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OB Pathology > chapter 61-Anterior Abdominal Wall > Flashcards

chapter 61-Anterior Abdominal Wall Flashcards

1
Q

What are the two most common anterior abdominal wall defects?

A

Omphalocele and gastroschisis

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2
Q

What are the less common abdominal wall defect?

A

ectopia cordis, limb-body somplex and cloacal exstrophy

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3
Q

At what week gestation is the embryo flat disk like?

A

5th week

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4
Q

when the embryo is flat disk like what are the three layers it consist of?

A
  1. ectoderm
  2. mesoderm
  3. endoderm
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5
Q

In the 6th week what is the process called that helps the embryo transform itself into a cylindrical shape?

A

the folding process

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6
Q

what week of development does the umbilical herniation of the bowel occur?

A

8th week

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7
Q

What causes the midgut to grow faster than the abdominal cavity early in development?

A

increased size of the liver and kidney and herniation develops

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8
Q

What week gestation does the intestines return to the abdominal cavity?

A

12 th week

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9
Q

what transformation is the critical part of the process of closing the abdominal wall?

A

intestines to return to abdominal cavity

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10
Q

The growth of the neural tube causes what?

A

it causes the embryo to fold at the caudal end, incorporating part of the yolk sac as the hindgut.

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11
Q

what does the hindgut turn into?

A

cloaca

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12
Q

what weeks does the fetal bowel normally migrates into the umbilical cord from the abdominal cavity.

A

8th to 12th week

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13
Q

Normal embryologic herniation of the bowel permits the development of?

A

the intrabdominal organ and allow necessary bowel rotation

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14
Q

herniation permits the bowel to ?

A

rotate around the superior mesenteric artery

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15
Q

Because of the lack of space within the abdominal cavity and the large feta liver and kidneys, this forces the bowel?

A

from the abdomen and into the extraembryonic coelom of the umbilical cord

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16
Q

It is important to image ________ and________ to evaluate for the presence of absence of defects.

A

cord insertion and anterior abdominal wall

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17
Q

What questions should be asked when evaluating the abdominal wall?

A
  1. is a limiting membrane present
  2. What is the relation of the umbilical cord to the defect?
  3. Which organs are involved?
  4. Is the bowel normal in appearance?
  5. Are other fetal malformations evident?
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18
Q

What are the tree most common abdominal wall defects?

A
  1. omphalocele
  2. gastroschisis
  3. umbilical hernia
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19
Q

The incidence of omphaloceles is roughly ___ in ______ live births

A

1 in 4000

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20
Q

when does omphalocele develop?

A

when there is a midline defect of the abdominal muscles, fascia and skin that results in herniation of the intrabdominal structures into the base of the umbilical cord

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21
Q

Omphalocele is cover by a membrane that consist of?

A

amnion and peritoneum

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22
Q

With omphalocele ____ level might be slightly _____ or within _____ _____

A

AFP; elevated; normal limits

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23
Q

Omphaloceles are characterized as what two types?

A
  1. Those that contain the liver within the sac

2. Those that contain a variable amount of bowel without liver

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24
Q

sonographic signs of omphalocele:

A
  1. central abdominal wall defect with evisceration of the bowel or a combination of liver and bowel into the base of the umbilical cord
  2. Membrane consisting of the peritoneum and amnion forms the omphalocele sac
  3. A normal cord instertion suggest hernia
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25
Q

_________ is found in 1/3 or fetuses with omphalocele

A

hydramnios

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26
Q

What are the associated anomalies of omphalocele?

A
  1. complex cardiac disease
  2. gastro intestional
  3. neural tube
  4. genirourinary tract (polycystic kidneys with a small omphalocele may indicate trisomy 13)
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27
Q

Omphalocele may occur concurrently with?

A

diaphragmatic hernia

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28
Q

when omphalocele with scoliosis is found consider ?

A

limb body wall complex

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29
Q

What is limb body wall complex?

A

a letal disorder which includes severe cranial defects, facial clefts, extensive abdominal wall defect of the chest, and abdomen and limb defects

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30
Q

Amniotic band syndrome may represent?

A

milder form of limb body wall complex and be predicted by amniotic band that entangle or amputate fetal parts

31
Q

When organomegaly and macroglossia are observed. What else is suspected?

A

Beckwith-Wiedemann syndrome

32
Q

When a low omphalocele is observed consider?

A

bladder or cloacal exstrophy

33
Q

what is considered when a large omphalocele, diaphragmatic hernia, ectopia cordis and other heart defects are observed?

A

Pentalogy of Cantrell

34
Q

What is gastroschisis?

A

an opening in the layers of the abdominal wall with evisceration of the bowel and infrequently,k the stomach and genitourinary organs but rarely the liver

35
Q

Gastroschisis is a periumbilical defect that nearly always is located to the ______ of the ________

A

right; umbilicua

36
Q

It is thought that gastroschisis is a consequence of?

