esophageal atresia and trachesophageal fistulas
DESCRIPTION
Esophageal Atresia and Trachesophageal Fistulas. Mohannad Ibn Homaid. Background Information. Definition of esophageal Artesia The problem and its magnitude The added problem of a TEF. Basic science. Embryology Pathophysiology of different types Associated anomalies. Embryology. - PowerPoint PPT PresentationTRANSCRIPT
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MOHANNAD IBN HOMAID
Esophageal Atresia and Trachesophageal Fistulas
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Background Information
Definition of esophageal Artesia
The problem and its magnitude
The added problem of a TEF
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Basic science
Embryology
Pathophysiology of different types
Associated anomalies
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Embryology
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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
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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
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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
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Esophageal atresia with distal TEF
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Esophageal Atresia without TEF
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Gap-o-Gram
Why is it preformed
How is it preformed
Interpretation
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Gap-o-Gram
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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
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Treatment
Medical TherapySurgical TherapyPreoperative CarePostoperative CareComplications Follow up
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Medical Therapy
Intravenous Fluid with adequate Glucose
Prophylactic Broad Spectrum Antibiotics
Replogle tube insertion
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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
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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)
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Post operative Care
Intubated and transferred to the NICUAntibiotics are continued until chest drain is
no longer neededSuctioning the oral secretions
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Complications
Early : Anastomotic leak Recurrent TEF Anastomotic Stricture
Late GERD Esophageal Dysmotiliy Tracheomalacia May appear early
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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
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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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Questions