Good Afternoon Everyone

EASOPHAGEAL ATRESIA & TRACHEO ESOPHAGEAL FISTULA

DEFINITIONEASOPHAGEAL ATRESIA

It is the failure of the esophagus to form a continuous passage from pharynx to stomach during embryonic development resulting in obstruction in infants normal swallowing routes.

TRACHEO ESOPHAGEAL FISTULA

It is the Abnormal connection between trachea and esophagus or failure of esophagus to separate into two distinct structure .

INCIDENCEApproximately in infants of 3,000-3,500 live

births.Occur Both males and famales, frequently

associated with prematurity.Occur one in 4,000 babies in the united

states is born with esophageal atresia. It is the 25th most common birth defect.

ETIOLOGYUnknownChromosomal anomalies (trisomy 18, trisomy

21, and trisomy 13)Failure of embryonic developmentDigestive tract problems(diaphragmatic hernia,

intestinal atresia or imperforated anus.)Congenital heart diseases(ventricular septal

defect,tetralogy of fallot or patent ductus arteriosus.)

Renal and urinary tract problems(horseshoe or polycystic kidney,absent kidney or hypospadias)

Muscular or skeletal problems Genetic factors Tetrogents Environmental factors VACTERL V- Vertebral defects

A- Ano rectal malformationC- Cardiovascular anomaliesT- Tracheaesophageal fistulaE- Esophageal atresiaR- Renal defectsL- Limb anomalies

TYPES

T

TYPE A

"LONG GAP", “PURE” OR “ISOLATED” ESOPHAGEAL ATRESIA

TYPE B

ESOPH AGEAL ATRESIA WITH PROXIMAL TEF (TRACHEOESOPHAGEAL FISTULA)

TYPE C

ESOPHAGEAL ATRESIA WITH DISTAL TEF (TRACHEOESOPHAGEAL FISTULA)

TYPE D

ESOPHAGEAL ATRESIA WITH BOTH PROXIMAL AND DISTAL TEFS (TWO TRACHEOESOPHAGEAL FISTULAS)

TYPE E

TEF (TRACHEOESOPHAGEAL FISTULA) ONLY WITH NO ESOPHAGEAL ATRESIA

TYPE F ESOPHAGEAL STENOSIS

`

Esophageal stenosis or stricture

PATHOPHYSIOLOGY

Esophagus developed from first segment of embryonic

gut.During the 4th and 5th week of gestation ,forgut normally

lengthens and separate longitudinally and longitudinal

portion fuse to form parallel channels. Anomalies involving

trachea and esophagus are caused by defective incomplete

fusion of the tracheal folds following separation or altered

cellular growth during embryonic development.

CLINICAL MANIFESTATIONExcessive Salivation & DroolingFrothy white bubbles in baby’s mouth3C’S of TEF Chocking (when the baby is feeding)

Coughing (when the baby is feeding)Cyanosis (when the baby is feeding)

VomitingBreathing DifficultyAbdominal Distension( very round full abdomen)

Apnea Increased respiratory distressPnemonitisRegurgitation or GaggingSigns of gastro esophageal refluxChronic respiratory problems

DIAGNOSTIC EVALUATIONHistory collectionPhysical ExaminationECGBrochoscopyRadiographic Studies (X-Ray,Ultrasound,CT

scan,MRI)

PLAIN X-RAY WITH CONTRAST IN THE UPPER ESOPHAGUS SHOWING ATRESIA

Aspiration of stomach content.Genetic testing. • Molecular genetic testing • Chromosome analysis EA/TEF may be suspected Prenatally by:- • Ultrasound examination • Fetal MRI

EA may be detected Postnatally by: •Failure to pass a nasogastric (NG) tube and radiographs that demonstrate coiling of the NG tube the pouch. • Tracheal compression and deviation on plain chest radiographs. • Absence of a gastric bubble on plain radiographs, which may suggest EA without a TEF or EA with a proximal TEF. • Three-dimensional CT scanning.

MANAGEMENTMEDICAL MANAGEMENT

Treatment include:-Maintanance of patient airway.Prevention of pneumonia.Gastric pouch decompression.Surgical repair of anomalies.Supportive therapy.Stop oral intake, start IV fluids.

Maintain supine position.Frequent and continuous suction.Provide respiratory support.Maintaining thermally neutral environment.Genetic Counseling.

SURGICAL MANAGEMENTTracheoesophageal fistula and esophageal

atresia repair

Normal Anatomy Indications

PROCEDURE,PART-I PROCEDURE,PART-II

AFTER CARE

Cervical Easophagostomy Bauginage Esophageal replacement procedure 1. Colon Interposition. 2. Gastric tube interposition. ET Tube intubation

Complication Of Surgery

Reaction to medicines.Breathing problems.Bleeding. Infection.Collapsed lung(pneumothorax).Food leakage from the area that is repair.Low body temperature(hypothermia).Narrowing of the repaired organ.Re-opening of the fistula.

NURSING MANAGEMENTPRE-OPERATIVE CARE Establishment of patient airway. Prevention of further respiratory compromise. Immediate after birth,nurse give the first feeding of plain

water and assist mother while feeding baby to observe any anomalies.

If cyanosis is present it can be resolved by removing secretions from oropharynx by suctioning and by oxygen administration.

Stop oral fluids and start IV fluids. Neonate is kept warm using an incubator or radient warmer. Daily change of cathether (Indwelling double lumen

cathether) to prevent infection.

Provide supine position with 30 degree elevation and of head to prevent aspiration ,If there is an atresia but no fistula,infant is placed in head down position to facilitate drainage.

In staged repair gastrotomy tube inserted and left open so that any air entering the stomach through fistula can escape and prevent regurgitation.

POST OPERATIVE CARE Elevate gastrotomy tube above the level of stomach so

that gravity helps an emptying of tube contents easily. Infant is returned to radiant warmer. Gastrotomy tube is connected to gravity drainage untill

infant can tolerate feeding. Before oral feedings are initiated chest tubes are

removed. Assist initial attempts of oral feedings . Tracheal suction. Antibiotics are administered.

COMPLICATIONS

Salivary Aspiration.Gastric acid reflux.Congenital heart disease.Gastro intestinal anomalies.Dehydration and electrolyte imbalance. 

NURSING DIAGNOSIS PRE OPERATIVE NURSING DIAGNOSISRisk for suffocation related abnormal

opening between esophagus and trachea. Risk for altered parenting related infants

physical defect and environmental factors causing parent infant separation.

Fluid volume deficit related to inability to take oral fluids.

POST OPERATIVE NURSING DIAGNOSISIneffective airway clearance Altered nutritional statusAltered comfort pain

Thank you for listening to my presentation