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Y4R4 - Surgery II 👨‍⚕️ > L1: Gastrochisis & Omphalocele > Flashcards

L1: Gastrochisis & Omphalocele Flashcards

1
Q

Def of Gastroschisis

A
  • Congenital defect of anterior abdominal wall, Most often to the right of umbilicus.
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2
Q

Pathophysiology of Gastroschisis

A
  • Due to unsupported right side of umbilicus after resorption of right umbilical vein at 4 Wk gestation
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3
Q

Incidence of Gastroschisis

A

0.4 - 3 per 10K

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4
Q

Age in Gastroschisis

A

Frequent with young mothers

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5
Q

CP of Gastroschisis

A
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6
Q

Associated Anomalies with Gastroschisis

A
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7
Q

Dx of Gastroschisis

A
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8
Q

Dx of Gastroschisis

  • US
A
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9
Q

Dx of Gastroschisis

  • MSAFP
A

Increases 9 times

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10
Q

TTT of Gastroschisis

A
  • pre, op & Post
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11
Q

TTT of Gastroschisis

  • Pre-Operative
A
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12
Q

Pre-Operative TTT of Gastroschisis

  • Is it a surgical emergency?
A

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
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13
Q

Pre-Operative TTT of Gastroschisis

  • Rapid Resuccitation
A
  • 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

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14
Q

Operative TTT of Gastroschisis

A
  • 1ry Closure
  • Silo Placement & Delayed Closure
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15
Q

Operative TTT of Gastroschisis

  • 1ry Closure
A
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16
Q

Indicators of increased intraabdominal pressure during 1ry Closure of Gastroschisis

A
  • 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).
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17
Q

Operative TTT of Gastroschisis

  • Silo Placement & Delayed Closure
A
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18
Q

Operative TTT of Gastroschisis

  • Indications of Silo Placement & Delayed Closure
A
  • Failure of reduction of the eviscerated bowel
  • Manifestations of increased intra-abdominal pressure during attempts of abdominal closure.
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19
Q

Operative TTT of Gastroschisis

  • Methods of Silo Placement & Delayed Closure
A
  • Preformed by using spring-loaded silo or silo constructed from rectangular Silastic Sheeting.
20
Q

Operative TTT of Gastroschisis

  • Aims of Silo Placement & Delayed Closure
A
  • 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.
21
Q

TTT of Gastrochisis

  • Post-operative
22
Q

Post-operative TTT of Gastrochisis

23
Q

Def of Exomphalos / Omphalocele

A

Congenital defect of anterior abdominal wall, Present at umbilical ring.

24
Q

Incidence of Exomphalos / Omphalocele

A

1-2 / 10K live births

25
Q

Sex in Exomphalos/Omphalocele

A

More in Males

26
Q

Sex in Exomphalos/Omphalocele

A

More in Males

27
Q

Age in Exomphalos/Omphalocele

A

Frequent with maternal age >30 Y

28
Q

CP of Exomphalos/Omphalocele

29
Q

Types of Exomphalos/Omphalocele

30
Q

Associated Anomalies of Exomphalos/Omphalocele

31
Q

Associated Anomalies of Exomphalos/Omphalocele

  • Cardiac
32
Q

Associated Anomalies of Exomphalos/Omphalocele

  • GIT
A

Duodenal atresia

33
Q

Associated Anomalies of Exomphalos/Omphalocele

  • Increased Incidence of Tumors
A
  • Wilms tumor.
  • Neuroblastoma tumor.
  • Adrenocortical tumors.
33
Q

Associated Anomalies of Exomphalos/Omphalocele

  • Chromosomal Anomalies
A
  • Trisomy 13, 15, 16, 18, 21.
  • Turner syndrome.
  • Klinefelter syndrome.
34
Q

Dx of Exomphalos/Omphalocele

35
Q

TTT of Exomphalos/Omphalocele

  • Pre-Operative
36
Q

Pre-Operative TTT of Exomphalos/Omphalocele

  • Is it Urgent?
A

less urgent than gastroschisis provided that the covering sac is intact.

37
Q

Pre-Operative TTT of Exomphalos/Omphalocele

  • Stabilization & Resuscitation
38
Q

Operative TTT of Exomphalos/Omphalocele

  • 1ry Closure
39
Q

Operative TTT of Exomphalos/Omphalocele

  • if 1ry Closure Fails
40
Q

Operative TTT of Exomphalos/Omphalocele

  • Silo Placement & Delayed Closure
41
Q

Non-Operative TTT of Exomphalos/Omphalocele

  • Indications
A

Indicated in cases with high operative risk
- Giant omphalocele
- Severe cardiac anomalies
- Significant chromosomal abnormalities

42
Q

Non-Operative TTT of Exomphalos/Omphalocele

  • Topical eschar forming agents
43
Q

Post-operative TTT of Omphalocele

44
Q

Compare Between Gastroschisis & Omphalocele in terms of

  • Size
  • Evisceration
  • Sac
  • Bowels
  • Anomalies
  • Maternal Age
  • Non-operative TTT

Y4R4 - Surgery II 👨‍⚕️ (32 decks)

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