Abdominal Wall Defects Flashcards
What is gastroschisis?
Is a congenital defect in the abdominal wall usually to the right of the umbilicus, in which abdominal content herniates through the wall.
Usually it is just involves the small intestine but it may also involve the colon, stomach and ovaries.
What causes gastroschisis?
It is caused by genetic and environmental factors such as smoking, maternal illness and drug dependency. It is also more prevalent in younger mothers.
How is gastroschisis treated?
Acute management:
IV fluids
IV antibiotics
Placing lower half of body in a protective bag.
These measures help to protect against dehydration, temperature loss and infection.
An NG tube is often placed to deflate the stomach and then the child will be prepared for a surgical repair.
The patient will need close monitoring in neonatal intensive care post operatively.
What is exomphalos?
It is a congenital abnormality in which the contents of the abdomen herniate into the umbilical cord through the umbilical ring.
The viscera, which often includes the liver, is covered by a thin membrane consisting of peritoneum and amnion.
It is also known as an omphalocele.
What conditions are exomphalos associated with and therefore what investigations should be done to investigate?
Trisomy 13, 18 and 21
Beckwith Wiedemann syndrome.
As part of the investigations into associated anomalies, the children will often have an:
Echocardiogram
Renal ultrasound
Chromosomal analysis.
How is exomphalos treated?
Acute management:
IV fluids
IV antibiotics
Placing lower half of body in a protective bag.
Small defects are taken to theatre, before surgery their stomachs will be deflated using a NG tube. Post op they will need neonatal ITU.
Larger defects will be treated conservatively, allowing the skin to grow over the defect.
When are abdominal wall defects usually diagnosed?
During antenatal screening.
What are the major differentiating factors between gastroschisis and exomphalos?
Gastroschisis:
Defect is usually to the right of the umbilicus.
Generally and isolated abnormality (may be associated with Arthrogryposis)
Herniated contents is not covered in a membrane.
Exomphalos:
Abdominal contents herniate through the abdominal ring.
Commonly associated with several conditions.
Herniated contents is covered in a membrane.
What is the vitello-intestinal duct?
When should it obliterate?
What happens if it remains patent?
The vitello-intestinal duct is narrow tube that joins the yolk sac to the midgut lumen of the developing fetus.
This usually obliterates by the 9th gestational week.
If it does not obliterate then the connection remains and there may be gastric discharge from the umbilicus.
What is Meckel’s diverticulum and what are the complications?
Meckel’s diverticulum is when there is a small remanent of the vitello-intestinal duct causing a diverticulum. 2% of general population
Mostly assymptomatic (2% of population) and may present with the same complications of other diverticuli aka:
Diverticulitis (may mimic appendicitis)
Lower GI bleeding
Obstruction
In Meckel’s Diverticulum what is the rule of 2’s? (5)
Rule of 2's: 2 inches long 2 feet away from the ileocaecal valve 2% of the population 2 types of tissue (gastric and pancreatic) 2 is the most common age of presentation
What is an umbilical granuloma?
An umbilical granuloma is an overgrowth of tissue during the healing process of the belly button (umbilicus).
It usually looks like a soft pink or red lump and often is wet or leaks small amounts of clear or yellow fluid.
It is most common in the first few weeks of a baby’s life.
What is bladder exstrophy?
A condition in which there is protrusion of the bladder through a defect in the abdominal wall. Along with bony pelvis and pelvic floor abnormalities.
