The Pulse | Monday, February 25, 2019

Word of the Week: Atresia

This week we are highlighting “Atresia” as the Word of the Week. As always, all of the terms and definitions are sourced from our very own SGNA GI/Endoscopy Nursing Review Course Certification Study Manual, 3rd Edition (2016).

Atresia (esophageal) is an incomplete embryonic separation of the trachea and esophagus. Remaining portions of the upper and lower esophagus result in a blind sac (atresia). May also occur in the biliary system and rectum.

Signs/Symptoms:

• Regurgitation of mucous and fluid
• Aspiration with first feeding of a neonate if upper esophagus attaches to trachea...coughing and cyanosis

Diagnosis:

• Cinematography
• Prenatal ultrasound
• Post-partum of a nasal feeding tube
• X-ray of the esophagus shows an air-filled pouch and air in the stomach and intestines

Treatment:

• Surgery to anastemose the esophagus and stomach and repair fistula at same time if present
• Progressive dilatation with growth of child

Other points to consider:

• Provocative testing is an optional technique designed to reproduce chest pain that may be esophageal in origin.
• It is important to exclude coronary disease as the cause of the patient's pain prior to testing. Agents that may be used are edrophonium (Tensilon, Elon) in conjunction with esophageal manometry.
• Procedure:
  • The patient is given two injections, one of normal saline (placebo) and the other edrophonium, which is a short acting cholinesterace inhibitor. It will normally increase the contractions amplitude and duration. The test is positive if the patient complains of his/her typical chest pain during the edrophonium infusion. During continuous recording of esophageal pressures, the saline placebo is administered intravenously, after which the patient performs 10 wet swallows, 20 seconds apart. Next, a bolus of cholinestrase inhibitor is administered rapidly; the dosage is 80 mcg/kg and should never exceed 10 mg. After the dose, the patient performs 10 liquid swallows, 20 seconds apart. The test is complete after 5 minutes of manometry tracings or 10 liquid swallows.
  • Adverse reactions:
    • Tearing
    • Dizziness
    • GI discomfort
    • Bradycardia
    • Pupillary constriction
    • Laryngospasm
• Note: Important to have atropine on hand for bradycardia.
• Other testing agents: (Bernstein test). Attempted simulation of non-cardiac chest pain by instillation of HCL acid through one of the ports of a manometry catheter or a nasogastric tube that is positioned in the esophagus.