mohannad ibn homaid esophageal atresia and trachesophageal fistulas
Post on 01-Jan-2016
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Background Information
Definition of esophageal Artesia
The problem and its magnitude
The added problem of a TEF
Pathophysiology
The problem of a blocked esophagus During Pregnancy In the neonatal Period
The problem of a Fistula If proximal vs distal
Associated anomalies VACTERL and CAHRGE
The different Types
Back to the Clinical world
During pregnancy mother could develop Polydramnios
In the neonatal Period Excessive Drooling and secretion RDS and chocking upon feeding Aspiration Pneumonia Failure to pass an NG tube
Other Anomalies
Work Up
Routine Lab Work CBC and U/E,VBG and ABG BUN and Serum Cr
Imaging Studies Prenatal Ultrasonography Chest Radiography Echocardiography Renal Ultrasound
Gap-o-Gram
Prognostic Classification
Waterston classification: Category A: weigh>2.5 Kg and are other wise well Category B : 1.8-2.5 Kg mild pneumonia and mild congnital
anomalies Category C: <1.8 Kg and severe pneumonia or severe congenital
anomaliesSpitz Classification
Group 1: > 1.5 no major cardiac disease Group 2: < 1.5 OR major cardiac disease Group 3: <1.5 AND major Cardiac Disease
Poenaru classification low risk and do not meet criteria in class II high risk and ventilator-dependent or who have life-threatening
anomalies, regardless of pulmonary status
Medical Therapy
Intravenous Fluid with adequate Glucose
Prophylactic Broad Spectrum Antibiotics
Replogle tube insertion
Surgical Therapy
In isolated Artesia Lengthening and anastomosis procedures Esophageal substitution Delayed vs immediate vs staged The gap-o-Gram
If TEF is present Divide and ligate the fistula
Pre operative care
In addition to medical therapyBronchoscopy for:
Detection of an upper pouch fistula Localization of the distal fistula Assessment of post operative risk for tracheomalacia Assessment of specific vascular anomalies ( right
sided aortic arch)
Post operative Care
Intubated and transferred to the NICUAntibiotics are continued until chest drain is
no longer neededSuctioning the oral secretions
Complications
Early : Anastomotic leak Recurrent TEF Anastomotic Stricture
Late GERD Esophageal Dysmotiliy Tracheomalacia May appear early
Follow up
Appointment 1 -3 – 12 months after discharge Focusing on sings of respiratory distress and
dysphagia Radiologic assessment only if significant
history of: Choking, cyanosis Regurgitation and dysphagia Failure to the thrive Coughing and wheezing
Out come and prognosis
Spitz Grouping Group I - Mortality rate of 3% Group II - Mortality rate of 41% Group III - Mortality rate of 78%
Waterston categorization Category A - Mortality rate of 0% Category B - Mortality rate of 4% Category C - Mortality rate of 11%
Prenatal diagnosis.
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