03.08 Abdominal Wall Defects

Question 1

Embryo forms four folds that will enclose the body cavities

Answer 1

4th week

Question 2

Rapit intestinal and liver growth
herniation of midgut into the umbilical cords
Presence of umbilical ceolom

Answer 2

6th week

Question 3

Midgut returns to the abdominal cavity

Answer 3

10th week

Question 4

Failure of the viscera to result to the abdominal cavity

Answer 4

Omphalocoele

Question 5

Failure of lateral fold to develop
Failure of the umbilical coelom to develop
The intestines rupture out of the body wall at the area of the resorbed right umbilical vein

Answer 5

Gastroschisis

Question 6

Gastroschisis is diagnosed thru ____ by ____

Answer 6

Prenatal ultrasound

20 weeks AOG

Question 7

Elevated maternal AFP
No sac
Smaller than omphalocele
Midgut
Born to mothers younger than 21
Preterm delivery

Answer 7

Gastroschisis

Question 8

Most common associated anomalies of gastroschisis

Answer 8

Intestinal atresia

Question 9

Managment of gastroschisis

Answer 9

Early delivery
Neonatal resuscitation and management
Surgery

Question 10

Primary goal is to return the viscera to the abdominal cavity while minimizing the risk of damage to the viscera

Answer 10

Surgery

Question 11

Surgical options

Answer 11

Primary closure

Staged

Question 12

Post-op syndrome when the abdomnial cavity might not be able to handle the sudden increase in volume

Answer 12

Abdominal compartment syndrome

Question 13

Bowels are returned to the abdominal cavity

Fascia and skin are closed

Answer 13

Primary closure

Question 14

Complications of primary closure

Answer 14

Abdominal distention

Abdominal compartment syndrome

Question 15

Can be done bedside without general anesthesia

Makes use of silastic sheets sewn together and sutured to the abdominal wall or a preformed silo with a circular spring

Answer 15

Staged closure or SILO

Question 16

Prevents high intraabdominal pressure and allows early extubation

Answer 16

Staged closure

Question 17

Avoids septic complication of having a foreign body

Answer 17

Primary closure

Question 18

Central abdominal wall defect under umbilical cord
Usually larger than 4 cm in diameter
Always covered by a translucent sac from which the umbilicus extends
Full term

Answer 18

Omphalocele

Question 19

Most common associated anomalies of omphalocele

Answer 19

Cardiac anomaly (VSD, ASD)

Question 20

Syndromes associated with omphalocele

Answer 20

Edwards Syndrome (Trisomy 18)
Beckwith-Wiedemann Syndrome
OEIS (omphalocele, exstrophy of the bladder, imperforate anus, spinal anomalies) syndome
Pentalogy of Cantrell
Cloacal Exstrophy

Question 21

Cephalic fold defect

Answer 21

Pentalogy of Cantrell

Question 22

Five characteristic findings of pentalogy of Cantrell

Answer 22

Omphalocele
Anterior diaphragmatic hernia
Sternal cleft
Ectopia cordis
Intracardiac defect

Question 23

Claustral fold defect
Infraumbilical defect
No spinal deformities

Answer 23

Cloacal exstrophy

Question 24

Management of omphalocele

Answer 24

Perinatal care
Neonatal resuscitation and management
Surgical management

Question 25

Indications of surgery for omphalocele

Answer 25

> 10 cm
Gestational age
Presence of associated anomalies

Question 26

Defect is small

Sac is excised

Answer 26

Primary closure

Question 27

Escharotic therapy

Answer 27

Staged closure

Question 28

Scarificant and disinfectant for staged closure

Answer 28

Silver sulfadiazine

Iodine

Question 29

Umbilicus is intact but there are segments of the bowels going out

Answer 29

Hernia of the umbilical cord

Question 30

Fascial defecct at the umbilicus
Covered by skin
Does not require surgery
Persistence of umbilical ring
Will close spontaneously by 3-4 years old

Answer 30

Umbilical hernia