2. EASOPHAGEAL ATRESIA
&
TRACHEO ESOPHAGEAL FISTULA

3. 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 .

4. 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.

5. 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)

6.  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

7. 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

8. `

9. Esophageal stenosis or stricture

10. 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.

11. 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)

12.  Apnea
 Increased respiratory distress
 Pnemonitis
 Regurgitation or Gagging
 Signs of gastro esophageal reflux
 Chronic respiratory problems

13. DIAGNOSTIC EVALUATION
 History collection
 Physical Examination
 ECG
 Brochoscopy
 Radiographic Studies (X-Ray,Ultrasound,CT scan,MRI)

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

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

16.  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.

17. 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.

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

19. SURGICAL MANAGEMENT
 Tracheoesophageal fistula and esophageal atresia repair
Normal Anatomy
Indications

20. PROCEDURE,PART-I
PROCEDURE,PART-II

21. AFTER CARE

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

23. 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.

24. 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.

25.  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.

26. 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.

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

28. 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.

29. POST OPERATIVE NURSING DIAGNOSIS
 Ineffective airway clearance
 Altered nutritional status
 Altered comfort pain