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Tracheo-esophageal Fistulas – Lung Development

by John McLachlan, PhD
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    00:00 born closer to term. Now, let’s look at some common abnormalities of lung development and one of the more common among lung development abnormalities is tracheo-oesophageal fistula with oesophageal atresia. Now these are standard terms which have particular meanings.

    00:17 So let’s just explain what those particular terms mean. In addition, we’ll also find tracheo-oesophageal fistulas on their own, syndromes called VATER or VACTERL, which are a combination of different kinds of defects all present in one child, lung hypoplasia where the lung is underdeveloped, and even lung agenesis where a lung completely fails to develop altogether. So tracheo-oesophageal fistula with oesophageal atresia is the most common of the lung conditions occurring in perhaps one in 3,000 or one in 4,500 live births. As you can see from the diagram, what happened is that there is a connection from the oesophagus to the atresia. This is the fistula.

    01:04 In addition, the oesophagus has blind ending, and it can either be above or below the level of the fistula. What happens under these circumstances is that there’ll be an excessive amount of amniotic fluid present. Because normally, the baby will swallow amniotic fluid and recycle it. So the amniotic fluid will build up in excess. Once the baby is born, when it begins to suckle, milk was likely to run down the oesophagus into the trachea and what that will do, in turn, is to make the baby choke on feeding, and perhaps regurgitate milk. Milk will dribble from the mouth and it’s important to note that it dribbles rather than being expelled forcibly. This is not projectile vomiting. I would indicate a different condition, pyloric stenosis, which will be covered in another lecture.

    01:59 Initially, the baby will be breathing normally, but one of the consequences of milk entering the lungs is that pneumonia may subsequently develop. Another sign that tracheo-oesophageal fistula with oesophageal atresia is present is that when the baby takes in-breath, then air can get into the stomach, and this may expand the stomach as a consequence. So we can see this in the lower form of the two diagrams. Less common is a fistula on its own.

    02:33 So this is sometimes called an H-type tracheo-oesophageal fistula. And only 4 percent of cases of tracheo-oesophageal fistula with oesophageal atresia are tracheo-oesophageal fistula on their own. Nonetheless, milk may still enter the respiratory system driven by the pressure of air. So a baby may still show many of the same signs as we saw with tracheo-oesophageal fistula with oesophageal atresia. I mentioned complex syndromes and VATER or VACTERL syndrome, maybe one of those,


    About the Lecture

    The lecture Tracheo-esophageal Fistulas – Lung Development by John McLachlan, PhD is from the course System-Specific Embryology with John McLachlan.


    Author of lecture Tracheo-esophageal Fistulas – Lung Development

     John McLachlan, PhD

    John McLachlan, PhD


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