Difficulty feeding

Introduction Difficulty in feeding is one of the clinical manifestations of inhalation in patients with tracheal congenital diseases. Tracheal congenital diseases are obstructive dyspnea that occurs to varying degrees after birth. In addition, premature infants also have difficulty in feeding. Because of the premature death of the mother, there is not enough time for the gastrointestinal function to develop. The earlier the premature infants leave the mother, the more immature the gastrointestinal function, the more the feeding is. difficult.

Cause

What is the cause of feeding difficulties?

Causes of tracheal congenital diseases:

Embryology: Both the esophagus and the respiratory tract originate in the foregut of the embryonic gut. The original esophagus is located behind the respiratory organs. The original intestine is divided into three parts: the foregut, the midgut and the hindgut. In the early stages, the cephalic and caudal sides of the gut were locked. At the end of the third week of embryogenesis, the pharyngeal membrane on the side of the original intestine ruptured, allowing the foregut to communicate with the ostium. As the heart shifts downward, the length of the esophagus increases rapidly. On the 21st to 26th day of embryogenesis, the larynx tracheal groove appears on both sides of the foregut, and then the epithelium grows to form the esophageal tracheal septum, separating the esophagus from the trachea. If the esophagus and the trachea are not completely separated, the lumens of the two can form an esophageal tracheal fistula. Esophageal atresia occurs when the esophageal trachea is displaced backwards or the foregut epithelium grows excessively into the esophageal lumen. In addition, in the early stage of esophageal development, part of the foregut cells are separated from the esophagus and continue to grow, which can form esophageal repetitive malformations, most of which are cysts close to the esophageal wall, and some cysts communicate with the esophageal lumen.

an examination

Related inspection

Gastrointestinal dysfunction

How to diagnose the difficulty of feeding?

This type of disease presents obstructive dyspnea with varying degrees of severity after birth. Wheezing can occur when inhaling, feeding is difficult, and growth and development are delayed. In the case of severe stenosis, the supraclavicular fossa, the intercostal soft tissue, and the soft tissue depression under the xiphoid are inhaled, and the above symptoms are aggravated when the respiratory tract infection occurs. Tracheal atresia, tracheal stenosis, and tracheoesophageal fistula are more common and are described as follows:

(1) tracheal atresia, convulsions after birth, often in the delivery room must be intubated first aid with tracheal intubation. Because of tracheal atresia, the tracheal tube often passes through the laryngeal cleft to the esophagus, and then the junction of the esophagus and the distal trachea reaches the lungs. Although the patient does not breathe, the X-ray shows that the trachea is inserted into the esophagus. When repeated intubation is still the same, the disease should be suspected.

(2) tracheal-esophageal fistula, can be divided into tracheal-esophageal fistula and bronchial-esophageal fistula. Although congenital anomalies are usually found in newborns, the former type can not be diagnosed until adolescents or even adults. Most cases have a history of long-term feeding cough or cough, often coughing out food particles, and occasionally with bronchiectasis.

(3) Children with congenital tracheal stenosis, if the stenosis is not very serious, can show clinical symptoms in adolescence, including: 1, shortness of breath, difficulty breathing, physical activity or increased secretions in the respiratory tract. 2. As the degree of stenosis increases, progressive dyspnea is present, and wheezing occurs when inhaling. 3. When the degree of stenosis is severe, the upper clavicle, the intercostal soft tissue, and the upper abdomen are simultaneously depressed (three concave signs).

Differential diagnosis

What are the symptoms of feeding difficulties that are easily confused?

Congenital tracheal diseases usually have symptoms after birth, so it is easy to diagnose. The identification of this disease is mainly concentrated on various congenital tracheal diseases. Now we briefly introduce various congenital tracheal diseases:

(1) Tracheal atresia or absence: This case is dead at birth, but the laryngeal and lung can develop normally, and sometimes the bronchus communicates with the esophagus.

(2) Tracheal esophageal fistula: This type of malformation is more common, and its incidence is about 1 in 3000 in newborns. In 1670 Durston reported the first congenital esophageal atresia. Gibson reported congenital esophageal atresia with esophageal fistula in 1697. In 1939, Ladd and Levin performed staging rectification on two patients and achieved success. In 1941, Haight and Towsley reported the first one-stage resection and success.

