EASOPHAGEAL ATRESIA
&
TRACHEO ESOPHAGEAL FISTULA
DEFINITION
EASOPHAGEAL ATRESIA

It is the failure of the esophagus to form a continuous passage
from pharynx to stomach du...
INCIDENCE

 Approximately in infants of 3,000-3,500 live births.
 Occur Both males and famales, frequently associated
wi...
ETIOLOGY

 Unknown
 Chromosomal anomalies (trisomy 18, trisomy 21, and
trisomy 13)
 Failure of embryonic development
 ...
 Muscular or skeletal problems
 Genetic factors
 Tetrogents
 Environmental factors
 VACTERL
V- Vertebral defects
A- A...
TYPES
TYPE A "LONG GAP", “PURE” OR “ISOLATED” ESOPHAGEAL ATRESIA

TYPE B ESOPH AGEAL ATRESIA WITH PROXIMAL TEF
(TRACHEOESO...
`
Esophageal stenosis or stricture
PATHOPHYSIOLOGY
Esophagus

developed from first segment of embryonic

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

 Excessive Salivation & Drooling
 Frothy white bubbles in baby’s mouth
 3C’S of TEF
Chocking (w...
 Apnea
 Increased respiratory distress
 Pnemonitis
 Regurgitation or Gagging
 Signs of gastro esophageal reflux
 Chr...
DIAGNOSTIC EVALUATION

 History collection
 Physical Examination
 ECG
 Brochoscopy
 Radiographic Studies (X-Ray,Ultra...
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 susp...
 EA may be detected Postnatally by:
•Failure to pass a nasogastric (NG) tube and
radiographs that demonstrate coiling of ...
MANAGEMENT
MEDICAL MANAGEMENT

Treatment include: Maintanance of patient airway.
 Prevention of pneumonia.
 Gastric pou...
 Maintain supine position.
 Frequent and continuous suction.
 Provide respiratory support.
 Maintaining thermally neut...
SURGICAL MANAGEMENT

 Tracheoesophageal 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 interposi...
Complication Of Surgery
 Reaction to medicines.
 Breathing problems.
 Bleeding.
 Infection.
 Collapsed lung(pneumotho...
NURSING MANAGEMENT
PRE-OPERATIVE CARE

 Establishment of patient airway.
 Prevention of further respiratory compromise.
...
 Provide supine position with 30 degree elevation and
of head to prevent aspiration ,If there is an atresia but
no fistul...
POST OPERATIVE CARE

 Elevate gastrotomy tube above the level of stomach so
that gravity helps an emptying of tube conten...
COMPLICATIONS

 Salivary Aspiration.
 Gastric acid reflux.
 Congenital heart disease.
 Gastro intestinal anomalies.
 ...
NURSING DIAGNOSIS
PRE OPERATIVE NURSING DIAGNOSIS

 Risk for suffocation related abnormal opening
between esophagus and t...
POST OPERATIVE NURSING DIAGNOSIS

 Ineffective airway clearance
 Altered nutritional status
 Altered comfort pain
1667690 634957274008535000
1667690 634957274008535000
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1667690 634957274008535000

  1. 1. EASOPHAGEAL ATRESIA & TRACHEO ESOPHAGEAL FISTULA
  2. 2. DEFINITION EASOPHAGEAL 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 .
  3. 3. INCIDENCE  Approximately 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.
  4. 4. ETIOLOGY  Unknown  Chromosomal anomalies (trisomy 18, trisomy 21, and trisomy 13)  Failure of embryonic development  Digestive 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)
  5. 5.  Muscular or skeletal problems  Genetic factors  Tetrogents  Environmental factors  VACTERL V- Vertebral defects A- Ano rectal malformation C- Cardiovascular anomalies T- Tracheaesophageal fistula E- Esophageal atresia R- Renal defects L- Limb anomalies
  6. 6. TYPES TYPE A "LONG GAP", “PURE” OR “ISOLATED” ESOPHAGEAL ATRESIA TYPE B ESOPH AGEAL ATRESIA WITH PROXIMAL TEF (TRACHEOESOPHAGEAL FISTULA) T 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
  7. 7. `
  8. 8. Esophageal stenosis or stricture
  9. 9. 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.
  10. 10. CLINICAL MANIFESTATION  Excessive Salivation & Drooling  Frothy white bubbles in baby’s mouth  3C’S of TEF Chocking (when the baby is feeding) Coughing (when the baby is feeding) Cyanosis (when the baby is feeding)  Vomiting  Breathing Difficulty  Abdominal Distension( very round full abdomen)
  11. 11.  Apnea  Increased respiratory distress  Pnemonitis  Regurgitation or Gagging  Signs of gastro esophageal reflux  Chronic respiratory problems
  12. 12. DIAGNOSTIC EVALUATION  History collection  Physical Examination  ECG  Brochoscopy  Radiographic Studies (X-Ray,Ultrasound,CT scan,MRI)
  13. 13. PLAIN X-RAY WITH CONTRAST IN THE UPPER ESOPHAGUS SHOWING ATRESIA
  14. 14.  Aspiration of stomach content.  Genetic testing. • Molecular genetic testing • Chromosome analysis  EA/TEF may be suspected Prenatally by:• Ultrasound examination • Fetal MRI
  15. 15.  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.
  16. 16. MANAGEMENT MEDICAL 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.
  17. 17.  Maintain supine position.  Frequent and continuous suction.  Provide respiratory support.  Maintaining thermally neutral environment.  Genetic Counseling.
  18. 18. SURGICAL MANAGEMENT  Tracheoesophageal fistula and esophageal atresia repair Normal Anatomy Indications
  19. 19. PROCEDURE,PART-I PROCEDURE,PART-II
  20. 20. AFTER CARE
  21. 21.  Cervical Easophagostomy  Bauginage  Esophageal replacement procedure 1. Colon Interposition. 2. Gastric tube interposition.  ET Tube intubation
  22. 22. 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.
  23. 23. NURSING MANAGEMENT PRE-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.
  24. 24.  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.
  25. 25. 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.
  26. 26. COMPLICATIONS  Salivary Aspiration.  Gastric acid reflux.  Congenital heart disease.  Gastro intestinal anomalies.  Dehydration and electrolyte imbalance.
  27. 27. NURSING DIAGNOSIS PRE OPERATIVE NURSING DIAGNOSIS  Risk 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.
  28. 28. POST OPERATIVE NURSING DIAGNOSIS  Ineffective airway clearance  Altered nutritional status  Altered comfort pain

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