Gastro schisms And Omphacele

Question 1

Gastroschisis

Answer 1

is a congenital defect in the anterior abdominal wall through which the abdominal contents freely protrude outside.

Question 2

Omphalocele

Answer 2

on the other hand is a congenital birth defect through the umbilical cord and the contents remain enclosed in a sac of visceral peritoneum. With omphalocele, the defect is usually much larger than in gastroschisis.

Question 3

etiological factors:

−

Answer 3

The use of salicylates − Maternal cigarette smoking − Maternal alcohol and drug use

Question 4

Diagnosis

Answer 4

• The diagnosis of gastroschisis is commonly made antenatally by a routine ultrasound examination.
• The herniated bowel in gastroschisis is bathed by amniotic fluid and both maternal serum and amniotic fluid alpha-fetoprotein (AFP) levels are elevated. This should be evaluated by an abdominal ultrasound.
• Maternal abdominal ultrasound usually shows the herniated bowel and perhaps the liver floating in the amniotic fluid.

appearance of bowel may range from almost normal-to-thick-walled inflamed intestines forming a mass (Fig. 36.2).

• Atresia or necrosis of intestines may be present. These have been associated with defects that have a small diameter

Question 5

Gastroschiss is not associated with other birth defects

Answer 5

True

Question 6

Newborns with gastroschisis are prone to develop:

−

Answer 6

Hypothermia − Dehydration − Sepsis − Hypoglycemia − Add to this, prematurity and low birth weight

Question 7

Treatment

Answer 7

Fluids and electrolytes need to be corrected and heat losses must be minimized.

intravenous (IV) fluid bolus (20 ml/kg ringer lactate solution or normal saline), followed by 10 % dextrose/0.25 normal saline solution

baby should be placed under a warmer.

• The exposed intestines should be covered with a moist warm pad and the eviscerated intestines should be situated on top of the baby’s abdomen to avoid traction upon the bowel mesentery.

Reduction of the herniated viscera is facilitated by evacuating meconium from the sigmoid colon; this can be easily accomplished during the operative procedure.

Broad-spectrum antibiotics are administered to prevent contamination of the peritoneal cavity.

• A central venous line is placed intraoperatively to provide parenteral nutrition

general procedure for gastroschisis repair is to simply reduce the herniated bowel back into the abdominal cavity

Upon admission to the neonatal intensive care unit, the herniated intestines are placed in a protective “silo,” then slowly compressing the silo to push the herniated intestine into the abdominal cavity. This allows for the bowel to return to its intended location without further traumatizing the infant’s viscera with undue internal pressure. The bowel is then slowly and gently pushed back down into the abdomen over the course of a few days.

Question 8

Omphalocele

Answer 8

, also known as exomphalos, is an abdominal wall defect in which the intestines, liver, and occasionally other organs remain outside of the abdomen in a sac (Figs. 37.

Question 9

Omphalocele is classified into two types:

Answer 9

minor and major.

• Minor omphalocele: There is protrusion of a small portion of the intestine only and the size of the defect is < 5 cm in diameter.
• Major omphalocele: There is protrusion of the intestines, liver, and other organs and the diameter of the defect is > 5 cm.

Question 10

Etiology

•

Answer 10

Various theories have been postulated; these include:

− Failure of the bowel to return into the abdomen by 10–12 weeks − Failure of lateral mesodermal body folds to migrate centrally − Persistence of the body stalk beyond 12 weeks’ gestation − A defect in the development of the muscles of the abdominal wall.

Question 11

Diagnosis

•

Answer 11

Omphalocele is usually detected antenatally during routine ultrasonographic evaluation.

• An omphalocele is diagnosed when an anterior midline abdominal mass is demonstrated on fetal ultrasonic evaluation.
• The mass consists of abdominal contents that have herniated through a midline central defect at the base of the umbilical cord insertion. The mass usually has a smooth surface and contains abdominal viscera, usually the liver, intestines, and stomach.
• Diagnostic amniocentesis is indicated when an omphalocele is demonstrated on antenatal ultrasound evaluation. This is to detect associated chromosomal abnormalities.
• The finding of an omphalocele should prompt a detailed ultrasonographic evaluation to detect associated anomalies.
• Fetal echocardiography and karyotyping should also be performed.

Question 12

Associated Anomalies

Answer 12

• Omphaloceles are associated with other anomalies in 70−80 % of the cases.

− Congenital heart disease (25 %): Most commonly ventricular septal defect, atrial septal defect, and tetralogy of Fallot.

− Central nervous system anomalies, congenital diaphragmatic hernia, renal anomalies, and skeletal abnormalities.

− Gastrointestinal abnormalities including midgut volvolus, malrotation, Meckel’s diverticulum, anorectal malformations, and intestinal and colonic atresia.

abnormal karyotype, most commonly Trisomy 13, Trisomy 18, Trisomy 21, and Turner syndrome.

syndrome.

• Some infants with omphalocele have an association with Beckwith–Wiedemann syndrome (i.e., exomphalos, macroglossia, and gigantism). They have coarse, rounded facial features, hyperplasia of the pancreatic islet cells with hypoglycemia, visceromegaly, and genitourinary abnormalities.

Question 13

Treatment

Answer 13

After birth, the exposed organs are returned to the abdominal cavity and the hernia is closed via surgery

Intravenous fluids are administered and the omphalocele sac is covered with a nonadherent dressing.

• The infant’s temperature should be preserved.
• Prophylactic antibiotics are given preoperatively.