A

atrophy of the right umbilical vein or a disruption of the omphalomesenteric artery

37
Q

Where are gastroschisis defects located?

A

small and are located next to the normal cord insertion

38
Q

T or F The insertion of the umbilical cord is normal in fetuses with gastroschisis

A

True

39
Q

T or F small bowel is always found in the herniation

A

True

40
Q

What other organs are involved with gastroschisis?

A

large bowel, stomach, genitourinary and rarely liver

41
Q

AFP levels are significantly _______ in gastro. comparted with imphalocele because of ___________.

A

higher; exposed bowel

42
Q

T or F Gastroschisis is found more in women

A

False; men

43
Q

Ischemia with gastroschisis may cause?

A

bowel perforation or meconium peritonitis

44
Q

What % of infants die when diagnosed with gastroschisis in which ischemia and gangrene of the bowel were present?

A

50

45
Q

How should the infant be delivered with gastroschisis and why?

A

cesarean to prevent bowel damage and contamination from vaginal deliver

46
Q

What is the prognosis for the infant with uncomplicated gastoschisis?

A

Excellent

47
Q

Sonographer may be able to detect gastroschisis after _____ weeks of gestation?

A

12

48
Q

Sonographic finding of gastroschisis

A
  • cord normally inserted into abdominal wall, defect always to the right of cord insertion
  • edges of bowel are irregular and free floating w/o covered membrane
  • multiple loops of bowel may be seen outside the abd. cavity in the area of the cord
49
Q

Sono. appearance of gastroschisis

A
  • Right paraumbilical defect of abdominal wall, rarely a left side defect
  • free floating herniated small bowel, large bowel, stomach, gallbladder, urinary bladder, and pelvic organs may be involved. (when organs other thatn small or large bowel are seen, body stalk anomalies should be suspected
50
Q

A herniated bowel may be mildly dilated with?

A

bowel wall thickening

51
Q

Notably dilated bowel may suggest?

A

infarction or bowel atresia

52
Q

what is amniotic band syndrome?

A

rupture of the amnion, which leads to entrapment or entanglement of the fetal parts by the sticky chorion

53
Q

Early entrapment by amniotic bands may lead to ?

A

severe craniofacial defects and internal malformation

54
Q

Late amniotic band entrapment may lead to?

A

amputation or limb restriction

55
Q

What is beckwith-wiedemann syndrome?

A

a rare group of disorder having in common the coexistence of omphalocele, macroglassia, and visceromegaly

56
Q

Sono finding of Beckwith-Widedmann syndrome?

A

presence of omphalocele, growth acceleration, macroglossia dn visceromegaly

57
Q

With B. W. syndrome what may be present in the third trimester?

A

polyhydramnios

58
Q

Bladder exstrophy is characterized by?

A

a defect in the lower abdominal wall and anterior wall of the urinary bladder

59
Q

Bladder exstrophy anomaly may be ____ or _____

A

mild or severe

60
Q

In bladder exstrophy the everted bladder becomes exposed on?

A

the lower abdominal wall

61
Q

T of F ; With bladder extrophy, the normal urinary bladder is not visible upon sono. evaluation

A

True

62
Q

Pentalogy of Cantrell is rare and is the association of?

A
  • a cleft or defect in the distal sternum
  • diaphragmatic defect
  • midline anterior ventral wall defect (most often omphalocele)
  • defect of the apical pericardium with communication intothe peritoneum
  • ectopic heart
63
Q

What is the usual primary findings of Pentalogy of Cantrell?

A

high or superumbilical omphalocele

64
Q

What happens if a diaphragmatic defect is large enough to produce a diaphragmatic hernia?

A

displacement of the heart and mediastinum should be observed, but the sternal and pericardial defects are not well seen

65
Q

the exposed heart present outside the chest wall through a cleft sternum?

A

ectopia cordis

66
Q

What is the most dramatic finding of ectopic cordis?

A

heart outside the thoracic cavity; a portion of all the heart may protrude through the defect in the sternum

67
Q

what is a cleft sternum?

A

partial or absent wouthout ectopia cordis, and is typically a superior or total cleft

68
Q

In cleft sternum; dramatic pulsations of the anterior chest wall occur from the heart beating against the ________ without the presence of the __________ to protect it.

A

chest, sternum

69
Q

sonographic appearance of PoC; ectopic cordis and cleft sternum;

A

heart may be seen to lie outside the normal thoracic cavity or bulge through the defective sternum
-common to see pericardian and pleural effusion
-

70
Q

what is limb body wall complex?

A

associated with large cranial defects; facial cleft; body wall complex defects involving the thorax, abdomen, or both; and limb defect

71
Q

left side body wall defects are _____ times more common than right side defects

A

3

72
Q

what are some other anomalies with limb body wall complex?

A

scoliosis and various internal malformations

73
Q

Limb body wall complex occurs with the fusion of ?

A

amnion and chorion

OB Pathology (16 decks)

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