أسئلة العاشرة جراحة رابعة دمياط (أطفال)

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Questions and Answers

Which statement accurately describes gastroschisis?

The abdominal contents protrude through a defect typically located to the right of the umbilicus. (correct)
It has a strong association with chromosomal abnormalities.
The herniated abdominal contents are covered by a peritoneal sac.
The condition is more prevalent in females.

What is the distinguishing characteristic of omphalocele when compared to gastroschisis?

Its occurrence specifically on the right side of the umbilicus.
The herniation of abdominal organs is contained within a peritoneal sac. (correct)
The absence of a covering sac.
A lower incidence of associated congenital anomalies.

Which anomaly is most frequently associated with omphalocele?

Congenital diaphragmatic hernia
Chromosomal abnormalities (correct)
Meckel's diverticulum
Pyloric stenosis

Which prenatal imaging technique is optimal for diagnosing abdominal wall defects?

Ultrasound (B) Signup and view all the answers

Which condition is least likely to be associated with gastroschisis?

Chromosomal abnormalities (C) Signup and view all the answers

Which factor is considered a risk factor for gastroschisis?

Maternal smoking (D) Signup and view all the answers

What is the immediate first step in managing an infant with gastroschisis after birth?

Placing the exposed bowel in a sterile bag with warm saline (D) Signup and view all the answers

Which closure method is typically preferred for a small omphalocele?

Immediate primary closure (D) Signup and view all the answers

What is a common complication seen in infants with gastroschisis?

Short bowel syndrome (D) Signup and view all the answers

In which scenario is cesarean section most frequently recommended for abdominal wall defects?

Omphalocele with large liver herniation (A) Signup and view all the answers

Which best describes the umbilical cord insertion in omphalocele?

Cord inserts at the apex of the defect (A) Signup and view all the answers

On what factor does the prognosis of omphalocele largely depend?

Presence of associated anomalies (D) Signup and view all the answers

Which statement accurately describes staged closure of gastroschisis?

It involves gradually reducing bowel contents using a silo. (B) Signup and view all the answers

What is a major cause of morbidity in infants with gastroschisis?

Sepsis and bowel dysfunction (B) Signup and view all the answers

Which surgical technique might be necessary for large omphaloceles which primary closure is not possible?

Use of prosthetic mesh (C) Signup and view all the answers

What is the primary rationale for using a silo in the staged closure of gastroschisis?

To gradually reduce the volume of herniated contents and abdominal domain. (C) Signup and view all the answers

In managing an infant with gastroschisis, which acid-base abnormality is most likely to arise during the initial resuscitation phase before surgical intervention?

Metabolic acidosis from hypovolemia and tissue hypoperfusion. (B) Signup and view all the answers

Which of the following is the most critical consideration when determining the suitability of primary closure for an omphalocele?

The ability to reduce the abdominal contents without causing increased intra-abdominal pressure. (A) Signup and view all the answers

Which of the following antenatal factors would most strongly influence the decision to perform an early delivery in a fetus diagnosed with omphalocele?

Rapid increase in omphalocele size with signs of impending rupture. (C) Signup and view all the answers

A neonate with gastroschisis develops acute oliguria and increasing abdominal distension post-operatively. Which complication is most likely responsible for these findings?

Abdominal compartment syndrome. (C) Signup and view all the answers

In counseling parents about the long-term prognosis for an infant with gastroschisis, which of the following is the most significant factor affecting the child's future quality of life?

The need for prolonged parenteral nutrition and potential liver dysfunction. (A) Signup and view all the answers

What is the most important factor in preventing heat loss in a newborn with gastroschisis immediately after delivery?

Placing the infant under a radiant warmer and covering the exposed viscera with sterile bowel bag. (C) Signup and view all the answers

Which of the following best describes the rationale behind delaying surgical intervention in some cases of omphalocele?

To facilitate gradual epithelialization to avoid abdominal compartment syndrome (A) Signup and view all the answers

A newborn is diagnosed with gastroschisis. After initial stabilization, which of the following is the most appropriate next step in management?

Placement of the bowel in a sterile bag with a silo for gradual reduction. (D) Signup and view all the answers

Which specific aspect of the omphalocele sac is most vital in determining the immediate course of treatment after birth?

The integrity of the omphalocele sac. (A) Signup and view all the answers

In an infant with gastroschisis, what is the most reliable indicator of successful bowel adaptation following surgical repair?

Achievement of full enteral feeds with adequate weight gain. (A) Signup and view all the answers

Which statement is most accurate regarding the genetic implications of abdominal wall defects?

Omphalocele is frequently associated with chromosomal abnormalities. (C) Signup and view all the answers

What is the best method to reduce the risk of infection in an infant with an unrepaired omphalocele?

Maintaining the integrity of the sac and applying topical agents such as silver sulfadiazine. (C) Signup and view all the answers

What is the crucial step of pre-operative management of neonates with abdominal wall defects?

Placement of a sterile bowel bag to minimize heat and fluid loss (D) Signup and view all the answers

What is the primary rationale for using total parenteral nutrition (TPN) in neonates with gastroschisis or large omphaloceles?

To bypass the gastrointestinal tract to allow for bowel adaptation and healing. (A) Signup and view all the answers

Flashcards

Gastroschisis Definition

A congenital abdominal wall defect where the bowel protrudes, typically to the right of the umbilicus, without a covering membrane.

Omphalocele Definition

A congenital abdominal wall defect where abdominal viscera protrude, contained within a sac made of peritoneum, amniotic membrane and Wharton's jelly

Cause of Gastroschisis

Results from failure of lateral folds of the embryonic disc to fuse during the 3rd-4th week of gestation disrupting the omphalomesenteric artery.

Cause of Omphalocele

Results from failure of the midgut to return to the abdomen by the 10th week of gestation during midgut rotation.