Alterations in Gastrointestinal Functional: Esophageal Atresia & Tracheoesophageal Fistula

Question 1

Esophageal Atresia & Tracheoesophageal Fistula: Epidemiology and Patho

Answer 1

1: 3500-4000 live births
Failure of esophagus to develop as a continuous tube during 4th & 5th week of gestation
Failure of trachea & esophagus to separate into 3 distinct structures

Question 2

Manifestations (FDCCCS)

Answer 2

Frothy saliva in mouth & nose, drooling, cyanosis, choking, coughing, sneezing

Question 3

Priority Concern

Answer 3

Risk of aspiration - cyanosis, apnea

Question 4

EA & TEF Associated anomalies

Answer 4

congenital heart defects, GI or urinary tract anomalies, musculoskeletal abnormalities

Question 5

50% associated with VATER or VACTERL Association: VATER

Answer 5

Vertebral defects
Imperforate Anus
TEF
Radial & Renal dysplasia

Question 6

50% associated with VATER or VACTERL Association: VACTERL

Answer 6

Vertebral
Anal
Cardiac
Trachea
Esophageal
Renal
Limb

Question 7

Most common type of EA and TEF

Answer 7

upper segment of the esophagus ends in a blind pouch connected to the trachea; the fistula connects the lower segment to the trachea
- breathe into stomach and into lungs and any food comes right back up

Question 8

Pre-op Care

Answer 8

• Surgical emergency; surgery ASAP with G-tube
• HOB slightly raised to minimize aspiration
• Maintain patent airway; NP suctioning prn
• Continuos/low intermittent suction to blind pouch
• NPO; IV fluids & antibiotics

Question 9

Post-op care

Answer 9

• IV fluids & antibiotics
• pain management
• TPN until oral or G-tube feeds tolerated -> go slow!! monitor weight gain or loss
• Complications: GE reflux, aspiration, strictures

Question 10

Discharge Planning

Answer 10

Parent teaching
- need to suction
- signs of respiratory distress (many will have some degree of tracheomalacia - softening of tracheal cartilage that causes a collapse)
- signs of constriction of esophagus (poor feeding, dysphagia, drooling, regurgitating undigested foods)
- precautions to initiate re: GER