Frequent foaming
Introduction
Introduction Atresia of oesophagus and tracheoesophagealfistula are not uncommon in the neonatal period. After the birth of the child, saliva increases, and the foam overflows from the mouth.
Cause
Cause
The esophagus and trachea in the early stage of the embryo are all produced by the original foregut, and the two are in common. At 5 to 6 weeks, a mediastinum was grown from the mesoderm, and the esophageal trachea was separated, the ventral side was the trachea, and the dorsal side was the esophagus. After the esophagus passes through a consolidation stage, the epithelial cells in the tube multiply and proliferate, and the esophagus is occluded. Later, vacuoles appear in the tube, merge with each other, and the esophagus is re-passed into a hollow tube. If the embryo does not develop properly during the first 8 weeks, separation and cavitation may cause different types of malformations. Some people think that it is related to vascular abnormalities, and the supply of blood flow to the foregut is reduced, which can cause occlusion. Older women, low birth weight children are prone to occur, and 1/3 are premature infants.
Examine
an examination
Related inspection
Esophagography esophagus X-ray barium meal examination
Diagnosis: All newborns have foaming at the mouth, vomiting or coughing, bruising, etc. after each feeding. After the mother has a history of polyhydramnios or other congenital malformations, congenital esophagus should be considered. The possibility of blocking. A soft abdomen indicates the presence of a fistula. In the upper section, there are symptoms such as coughing and difficulty in breathing after the fistula. Bloating occurs when there is a fistula in the lower part. To further confirm the diagnosis, a simple method can insert the No. 8 catheter from the nostril, and when inserted into 8 to 12 cm, it is often folded back due to obstruction, and normal children can be smoothly and unimpeded into the stomach. However, it should be noted that sometimes the catheter is thinner and can be curled in the blind end of the esophagus, causing an illusion of stomach. Check the presence or absence of the fistula. The outer end of the catheter can be placed in the basin, and the catheter can be moved up and down in the esophagus. When the tip reaches the level of the fistula, blisters can be seen in the basin, and the child has more blisters when crying or coughing. The position of the fistula can also be determined based on the length of the insertion catheter. If there are conditions, you can take X-ray film, observe the obstruction of the catheter insertion, and understand the height of the blind end, generally in the thoracic vertebra 4 to 5 level. Type I and type II are not inflated in the stomach. Type III or IV, V-type air from the fistula into the stomach, visible gastrointestinal aeration. Intravenous injection of lipiodol 1 ~ 2ml for iodized oil angiography can check the presence or absence of fistula, generally do not routinely check, avoid the use of tincture, because of the risk of increased aspiration pneumonia. Some people used an esophagoscopy or a bronchoscope to directly observe, or dripped in the bronchoscope to observe the presence or absence of blue inflow in the esophagus. Try to strive for a clear diagnosis when there is no secondary pneumonia. Also check for pneumonia and other organ deformities (heart, digestion, urinary).
Laboratory examination: There is currently no relevant information.
Other auxiliary inspections:
1. X-ray and endoscopy
X-ray examination is simple and accurate, and has a decisive diagnostic significance for this disease. The chest and abdomen should be routinely seen or photographed. If there is no gas in the abdomen, it is characterized by esophageal atresia; if there is esophageal tracheal fistula, there may be gas accumulation in the stomach and intestine. Therefore, there is no gas in the abdominal cavity to completely exclude the esophageal atresia. If the newborn has pneumonia complicated with atelectasis, especially the right upper lobe atelectasis, mostly type III esophageal atresia, there may be a large amount of gas in the gastrointestinal tract. The chest anterior segment shows a closed proximal aeration, which is inserted into the stomach tube and is blocked and folded back. The lateral slice shows that the inflated blind end forms a shallow curved impression on the trachea forward. Iodine angiography may cause inhalation of pneumonia and is often unnecessary. Barium meal inspection should be taboo.
2. Some scholars use endoscopy to diagnose the disease. In order to facilitate the discovery of the fistula, a small amount of blueberry is dripped from the trachea, and then the blue part is observed from the esophagoscope; or a little blue is swallowed first, then the fiberoptic bronchoscope is used. Look for the blue appearance from the tracheobronchial to determine the fistula and its location. Cudmore (1990) reported that the methylcellulose suspension (0.5 ml) of autoclaved micronized barium sulfate was visually safe. In addition, active fluoroscopy can be used to diagnose primary or recurrent tracheoesophageal fistula, umbilical angiography to confirm the diagnosis of right aortic arch and CT. It is worth noting that the mucus in the blind end should be exhausted before the test, and it is ready to give oxygen, suck and keep warm.
Diagnosis
Differential diagnosis
Differentially diagnosed diseases include:
1. Congenital heart disease with or without cyanosis;
2. Aortic arch deformity;
3. All lesions that cause neonatal respiratory distress syndrome;
4. Laryngeal esophageal fissure deformity;
5. Neurological dysphagia;
6. Gastroesophageal reflux and so on.
