Atresia and Trachesophageal Fistulas Background Information Definition of esophageal Artesia The problem and its magnitude The added problem of a TEF Basic science Embryology Pathophysiology of different types ID: 774908
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Slide1
Mohannad Ibn Homaid
Esophageal
Atresia
and
Trachesophageal
Fistulas
Slide2Background Information
Definition of esophageal Artesia
The problem and its magnitude
The added problem of a TEF
Slide3Basic science
Embryology
Pathophysiology of different types
Associated anomalies
Slide4Embryology
Slide5Pathophysiology
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
Slide6Slide7Back 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
Slide8Work 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
Slide9Esophageal atresia with distal TEF
Slide10Esophageal Atresia without TEF
Slide11Gap-o-Gram
Why is it preformed
How is it preformed
Interpretation
Slide12Gap-o-Gram
Slide13Prognostic 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 anomalies
Spitz 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
Slide14Treatment
Medical Therapy
Surgical Therapy
Preoperative Care
Postoperative Care
Complications
Follow up
Slide15Medical Therapy
Intravenous Fluid with adequate Glucose
Prophylactic Broad Spectrum Antibiotics
Replogle
tube insertion
Slide16Surgical 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
Slide17Pre operative care
In addition to medical therapy
Bronchoscopy
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)
Slide18Post operative Care
Intubated
and transferred to the NICU
Antibiotics are continued until chest drain is no longer needed
Suctioning the oral secretions
Slide19Complications
Early :
Anastomotic
leak
Recurrent TEF
Anastomotic
Stricture
Late
GERD
Esophageal
Dysmotiliy
Tracheomalacia
May appear early
Slide20Follow 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
Slide21Out 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.
Slide22Questions