Anterior Abdomial Wall Defects Flashcards
Types of AAW Defects
• Bladder _______
•__________ anomaly
• ________ Exstrophy
• Ectopia ______
• ________
•___________
• Pentalogy of Cantrell
•_________ Syndrome
exstrophy
Body stalk
Cloacal; Cordis
Gastroschisis
Omphalocele
Prune belly
Omphalocele is a congenital _________ anterior abdominal wall ____________ defect of variable sizes in the area of the
_________ and covered by a _________, and containing herniated abdominal contents (typically ________ , but often ________, and occasionally ________ or ________).
central ; Musculo-aponeurotic fascia
umbilicus; membranous sac
bowel ; liver
stomach ; bladder
Gastroschisis is a congenital ______ anterior abdominal wall defect, usually to the (left or right?) side of the ________ characterized by evisceration of abdominal visceral especially ________ and without __________
complete
Right; umbilicus
bowel; any covering.
Embryology of abdominal wall
• _____th week-folding of the flat embryonic disk into ______ planes(________, ________, ________ and ________ folds)
• Each fold converge at the ________, thus obliterating the ________________.
• The lateral folds form the ________ of the abdominal wall
• The cephalic and caudal folds form the ________ and ________.
4-5th ; four
cephalic, caudal, right and left lateral
umbilicus ; extraembryonic coelom.
lateral ;epigastrum ; hypogastrum.
•
Embryology of abdominal wall
At ______ week-abdominal cavity becomes too small to accommodate its content
• Results in protrusion of the _____ into the _________________ at base of umbilical cord.
6th; midgut
residual extraembryonic coelom
Embryology of abdominal wall 2
• The temporary herniation involves ____ degrees __________ rotation of midgut around the __________ pedicle- Physiologic midgut herniation.
• There is further rotation to ____ degree in the abdominal cavity for reduction of
the hernia at ______ week.
90 ; counterclockwise
superior mesenteric pedicle
270 ; 12th week.
Rupture of omphalocele = ???
Gastroschisis
Risk Factors
• Gastroschisis
•________ maternal age
•______ gravida
• __________
• ________ secondary to IUGR
Young; Low
Prematurity; low birth weight
Risk Factors
Omphalocele
• ________ maternal age
•________ births
•______ gravida
• __________ births
• Maternal obesity(BMI >30kg/m2
• Maternal D.M
Increased
Multiple
High
Consecutive
Which has intact umbilical cord?
Gastroschisis or omphalocoele?
Gastroschisis
Classifications of Gastroschisis
•__________
•____________
Simple
complex
Classifications of Omphalocele
• _________ vs _________
• _________ sac vs _________ sac
• _________ vs _________
Minor vs Major
• Intact sac vs ruptured sac
• Syndromic vs non-syndromic
Definitive care
• Omphalocele
• In omphalocele minor- do __________
• In intact omphalocele major- do ________ Or _______ , use ________ agents.
• In ruptured omphalocele major- you may initially apply a ______, then close when __________________.
• In syndromic omphalocele- treat ______________
primary closure
staged or delayed repair; escharotic
silo; content is well reduced
associated abnormalities.
Definitive care of Gastroschisis
• If simple Gastroschisis- Apply ______ for ________ then do ____ closure
• If complex Gastroschisis- emergency ___________, repair _________ , atresia then either ________ as above, or ___________ and close primarily.
Silo; gradual reduction; primary
exploration; perforations; apply silo
resection of bowel
Omphalocele features
Hint:cOngenital
O-Umblicius ,old mother risk
M-(midline),membrane
PHA (Wharton jelly,parietal peritoneum ,amniotic membrane
Associated cOngenital defects
Gastrochisis features
hInt:Gafp
G-Opening towards the right
Just small bowel inside
Increased AFP
Aponeurosis
Flattened thin stretch of CT that connects bone to muscle
Layers of abd wall
Lateral cut
Skin
Fascia-Campers and Scarpa’s
External oblique
Internal oblique
Tranversus Abdominus
Tranversalis fascia
Extraperitoneal fat
Parietal peritoneum
Prognosis of omphalocele
GERD
ventral hernia
FTT
Pulmonary hypoplasia with recurrent respiratory infection
Prognosis of Gastrochisis
Intestinal malrotation
Intestinal atresia
Short bowel syndrome
Gastrochisis aetiology
1)failure of migration and fusion of lateral folds of Embryonic disc on 3rd-4th week
2)Disruption of right omphalomesenteric artery as midgut returns to abd in 10weeks causing ischemia of abd wall and weakness then herniation
3)Rupture of omphalocele
Omphalocele aetiology
1)Due to failure of midgut to return to abd by 10th week of gestation during midgut rotation
2)failure of left and right folds to close normally
Clinical features of omphalocele
Central abd wall defect >4cm and above
Covered by translucent sac from which umbilical cord extends
Muscles of abd wall are normal but rectus inserted laterally on the coastal margin creating a depression superiorly-recti diverticulum
Babies with omphalocele are usually full term
Sac usually contains liver,midgut sometimes spleen or gonads
Complications of omphalocele
Dehydration
Rupture
Sepsis
Intestinal obstruction
Bowel perforation
Hypoglycemia
Pentalogy of cantrel
Supraumbilical omphalocele
Lower sternal cleft
Defect in central tendon of diaphragm
Defect in pericardium
Intracardiac abnormality-VSD
Beckwith-weidermann syndrome
Congenital abd wall defect-omphalocele
Macroglossia
Visceromegaly
Hypoglycemia-islet cells hyperplasia
Gastrochisis features-2
A _ defect <4cm
_ to umbilicus
Skin bridge maybe present between _and _
Abd wall muscle is _
No sac covering
No remnant of sac is present
Condition assc with gastrochisis included - illegal atresia or malrotation
No other serious cOngenital abnormalities
A small defect <4cm
Adjacent to umbilicus
Skin bridge maybe present between cord and defect
Abd wall muscle is normal
No sac covering
No remnant of sac is present
Condition assc with gastrochisis included gut anomalies with jejenum illegal atresia or malrotation
No other serious cOngenital abnormalities
