Oesophageal atresia

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My presentation in General Surgery course which was in September 2012.

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  • here is a nice video presentation on youtube having all such aspects covered https://www.youtube.com/watch?v=GWLenvQDDzE&list=UURK2qC_k1YAkwbaVRoCLlJg
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Oesophageal atresia

  1. 1. Kingdom of Saudi ArabiaMinistry of Higher Education King Faisal University College of Medicine By Fahad H. Al Hulaibi 208004222
  2. 2.  Definition. Epidemiology. Embryology of esophagus & Trachea. Types & classifications. Associated anomalies. Pathophysiology. Diagnosis & Treatment.
  3. 3. is a disorder of the digestive system in whichthe esophagus does not develop properly.
  4. 4.  Atrasia: Congenital absence or closure of a normal body opening. Normal Atrasia
  5. 5.  Fisula:Is a permanent abnormal passageway between two organs in the body or between an organ and the exterior of the body. Normal Fistual
  6. 6. 1 case in 3000-4500 births. thehighest incidence of this disorder is in Finland, where it is 1 case in 2500 births.
  7. 7.  2% risk of recurrence is present when a sibling is affected. Increase in advanced maternal age.
  8. 8.  Atweek 4 , the Tracheabroncheal diverticulum developed to Tracheabroncheal sputum. There is a failure to separation in the sputum leading to fistula. During week 8, the primitive gut failure to recanalization. That lead to atrasia.
  9. 9.  Type A - Esophageal atresia without fistula or so- called pure esophageal atresia (10%) Type B - Esophageal atresia with proximal TEF (< 1%) Type C - Esophageal atresia with distal TEF (85%) Type D - Esophageal atresia with proximal and distal TEFs (< 1%) Type E - TEF without esophageal atresia or so- called H-type fistula (4%) Type F - Congenital esophageal stenosis (< 1%) (This is not discussed in this article)
  10. 10.  Currently,most authorities believe that the development of esophageal atresia has a nongenetic basis. Ina 1987 Kluth eschews has the concept that esophageal vascular events, ischemic events, or both may be causes in cases of esophageal atresia without fistula. In 2003, Spilde et al reported esophageal atresia-TEF formations Adriamycin induced teratogenesis.
  11. 11. (VACTERL) Vertebral defects. Anorectal malformations. Cardiovascular defects. TrachoEsophageal deffect. Renal anomalies. Limb deformities. 25% of all patients with esophageal atresia
  12. 12. CHARGE Coloboma. Heart defects. Atresia choanae. Developmental retardation. Genital hypoplasia. Ear deformities .
  13. 13.  Neurologic defects -Neural tube defects, hydrocephalus, tethered cord, holoprosencephaly GI defects -Duodenal atresia, ileal atresia, hypertrophic pyloric stenosis, omphalocele, malrotation, Meckel diverticulum Pulmonary defects - Unilateral pulmonary agenesis, diaphragmatic hernia Genitalia defects - Undescended testicles, ambiguous genitalia, hypospadias
  14. 14. A fetus with EA cannot effectively swallow amniotic fluid.A fetus with esophageal atresia and a distal TEF, amniotic fluid presumably flows through the trachea and down the fistula to the gut  Polyhydramnios  premature labor
  15. 15.  The neonate with EA cannot swallow and there is copious amounts of saliva. Aspiration of saliva or milk, if the baby is allowed to suckle, can lead to an aspiration pneumonitis.
  16. 16.  In a baby with esophageal atresia and a distal TEF, the lungs may be exposed to gastric secretions. Also, air from the trachea can pass down the distal fistula when the baby cries, strains, or receives ventilation. This condition can lead to an acute gastric perforation, which is often lethal.
  17. 17.  Prenatal:1. polyhydramnios
  18. 18. 2. PrenatalUltrasonographysensitivity 40%Abscenc of stomach bubbles, with fliud filled loops of bowels
  19. 19.  Post-natal:1. White, frothy bubbles of mucus in the mouth and, sometimes, the nose.2. Episodes of coughing, choking and cyanosis.3. These episodes may be exaggerated during feeding.
  20. 20.  Laboratory Studies:CBC countElectrolyte levelsVenous gas concentrationsBUN and serum creatinine levelsBlood glucose levelSerum calcium levelABG concentrations, as necessary
  21. 21.  Genetic testing:chromosome analysismicroarray genomic hybridization (array GH)
  22. 22. Chest radiographyNG tube arrestedAir in stomachAP viewLateral view
  23. 23. CT scan
  24. 24. Renal UltraSonographyis used to evaluate associated kidney anomalies, ureteral anomalies, or both.
  25. 25. Echocardiography.who have clinical signs of cardiovascular disease.
  26. 26. Limb radiography if the limbs appear abnormal.
  27. 27.  Preoperative management:1. The oral pharynx should be cleared.2. The infants head should be elevated.3. IV fluids (10% dextrose in water).4. Oxygen therapy is used.5. In infants with respiratory failure, endotracheal intubation should be performed.6. broad-spectrum antibiotics(such as ampicillin plus gentamicin)
  28. 28.  Surgical techniques vary according to surgeons preferences and variations in pathologic anatomy. Thebest esophagus is the patients esophagus.
  29. 29.  Infantsborn with esophageal atresia without fistula  early gastrostomy
  30. 30. Kimura, Livaditis, Scharli, or Foker procedures
  31. 31.  Infantsborn with esophageal atresia with fistula  early gastrostomy
  32. 32.  Roberta A Pagon, Editor-in-chief, Thomas D Bird, Cynthia R Dolan, Karen Stephens, and Margaret P Adam, GeneReviews™, Seattle (WA): University of Washington, Seattle; 1993. Amulya K Saxena, Esophageal Atresia With or Without Tracheoesophageal Fistula, Medscape. eMedicine, Updated: Apr 25, 2012, link: (http://emedicine.medscape.com/article/935858-overview#showall ) DWAYNE C. CLARK, Esophageal Atresia and Tracheoesophageal Fistula, 1999 Feb 15;59(4):910-916. Kronemer KA, Snyder-Warwick A. Esophageal atresia/tracheoesophageal fistula. 2008. Available online at eMedicine. Accessed 4-1-11.

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