Tracho oesophagial fistula

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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