18 Questions
What is the main difference between omphalocele and gastroschisis?
The location of the abdominal wall disorder
What does gastroschisis mean in Greek?
Stomach cleft
What is the cause of gastroschisis?
Failure of abdominal wall closure
What complication arises if there is twisting of the mesentery upon bowel reentering the abdomen?
Volvulus of the bowel
How does the treatment differ for a ruptured sac in omphalocele compared to an unruptured sac?
Use of external dressing for pressure in unruptured sac
What is a similarity between omphalocele and neural tube defects in terms of development?
Both fail to close during gestation
What is a potential cause of intestinal obstruction in infants according to the text?
Thicker-than-usual meconium formation
How is an omphalocele or gastroschisis usually identified during pregnancy?
By an elevated maternal serum a-fetoprotein level
What is the therapeutic management approach for gastrointestinal distention in neonates?
Immediate surgery to relieve the obstruction
What might be a sign of infant abdominal pain according to the text?
Pulling the legs up against the abdomen
What imaging technique would likely reveal no air below the level of intestine obstruction?
Abdominal X-ray
When might an amniocentesis be performed during pregnancy according to the text?
To evaluate the level of AFP in amniotic fluid
What is the purpose of inserting a gastrostomy into the stomach?
To prevent dehydration and electrolyte imbalance
What is the structure of an umbilical hernia typically like?
Less than 2 cm in diameter with a small fascial ring
When is surgical repair often not necessary for mild umbilical hernia cases?
When the child begins to walk around 2 years of age
What can be visible when a baby with an umbilical hernia cries?
A bulging protrusion under the skin at the umbilicus
What are IV medications given for in cases involving a gastrostomy?
To restrict the stomach's ability to produce acid
In which group is umbilical hernia more common according to the text?
Black children
Study Notes
Surgical Approaches for Omphalocele
- Replace only a portion of the bowel at one time, with the remainder contained by a Silastic pouch (silo) suspended over the infant's bed
- Over the next 5-7 days, bowel is gradually returned to the abdomen by multiple surgical procedures
Omphalocele
- Abdominal wall disorder where the intestine or other organs protrude through the navel
- If ruptured sac: treated like gastroschisis due to infection potential
- If unruptured sac: external dressing with mild pressure is used to gradually compress abdominal contents, allowing skin to stretch between treatments
Gastroschisis
- Derived from Greek words for "stomach cleft" or "fissure"
- Abdominal wall disorder where organs spill freely from the abdominal wall, usually to the right of the umbilicus
- Incidence: 4-5 per 10,000 live births
- Children often have decreased bowel motility and difficulty absorbing nutrients and passing stool, even after surgical correction
Intestinal Obstructions
- Can be caused by a failure of canalization of the intestine in utero
- Atresia (complete closure) or stenosis (narrowing) of fetal bowel can develop
- Most common site: duodenum
- Twisting of the mesentery of the bowel can cause volvulus, a potential problem for the first 6 months
Abdominal Wall Defects
Umbilical Hernia
- Protrusion of a portion of intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord
- Incidence: more common in Black children, low-birth-weight infants, and girls
- Structure: 1-2 cm in diameter but may be as large as an orange when the child cries or strains
- Size of protruding mass is not as important as the size of the fascial ring through which the intestine protrudes
Diagnosis and Assessment
- Omphalocele and gastroschisis can be identified by an elevated maternal serum alpha-fetoprotein (MAFP) during pregnancy
- Prenatal sonogram can determine abdominal wall/spinal disorders
- Presence is obvious on inspection at birth if omphalocele or gastroschisis is identified in utero
- Cesarean birth may be prepared to protect exposed intestine
Therapeutic Management
- Insertion of an orogastric or nasogastric tube to prevent further gastrointestinal distension
- IV therapy to restore fluid and electrolyte balance
- Immediate surgery is scheduled to relieve the obstruction before pressure on the bowel causes death of the involved intestinal lining
- Obstruction repair usually involves laparoscopy, although full abdominal surgery may be necessary
Test your knowledge on gastrostomy insertion, post-operative care, and related procedures such as IV fluids, parenteral nutrition, IV medications, antibiotics, and surgical interventions.
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