Congenital esophageal atresia with esophageal tracheal fistula can be divided into 5 types:

Type I esophagus was closed at the proximal and distal ends, and there was no esophageal fistula.

The proximal end of the type II esophagus is connected to the trachea, and the distal end of the esophagus is blind.

The proximal type III esophageal atresia is blind, and the distal end is connected with the trachea.

The proximal and distal esophagus of the IV type are connected to the trachea.

V-shaped esophagus has no occlusion, only esophageal tracheal fistula.

The most common type III, about 85% to 93%. This case is type IV and is relatively rare. The typical clinical manifestations of esophageal atresia are coughing after feeding, and difficulty breathing and blemishes. The child has too much saliva, and it can be seen that the foamed saliva overflows from the mouth and nostrils. When the esophageal atresia is suspected, the stomach can be inserted into the stomach through the nostrils or the oral cavity. Normal children can enter the stomach smoothly, and the children with esophageal atresia are blocked by about 8~12 cm, or the catheter is repeatedly pulled out from the mouth. X-ray examination can be clear. diagnosis. A small bag of the upper esophagus and its position can be displayed by injecting 1 ml of contrast agent through the catheter. Type IV is characterized by the presence of iodine into the trachea at the blind end of the upper esophagus, while the gastrointestinal tract is inflated, and the contrast agent can pass through the trachea into the other fistula to the distal end of the esophagus.

(3) Tracheal fistula: a thin layer of connective tissue membrane is present in the tracheal cavity, and a small hole is formed in the central part of the diaphragm for gas to pass. The tracheal fistula is often located below the annular cartilage. After the tracheal tomography and endoscopy are clearly diagnosed, the septum can be removed by bronchoscopy. The long and thick diaphragm is firstly tracheotomy under the tracheal fistula, the catheter is inserted, and the tracheal fistula is removed after growing up.

(4) Congenital tracheal stenosis: no abnormalities in the development of the tracheal wall but narrow lumen. There are three types of stenosis lesions and morphologies (Fig. 2): 1 stenosis of the tracheal segment: the inner diameter of the annular cartilage is normal, the stenosis of the tracheal cavity below the annular cartilage is the most severe, and the stenosis above the carina is the most severe, sometimes only a few millimeters. The main bronchi is normal. 2 tracheal funnel-shaped stenosis: can occur in the upper, middle or lower segment of the trachea. The length of the narrow section is different. The diameter of the trachea above the stenosis segment is normal, and the inner diameter of the stenosis segment is gradually narrow and funnel-shaped. 3 tracheal short stenosis: often occurs in the lower trachea, narrow length and length, may be associated with bronchial abnormalities, this type is most common.

This type of disease presents obstructive dyspnea with varying degrees of severity after birth. Wheezing can occur when inhaling, feeding is difficult, and growth and development are delayed. In the case of severe stenosis, the supraclavicular fossa, the intercostal soft tissue, and the soft tissue depression under the xiphoid are inhaled, and the above symptoms are aggravated when the respiratory tract infection occurs. Tracheal atresia, tracheal stenosis, and tracheoesophageal fistula are more common and are described as follows:

(1) tracheal atresia, convulsions after birth, often in the delivery room must be intubated first aid with tracheal intubation. Because of tracheal atresia, the tracheal tube often passes through the laryngeal cleft to the esophagus, and then the junction of the esophagus and the distal trachea reaches the lungs. Although the patient does not breathe, the X-ray shows that the trachea is inserted into the esophagus. When repeated intubation is still the same, the disease should be suspected.

(2) tracheal-esophageal fistula, can be divided into tracheal-esophageal fistula and bronchial-esophageal fistula. Although congenital anomalies are usually found in newborns, the former type can not be diagnosed until adolescents or even adults. Most cases have a history of long-term feeding cough or cough, often coughing out food particles, and occasionally with bronchiectasis.

(3) Children with congenital tracheal stenosis, if the stenosis is not very serious, can show clinical symptoms in adolescence, including: 1, shortness of breath, difficulty breathing, physical activity or increased secretions in the respiratory tract. 2. As the degree of stenosis increases, progressive dyspnea is present, and wheezing occurs when inhaling. 3. When the degree of stenosis is severe, the upper clavicle, the intercostal soft tissue, and the upper abdomen are simultaneously depressed (three concave signs).

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