Gastrostomy Insertion and Post-Operative Care Quiz

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Questions and Answers

What is the main difference between omphalocele and gastroschisis?

The presence of a membrane containing abdominal organs

The location of the abdominal wall disorder (correct)

The surgical procedures used for correction

The amount of intestinal contents herniating

What does gastroschisis mean in Greek?

Stomach enclosure

Stomach cleft (correct)

Abdominal fissure

Abdominal hernia

What is the cause of gastroschisis?

Failure of abdominal wall closure (correct)

Mesentery twisted as bowel reentered abdomen

Incomplete canalization of intestine

Mesentery fusion with the umbilical cord

What complication arises if there is twisting of the mesentery upon bowel reentering the abdomen?

Volvulus of the bowel Signup and view all the answers

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 Signup and view all the answers

What is a similarity between omphalocele and neural tube defects in terms of development?

Both fail to close during gestation Signup and view all the answers

What is a potential cause of intestinal obstruction in infants according to the text?

Thicker-than-usual meconium formation Signup and view all the answers

How is an omphalocele or gastroschisis usually identified during pregnancy?

By an elevated maternal serum a-fetoprotein level Signup and view all the answers

What is the therapeutic management approach for gastrointestinal distention in neonates?

Immediate surgery to relieve the obstruction Signup and view all the answers

What might be a sign of infant abdominal pain according to the text?

Pulling the legs up against the abdomen Signup and view all the answers

What imaging technique would likely reveal no air below the level of intestine obstruction?

Abdominal X-ray Signup and view all the answers

When might an amniocentesis be performed during pregnancy according to the text?

To evaluate the level of AFP in amniotic fluid Signup and view all the answers

What is the purpose of inserting a gastrostomy into the stomach?

To prevent dehydration and electrolyte imbalance Signup and view all the answers

What is the structure of an umbilical hernia typically like?

Less than 2 cm in diameter with a small fascial ring Signup and view all the answers

When is surgical repair often not necessary for mild umbilical hernia cases?

When the child begins to walk around 2 years of age Signup and view all the answers

What can be visible when a baby with an umbilical hernia cries?

A bulging protrusion under the skin at the umbilicus Signup and view all the answers

What are IV medications given for in cases involving a gastrostomy?

To restrict the stomach's ability to produce acid Signup and view all the answers

In which group is umbilical hernia more common according to the text?

Black children Signup and view all the answers

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

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Description

Test your knowledge on gastrostomy insertion, post-operative care, and related procedures such as IV fluids, parenteral nutrition, IV medications, antibiotics, and surgical interventions.