Abdominsl Wall Defects

Question 1

Which abdominal wall defects are found periumbilically

Answer 1

Exomphalos
Gastroschisis

Question 2

Which abdominal wall defects are found in lower midline

Answer 2

Bladder extrophy
Cloacal extrophy

Question 3

Which abdominal wall defects are found in upper midline

Answer 3

Eternal defects
Cardiac ectopy

Question 4

Which abdominal wall defects are found generalised

Answer 4

Diastase’s of rectum sheath
Prune belly syndrome

Question 5

Differentiate between gastroschisis and exomphalos

Answer 5

-Gastroschisis doesn’t have a sac vs Exomphalos has a sac
-Umbilical cord arises from normal place on the left of defect vs cord central on the sac
-rarely presents with congenital anomalies vs ass with major congenital anomalies
-gastroschisis May be associated with with intestinal atresia
-Gastroschisis has better prognosis than exomphalos
-In gastroschisis, evisceration usually only contains intestine which may be oedematous and thickened

Question 6

What are the risk factors for gastroschisis (5/7)

Answer 6

Prematurity
Small for gestational age
Low maternal age
Low SES
Asprin, ibuprofen, pseudophedrine in 1st trimester
Alcohol, cigarettes

Question 7

Discuss management of gastroschisis

Answer 7

Antenatal US dx facilitates planned delivery in tertiary hospital, bowel protected from injury.

Management:
1. Insert IVI line and give maintainance fluids (add 10% extra to compensate for evaporative fluid loses)
- blouses May be required if delayed Descuss
2. Monitor Urine output
3. NGT and NPO
4. Place bowel in preformed Silo if available or cover with plastic to prevent hypothermia and pretexts bowel
5. Give Ab prior to transfer
6. Untwist twisted bowel, bowel is ischemia May be caused by twisted messentery, enlargement of defect may relieve ischaemia (inject local and lift sheath away from bowel with mosquito clip, cut 1cm left laterally.
Transfer to surgery asap