Paediatric_Umbilical_Disorders_Flashcards
What are the components of the umbilicus during development?
Two umbilical arteries and one umbilical vein. The arteries are continuous with the internal iliac arteries and the vein is continuous with the falciform ligament (ductus venosus).
What happens to the umbilicus after birth?
The cord dessicates and separates, and the umbilical ring closes.
How common is an umbilical hernia in neonates and which group is more affected?
Up to 20% of neonates may have an umbilical hernia, more common in premature infants.
What is the natural course of most umbilical hernias?
The majority will close spontaneously, taking between 12 months and three years. Strangulation is rare.
What is a paraumbilical hernia and how does it differ from an umbilical hernia?
Due to defects in the linea alba close to the umbilicus. The edges are more clearly defined than those of an umbilical hernia and are less likely to resolve spontaneously.
What is omphalitis and what is the commonest cause?
An infection of the umbilicus, commonly caused by Staphylococcus aureus. It is potentially serious due to the risk of rapid spread through the umbilical vessels, leading to portal pyaemia and portal vein thrombosis. Treatment involves topical and systemic antibiotics.
What are umbilical granulomas and how are they treated?
Cherry red lesions surrounding the umbilicus that may bleed on contact and have seropurulent discharge. Infection is unusual, and they often respond to chemical cautery with topically applied silver nitrate.
What characterises a persistent urachus and what causes it?
Urinary discharge from the umbilicus, caused by persistence of the urachus which attaches to the bladder. Associated with other urogenital abnormalities.
What characterises a persistent vitello-intestinal duct and what is the common presentation?
Umbilical discharge that discharges small bowel content. Complete persistence is rare; more common is persistence of part of the duct (Meckel’s diverticulum). Best imaged using a contrast study and managed by laparotomy and surgical closure.
summarise paediatric umbilical disorders
Paediatric umbilical disorders
Embryology
During development the umbilicus has two umbilical arteries and one umbilical vein. The arteries are continuous with the internal iliac arteries and the vein is continuous with the falciform ligament (ductus venosus). After birth, the cord dessicates and separates and the umbilical ring closes.
Umbilical hernia
Up to 20% of neonates may have an umbilical hernia, it is more common in premature infants. The majority of these hernias will close spontaneously (may take between 12 months and three years). Strangulation is rare.
Paraumbilical hernia
These are due to defects in the linea alba that are in close proximity to the umbilicus. The edges of a paraumbilical hernia are more clearly defined than those of an umbilical hernia. They are less likely to resolve spontaneously than an umbilical hernia.
Omphalitis
This condition consists of an infection of the umbilicus. Infection with Staphylococcus aureus is the commonest cause. The condition is potentially serious as infection may spread rapidly through the umbilical vessels in neonates with a risk of portal pyaemia, and portal vein thrombosis. Treatment is usually with a combination of topical and systemic antibiotics.
Umbilical granuloma
These consist of cherry red lesions surrounding the umbilicus, they may bleed on contact and be a site of seropurulent discharge. Infection is unusual and they will often respond favourably to chemical cautery with topically applied silver nitrate.
Persistent urachus
This is characterised by urinary discharge from the umbilicus. It is caused by persistence of the urachus which attaches to the bladder. They are associated with other urogenital abnormalities.
Persistent vitello-intestinal duct
This will typically present as an umbilical discharge that discharges small bowel content. Complete persistence of the duct is a rare condition. Much more common is the persistence of part of the duct (Meckel’s diverticulum). Persistent vitello-intestinal ducts are best imaged using a contrast study to delineate the anatomy and are managed by laparotomy and surgical closure.
A mother brings her 5-week-old newborn baby to see you. She reports that she has noticed that his belly button is always wet and leaks out yellow fluid. On examination, you note a small, red growth of tissue in the centre of the umbilicus, covered with clear mucus. The child is otherwise well, apyrexial and developing normally.
Which one of the following is the most likely diagnosis?
Omphalitis
Umbilical hernia
Umbilical granuloma
Umbilical cellulitis
Gastroschisis
Umbilical granuloma
An umbilical granuloma is an overgrowth of tissue which occurs during the healing process of the umbilicus. It is most common in the first few weeks of life. On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid. It is treated by regular application of salt to the wound, if this does not help then the granuloma can be cauterised with silver nitrate.
Omphalitis or umbilical cellulitis is a bacterial infection of the umbilical stump which presents as a superficial cellulitis, usually a few days after birth.
Umbilical hernias occur in 1 in 5 newborn children and usually resolves by 2 years.
Gastroschisis is a congenital condition which is characterised by a defect in the anterior abdominal wall through which the abdominal contents protrude.
