tracho oesophagial fistula
TRANSCRIPT
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Power point presentationPower point presentationonon
TrachoEsophagial fistula TrachoEsophagial fistula (TEF)(TEF)
Submitted to:Submitted to: Resp. Manpreet sirResp. Manpreet sir (paediatric lecturer(paediatric lecturer))
Submitted by:Submitted by: Kamaljit kaurKamaljit kaur Bsc.nsg. 3Bsc.nsg. 3rdrd yr. yr.
Roll no. 25Roll no. 25
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Learning objective:Learning objective:• Definition• Etiology • Pathophysiology• classification• Clinical manifestation • Diagnostic studies• Complication• Management• Nursing management
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DefinitionDefinitionA tracheoesophageal fistula (TEF) is
a congenital or acquired communication between the trachea and esophagus.
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EtiologyEtiology• Exact cause is unknown• Some etiological factors include: Genetic factorTeratogenic stimuli Intrauterine environment
• These anomalies may develop due to deviation of the septum b\w oesophagus and tracheao or altered growth of septum b\w them.
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PathophysiologyPathophysiology Etiological factors
Accumulation of saliva or feeds in upper oesophageal pouch
Gastric secretions may regurgitate through distal fistula
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Abdominal distension occur due to air entering the lower oesophagus through fistula and passing into the stomach during crying
Respiratory distress
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5 main categories of congenital 5 main categories of congenital TEFs:TEFs:
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ClassificationClassification Type 1: EA without fistula. There is no
connection between esophagus to traechea. The upper segment and lower segment of esophagus is blind.
Type 2: EA with TEF(upper). Upper segment of esophagus open into traechea by fistula
Type 3:EA With TEF(lower). The distal lower segment of esophagus connects into trachea by fistula
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Type 4: EA with TEF both upper and lower segment. There is EA with fistula b\w both proximal and distal ends of trachea and esophagus
Type 5: H type TEF. Both proximal/ upper and distal/ lower segment of esophagus open into trachea by fistula. No EA present
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Clinical featuresClinical features
• Excessive salivation • Contant drooling• Large amt. of secretion from nose• coughing, gagging , choking and cyanosis• Laryngospasm• Difficulty in breathing• Poor feeding
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Diagnosis of TEFDiagnosis of TEF• Physical examination :Presence of air in
the gastrointestinal lumen with Percussion.• Absence of gas in the abdomen suggests that
the patient has either atresia without a fistula or atresia with a proximal fistula only
. Some clinicians prefer direct visualization by flexible esophagoscopy or bronchoscopy and assess its exact location prior to surgery.
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• Chest x-ray or passing radio opaque catheter through esophagus: (A) Diagnosis of esophageal atresia is confirmed when a 10-gauge (French) catheter cannot be passed beyond 10 cm from the gums. (B) A smaller-caliber tube is not used because it may curl up in the upper esophageal segment, giving a false impression of esophageal continuity.
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• USG: Prenatal 3D ultrasounds after 24 weeks may reveal polyhydramnios, absence of fluid-filled stomach, small abdomen, and a distended esophageal pouch
• Bronchoscopy can also help to detect the abnormalities.
• ECG or echocardiogram can be done to detect associated cardiac anomalies.
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ComplicationComplicationRecurrent TEF( tracheomalacia)StenosisGastroesophagial refluxRecurrent pneumoniaAirway hyperactivity
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ManagementManagementImmediate management:1) Attention to ventilation2) Determine appropriate time for surgery.
3) For ↓ aspiration risk: Elevate neonate’s head at least 30º Suctioning can be done frequently to prevent aspiration. Gastrostomy is done to decompress the stomach &
afterwards to feed the the infant.4) Supportive care include maintance of nutritional
requirements and warmth, preventions of infections, antibiotic therapy, chest physiotherapy.
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Surgical management• Thoractomy• Gastrostomy• Other surgical intervention include:
cervical oesophagostomy, esophagocoloplasty, esophagogastroplasty
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Nursing management:Pre-operative care:Prevent aspiration by positioning,
suctioning, thus reduce chance of respiratory infection.
Monitor vital signsMaintain fluids balance and intake output
chartProvide emotional support to the parents.
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Post-operative care:Maintain clear airwayProvide adequate feeding by IV or gastrostomy
feedingProvide comfort measures to reduce painMaintain chest tube drainage with precautions.Maintain hygieneMonitors child’s conditionsProvide health edu. to the parents.
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Thank for your attentionThank for your attention