ESOPHAGEAL ATRESIA

AND
TRACHEO-ESOPHEGEAL FISTULA

Submitted To Submitted By

Miss Shikha Sharma Mr. Ankit Kushwah

Asst. Professor Bsc Nursing 3rd Year

Kanyakubj Nursing College Indore Kanyakubj Nursing College Indore

 INTRODUCTION

 Atresia means – Failure.

 Fistula means – Abnormal connection.
 Esophagus dose not develope properly.
 Esophageal atresia and tracheo-edophageal fistula are the
malformation of digestive system. It is a
condition resulting from abnormal development before birth of the
tube that carries food from the mouth to the stomach.
 DEFINITION

 Esophageal atresia:- Esophageal atresia is the

failure of esophagus to form a continuous passage
from the pharynx to the stomach.

 Tracheo-esophageal fistula:- Tracheo-edophageal

fistula is an abnormal connection between the
trachea and the esophagus.
 CLASSIFICATION/TYPES
 Type (A):- In this type, There is esophageal atresia and proximal and
distal segments of esophagus are blind. There is no communication
between trachea and esophagus. this type is present in 3 – 7% of cases.
 Type (B):- In this type, esophageal atresia is present and the blind
proximal segment of esophagus connects with trachea by a fistula, the
distal end of esophagus is blind.this type is present in 0.8% cases.
 Type (C):- In this type, esophageal atresia is present.the proximal end of
esophagus is a blind pouch and distal segment of esophagus is connected
by fistula to trachea. This is the commonest type, present in about 80 –
90% cases.
 Type (D):- It is the rarest type that occurs in 0.7%
cases. In this type, both upper and lower segments of
esophagus communicat with trachea.

 Type (E):- In this type, esophagus and trachea are

normal and completely formed but are connected by a
fistula.this type is also known as `H`type and is present
in 4.2% cases.
 EPIDEMIOLOGY

1 case in 3000 – 4500 birth ( In tracheo-edophageal fistula).

 The highest incidence of this disorder is in Finland, where it is 1case in
2500 births.
 2% risk of recurrence is present when a sibling is affected.
 Increase in advanced maternal age.
 ETIOLOGY/CAUSES

 Exact causes still unknown.

 Influenceing factors are heritable genetic factors.
 Intra-uterine environment.
 Teratogenic stimuli.
 Disturbed growth and development.
 Tracheo-edophageal fistula results due to failure of growth along the septum and
esophageal atresia develops due to deficient growth of the dorsal wall.
 The failure of proper separation of the embryonic channel into the esophagus and
trachea occurs during 4th and 5th weeks gestational life.
 COMPLICATIONS

 Tracheomalacia.
 Anastomotic leak.
 Dysphagia.
 Respiratory distress.
 Gastro-esophageal reflux.
 RISK FACTOR

 Polyhydramnios:- Amniotic fluid more than 2000 ml.

 Premature infant:- Born before 37 weeks.
 Low birth weight barbies below 2500 gm.
 Other digestive tract problems, such as diagphragmatic hernia, duodenal
atresia,or imperforate anus.
 CLINICAL MANIFESTATIONS

 Choking .
 Coughing.
 Cynosis .
 The baby presents with excessive salivation,(blowing bubbles).
 Constant drooling .
 Large amount of secretions form nose .
 On the very first feed, after first or second swallow, the infants
coughs,chokes or fluid returns out through nose and mouth.
 DIAGNOSTIC EVALUATION

 Simple technique can be done to diagnose the condition with plain catheter.
 Inability to pass catheter through nose or mouth into the stomach indicates blind
pouch or atresia.
 Antenatal diagnosis of the condition can be done by USG(Ultrasonography).
Postnatal diagnostic procedures include USG.
 Plain x – ray abdomen.
 Chest x – ray or passing of radiopaque catheter through esophagus and confirming
the anomalies by x – ray.
 Bronchoscopy also help to confirm the diagnosis.
 MANAGEMENT

 Medicalmanagement:- Immediately after diagnosis, the infant should be managed with

propped up position (30° angle) to prevent reflux of gastric secretion and nothing per mouth.
 Airway clearance and O2 therapy.
 IV fluid therapy.
 Nasogetric tube aspiration nasogastric tube to be kept in situ and suctioning to be done
frequently to prevent aspiration.
 Theblind pouch to be washed with normal saline to prevent blocking of tube with thick
mucus.
 Gastrostomy is done to decompress the stomach and to prevent aspiration and ofterwords to
feed the infant.
 Supportivecare should include maintenance of nutritional
requirements and warmth.
 Prevention of infections, antibiotics therapy.
 Respiratory support and detection and treatment of complications.
 Continuous monitoring of patients condition and chest Physiotherapy
and postural drainag.
 SURGICAL MANAGEMENT

 The surgical correction of defect is done by end to end anastomosis with excision of the
fistula by right posterolateral thoracotomy followed by intercostal chest drainage.
 This is done when the infant has more than 2 kg, body Weight and no pneumonia
present and the baby is clinically stable.
 Surgical correction can be done in stage with division of fistula.
 Gastrostomy is performed in initial stage followed by esophageal anastomosis or
colonic transplant after one year.
 Other surgical interventions include cervical esophagostomy, esophago-coloplasty and
esophago-gastroplasty.
 NURSING MANAGEMENT:-

 Nursing assessment is very important to defect the condition immediate after birth or at first
feed.
 Risk factors to be excluded by details history of the condition. Clinical features and
problems to be assessed promptly for life saving measures.
1. Preoperative nursing management:-
 Prevent aspiration by positioning , suctioning and nothing per month,thus reducing chance
of respiratory infections.
 Preventing dehydration by I v fluid, intake and out put recording
 Monitoring of vital signs and child’s general health.
 Preventing infections by infections control measures.
 Reducing Parental anxiety by imotional support.
 POST OPERATIVE NURSING
MANAGEMENT
 Providing adequate feeding by I v fluid and gestrostomy feeding
 Maintain clear airway.
 Reducing pain by analgesics and comfort measure.
 Maintaining chest tube drainage with necessary precautions.
 Preventing infections by general cleanlines, hygienic measures and administering
antibiotics.
 Monitoring child’s condition and detecting problems for early intervention.
 Stimulating parent child bondage by Parental participation in care of the infant.
 Improving knowledge by necessary health education, encourage questions and
explaining the answers.
 NURSING DIAGNOSIS

 Impaired breathing related to frequent laryngospasm and excessive

secrations in the trachea.
 Risk for deficient fluid Volume Related to inability to take oral feed.
 Altered comfort related to surgical process.
 Aspiration related to structural abnormality.
 Knowledge deficient related to low self steem and Hospitalization.
 HEALTH EDUCATION

 You can reduces you risk of having a baby with any congenital
disability by maintaining a healthy pregnancy that includes:-
 Eating healthy foods
 Exercising.
 Getting enough rest.
 Seeing your provider regularly.