Alterations in Gastrointestinal Functional: Esophageal Atresia & Tracheoesophageal Fistula Flashcards
Esophageal Atresia & Tracheoesophageal Fistula: Epidemiology and Patho
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
Manifestations (FDCCCS)
Frothy saliva in mouth & nose, drooling, cyanosis, choking, coughing, sneezing
Priority Concern
Risk of aspiration - cyanosis, apnea
EA & TEF Associated anomalies
congenital heart defects, GI or urinary tract anomalies, musculoskeletal abnormalities
50% associated with VATER or VACTERL Association: VATER
Vertebral defects
Imperforate Anus
TEF
Radial & Renal dysplasia
50% associated with VATER or VACTERL Association: VACTERL
Vertebral
Anal
Cardiac
Trachea
Esophageal
Renal
Limb
Most common type of EA and TEF
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
Pre-op Care
- 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
Post-op care
- 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
Discharge Planning
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
