L1: Gastrochisis & Omphalocele Flashcards
Def of Gastroschisis
- Congenital defect of anterior abdominal wall, Most often to the right of umbilicus.
Pathophysiology of Gastroschisis
- Due to unsupported right side of umbilicus after resorption of right umbilical vein at 4 Wk gestation
Incidence of Gastroschisis
0.4 - 3 per 10K
Age in Gastroschisis
Frequent with young mothers
CP of Gastroschisis
Associated Anomalies with Gastroschisis
Dx of Gastroschisis
Dx of Gastroschisis
- US
Dx of Gastroschisis
- MSAFP
Increases 9 times
TTT of Gastroschisis
- pre, op & Post
TTT of Gastroschisis
- Pre-Operative
Pre-Operative TTT of Gastroschisis
- Is it a surgical emergency?
It is a true surgical emergency that require rapid surgical intervention to:
- Prevent injury of the eviscerated bowel
- Control the problem of heat & fluid loss
Pre-Operative TTT of Gastroschisis
- Rapid Resuccitation
- Placement of lower ½ of infant in sterile bowel bag or wrap the eviscerated bowel with sterile moistened saline gauze dressings to control fluid & heat losses.
- Nasogastric tube for gastrointestinal decompression in order to facilitate reduction of the viscera inside the abdomen.
- Fluid resuscitation: 125-150% of the required maintenance fluids because of the large surface area of the body of the neonate in relation to the low body weight.
- ABG & correction of any abnormality.
- Broad spectrum antibiotics to guard against possible sepsis.
- Screening for associated anomalies (Uncommon with gastroschisis).
N.B.: Control of hypothermia is essential in cases with abdominal wall defects
Operative TTT of Gastroschisis
- 1ry Closure
- Silo Placement & Delayed Closure
Operative TTT of Gastroschisis
- 1ry Closure
Indicators of increased intraabdominal pressure during 1ry Closure of Gastroschisis
- Peak inspiratory pressure › 25 mmhg.
- CVP raised 4 mmHg or more.
- Bladder pressure › 20 mmHg (Intravesical pressure is measured by a catheter connected to a manometer).
Operative TTT of Gastroschisis
- Silo Placement & Delayed Closure
Operative TTT of Gastroschisis
- Indications of Silo Placement & Delayed Closure
- Failure of reduction of the eviscerated bowel
- Manifestations of increased intra-abdominal pressure during attempts of abdominal closure.
Operative TTT of Gastroschisis
- Methods of Silo Placement & Delayed Closure
- Preformed by using spring-loaded silo or silo constructed from rectangular Silastic Sheeting.
Operative TTT of Gastroschisis
- Aims of Silo Placement & Delayed Closure
- Aims at progressive reduction of eviscerated bowel over no more than 5-7 days.
- Once bowel reduced completely, fascial edges approximated to remove silo for delayed closure.
TTT of Gastrochisis
- Post-operative
Post-operative TTT of Gastrochisis
Def of Exomphalos / Omphalocele
Congenital defect of anterior abdominal wall, Present at umbilical ring.
Incidence of Exomphalos / Omphalocele
1-2 / 10K live births
