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Y4R4 - Surgery II 👨‍⚕️ > L2: NTDs > Flashcards

L2: NTDs Flashcards

1
Q

Neural Tube Development

A
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2
Q

Types of Neural Tube Defects

A
  • Spina Bifida Occulta
  • Tethered Cord
  • Meningocele
  • Myelomeningocele
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3
Q

Incidence of Spina Bifida Occulta

A

Very mild but Common

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4
Q

Spinal Cord Affection in Spina Bifida Occulta

A

Very rarely causes disability

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5
Q

How to detect Spina Bifida Occulta?

A
  • x-ray
  • investigating a back injury.
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6
Q

Spinal Cord affection in Tethered Cord

A

The spinal cord could be caught against the vertebrae (Normal cord ends at lower end of L1)

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7
Q

CP of Tethered Cord

A
  • Motor weakness of lower limbs
  • Sphincteric problems such as inefficient bladder control.
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8
Q

Incidence of Meningocele

A

Least common form

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9
Q

Spinal Cord affection in Meningocele

A
  • The nerves are not badly damaged and able to function normally.
  • Limited disability is present.
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10
Q

CP of Meningocele

A
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11
Q

Incidence of Myelomeningocele

A

Most serious and common

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12
Q

Spinal Cord Affection in Myelomeningocele

A
  • The spinal cord is damaged or not properly developed resulting in motor and sensory deficit.
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13
Q

CP of Myelomeningocele

A
  • The cyst not only contains meninges and CSF but also the nerves and spinal cord.
  • Majority have bowel and bladder problems
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14
Q

High Cost of NTDs

A
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15
Q

Dx of NTDs

A
  • Prenatal Detection of NTDs
  • US
  • Amniocentesis
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16
Q

Senseitivity of AFP in detection of NTDs

A

91% sensitivity in spina bifida

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17
Q

AFP in detection of NTDs

  • Normal
A
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18
Q

AFP in detection of NTDs

  • What is Diagnostic Level?
A

High maternal serum AFP > 2 multiples of median for appropriate week of gestation.

19
Q

US in detection of NTDs

A
20
Q

US in detection of NTDs

  • Advantages
A
  • Diffrentiate NTD fron non-neurological causes of elevated AFP e.g. omphalocele
21
Q

Amniocentesis in detection of NTDs

A
22
Q

Amniocentesis in detection of NTDs

  • Uses
A
  • Show elevated AFP between 12-15 week earlier than serum AFP
23
Q

Amniocentesis in detection of NTDs

  • Disadvantages
A

Carries 6% risk of abortion and fetal loss

24
Q

Amniocentesis in detection of NTDs

  • Indications
A
  1. Pregnancies subsequent to NTD
  2. Elevated AFP with Normal US
25
Q

Factors associated with Increased Risk of NTDs

A
26
Q

The only most significant risk factor associated with NTDs is

A

Folic Acid

27
Q

Prophylaxis against NTDs

A
28
Q

Nursing Care in NTDs

A
28
Q

TTT aspects of NTDs

A
  • Nursing Care
  • General Assessment
  • Neurological Pre-operative Assessment
29
Q

Nursing Care in NTDs

  • Ex & INVx
A

Like any other neonate with congenital anomalies efforts should be towards careful Ex and INVx to rule out other anomalies.

30
Q

Nursing Care in NTDs

  • Position
A

Nursed in Trendlenburg position aiming to & pressure & keep it away from cystic lesion.

31
Q

Nursing Care in NTDs

  • Precautions
A
  1. Much care not to disturb intact membrane (high incidence of infection & urgent surgery).
  2. Cover lesion with Gauze ring soaked with normal saline or Ringer solution to prevent dryness
  3. Avoid antiseptics e.g. betadine as it is Neurotoxic affecting functioning roots in placode
  4. Avoid mechanical trauma to placode
  5. No need for ultra frequent dressing
32
Q

General Assessment in NTDs

A
33
Q

General Assessment in NTDs

  • Ruptured or not?
A
  • Ruptured lesions start prophylactic antibiotic & Urgent surgery
34
Q

General Assessment in NTDs

  • Site & Site of Defect
A

For proper planning for closure

35
Q

General Assessment in NTDs

  • Neonatologist
A
  • Other anomalies (average 2-2.5% additional anomalies)
  • Condition oppose with surgery e.g. lung immaturity
36
Q

General Assessment in NTDs

  • Bladder
A
  • Start with on regular urinery catheterization
  • Urological consultation
37
Q

General Assessment in NTDs

  • Orthopedic
A

For sever kyphotic or scoliotic deformities and hip, knee and foot deformities

38
Q

Neurological Pre-Operative Assessment in NTDs

A
39
Q

Neurological Pre-Operative Assessment in NTDs

  • Spontaneous Movement of LL
A

Which associated with better outcome.

40
Q

Neurological Pre-Operative Assessment in NTDs

  • Lowest Level of Neurological Function
A
  • Response to painful stimuli
  • Differentiate () voluntary movement from reflex movement→ which is stereotyped and not persist after stimulus
41
Q

Neurological Pre-Operative Assessment in NTDs

  • Other Neurological Assossiations
A
42
Q

Check Mamdouh Notes

A

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Y4R4 - Surgery II 👨‍⚕️ (16 decks)

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