastrium
• reverse peristalsis visualized

Question 7

management of HPS

Answer 7

Surgery
surgical procedure—pyloromyotomy

Correction of fluid and electrolyte imbalance before surgery

Post-operative feeding:
introduce gradually within 4-6 hours

Full feeding schedule by 48 hours post-op

Question 8

Intussusception

Answer 8

Most common cause of intestinal obstruction in the first 2 years of life.

Males predominate by 3:2 ratio

Peak incidence is between 5-9 months of age

Incidence increases in spring, summer and middle of winter

More common in children with CF

Question 9

Pathophysiology of Intussusception

Answer 9

Cause not generally apparent

Predisposing factors

Telescoping of one portion of the intestine into another

Most common site is the ileocecal valve

Invagination causes obstruction to the flow of intestinal contents

Edema and inflammation decrease blood flow –> ischemia, perforation, peritonitis, shock

Question 10

Physical Findings of Intussusception

Answer 10

Colicky; cramp like pain

intermittent abdominal pain

Vomiting

Currant jelly-like stools; blood mucus

Screaming with drawing up of legs

Periods of calm or lethargy between episodes

“currant jelly” stools

Fever sometimes

Sausage-like mass in RUQ may be palpated

Distended abdomen, pain on palpation

Question 11

Management of Intussusception

Answer 11

Enema (diagnostic and therapeutic)

Barium

Water-soluble contrast and air pressure

IV fluids

NG compression

Antibiotic therapy

Emergency referral for surgery