Tracheoesophageal fistula

A Tracheoesophageal fistula (TEF) is an abnormal connection (fistula) between the Oesophagus and the trachea. TEF is a common congenital abnormality.
Oesophageal atresia is failure of oesophagus to form a continuous passage from the pharynx to the stomach
TEF is an abnormal connection between the trachea and the oesophagus

1. CASE PRESENTATION ON TRACHEOESOPHAGEAL FISTULA Presented by: MAKBUL HUSSAIN CHOWDHURY Pharm. D 5 th Year 15Z11T0006

2. DEFINITION A Tracheoesophageal fistula (TEF) is an abnormal connection (fistula) between the Oesophagus and the trachea. TEF is a common congenital abnormality. Oesophageal atresia is failure of oesophagus to form a continuous passage from the pharynx to the stomach TEF is an abnormal connection between the trachea and the oesophagus

3. CAUSES Trisomy 13, 18, or 21 Other digestive tract problems (such as diaphragmatic hernia, duodenal atresia, or imperforate anus) Heart Kidney and urinary tract problems Muscular or skeletal problems VACTERL syndrome (which involves Vertebral, Anal, Cardiac, Renal, and Limb abnormalities)

4. SYMPTOMS white bubbles in the mouth Coughing or choking when feeding Vomiting Blue color of the skin (cyanosis), especially when the baby is feeding Difficulty breathing Very round, full abdomen

5. DIAGNOSIS Chest X-ray Passing radio opaque catheter through Oesophagus and conforming the anomaly by X-Ray

6. CLASSIFICATION TYPE 1: EA without fistula (8%) It is second most common type. There is no connection of oesophagus to trachea. The upper segment and lower segment of oesophagus are blind TYPE 2: EA with TEF. It is rare and found in less than 1% of all cases. Upper segment of oesophagus is open into trachea by a fistula. The distal or lower segment is blind .

7. CLASSIFICATION TYPE 3: EA with TEF(80-90%). It is most common type. In this condition, upper segment of the oesophagus has blind end. The distal or lower segment of oesophagus connects into trachea by fistula . TYPE 4: EA with TEF both upper and lower segment. it is also rare(less than 1%). There is EA with fistula between both upper and lower ends of the trachea and oesophagus .

8. TYPE 5: H-Type TEF. It is found in about 4% of all cases and not usually diagnosed at birth. Both upper and lower segment of the oesophagus open into the trachea by a fistula. No EA is present.

9. CASE STUDY Name : N. Ramesh Age: 3 days Sex : Male Dept : Paedatric Body Weight: 2.6 kg IP No. : 19062515641

10. CHIEF COMPLAINTS Nasal flaring, difficulty in breathing since birth Choking and cyanosis HISTORY OF PRESENT ILLNESS Baby is born through LSCS delivery. Mother observes when baby take feed turns blue and difficulty in breathing. After that they came into this hospital and diagnosed with TEF

11. PRESENT SURGICAL HISTORY TEF is repaired • Tramadol 6mg is given • Induction: Propofol 3mg + atracurium 1.5mg, ET tube fixed at 8.5cm, oxygen and nitrogen oxide is given. • Pulse rate was up to 154-170 • SpO2 was 100% • I/V fluids 10% dextrose+ inj. Paracip 30mg was given

12. HISTORY OF PAST ILLNESS No H/O pulmonary HTN, TB, DM No past surgical history in patient FAMILY HISTORY Type of family: Joint No . Of family members: 5 Any illness in the family: H/O Hypothyroidism in mother and she is taking tab. Thyronorm 2.5mg. No H/O HTN , DM, TB, Epilepsy in family

13. IMMUNIZATION HISTORY Vit . K is given at birth Polio drops are given DIETARY HISTORY Breastfeeding: Breast milk is giving by NG Present diet: NG tube feeding

14. BIRTH HISTORY Gestational history or antenatal history • T1: -Spontaneous conception Urine pregnancy test is positive No H/O fever in mother • T2: - Two doses of tetanus are given to mother Folic acid is taken by mother H/O Hypothyroidism is present. • T3 : - Uneventful Gestational age: 37 completed weeks

15. PHYSICAL EXAMINATION SKIN COLOUR: pinkish body and extremities POSTURE : normal GAIT : normal BLEEDING/DISCHARGE : no HAIR : Black and shiny EYE/ENT : Normal symmetry in eyes No any discharge from eyes and ears and nose Body build: thin Emotional state: normal

16. TEETH AND GUMS: Teeth are not present and gums are pink and normal ORAL MUCOSA: Good condition GLANDS : No any lymph nodes are present CHEST : B/L air entry equal B/L symmetrical chest size. No retractions ABDOMEN : Soft Non distended TOES AND NAILS: Nails are grown up to finger tips DEPENDENCY LEVEL: Baby is on ventilator on SIMV mode

17. VITAL SIGNS Vital signs Day-1 Day-2 Day-3 Normal values Temperature 98.7° F 100° F 98.6° F 98.6° F Respiration rate 24bpm 18 bpm 20 bpm 12–18 bpm Heart rate 140bpm 136bpm 120 bpm 60-100 bpm

18. Lab Investigation Content 31/8/19 1/9/19 2/9/19 NORMAL RANGE REMARKS Hb 15.7 15.3 15.0 12-16gm% Decreased Neutrophills 75 - 85 50-70% Increased lymphocytes 18 - 10 20-40% Normal Monocytes 02 - 02 2-10% Normal Eosinophills 05 - 03 1-6% Normal TLC 22,300 - 14,700 4,000-10,000 cells/cum Increased RBS 205 - - 74-140mg/dl Increased S. Creatinine 0.58 - 0.35 0.6-1.2mg/dl Normal T. bilirubin - 6.3 7.9 0.2-1.0mg/dl Increased D. bilirubin - 0.19 - 0.0- 0.20mg/dl Normal BUN - - 6 7-18mg/dl Decreased

19. FINAL DIAGNOSIS TRACHEOESOPHAGEAL FISTULA

20. MEDICATION DRUG DOSE ROUTE FREQUESCY ACTION inj. Amikacin 40mg IV OD Antibiotic Inj.Pipzo ( piperacillin and tazobactum 200mg IV 8Hrly Antibiotic IVF+Ca gluconate 75ml+2.5cc IV 8Hrly Mineral supplement Syrup Ostocalcium 5ml PO TDS Mineral

21. PATIENT COUNSELLING Monitor the colour of the child. Ensure adequate nutrition. Monitor fluid intake and output Provide information to family before discharge about how to manage the temperature of the child. Encourage the mother to give breast feeding to the child. Follow up . PHARMACIST INTERAVENTION The given prescription is Rational

22. Thank you