abdominal wall defects Flashcards by Anonymous mous

define omphalocele

failure of viscera to return to the abdominal cavity , organs stick out through an opening in the muscles at the area of the umbilical region and are covered by a thin peritoneal layer.

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What conditions are associated with omphalocele

Heart malformations (20 percent)
Beckwith-Wiedeman Syndrome (a condition typified by a large tongue, high insulin and low blood sugar)
Chromosomal abnormalities ( trisomy 12,18,downs,turners)
CNS
Genitourinary

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How is omphalocele diagnosed prenatally

Ultrasound: may see herniated organs
Echo-cardiography: cardiac problems
amniocentesis: Karyotype of fetal cells for any chromosomal abnormalities

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How is omphalocele diagnosed postnatally

see viscera covered by membrane

hypoglycemia- associated with Beckwith-Wiedeman Syndrome

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How do you treat omphalocele non surgically

Sac is soaked in saline to reduce water loss

NG tube

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How do you treat omphalocele surgically

Primary closure- excision of sac and closure by putting skin and fascia over the abdominal contents
staged neonatal closure- gradual reduction of the sac with sac excision and closure ( with mesh or surgery)
Scarification- allows development of eschar ( dead tissue) this epitheliazes over time that leaves a hernia for later repair
ruptured - create silo

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define gastroschisis

Defect in abdominal wall lateral to the umbilicus
• Any part of the GI tract may protrude
• Not covered by a sac

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What are the causes of gastroschisis

-failure of the mesoderm to form in the anterior
abdominal wall
-failure of the lateral folds to fuse in the midline
-thrombosis (umbilical vein) causes necrosis of the surrounding abdominal wall

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How is gastroschisis diagnosed prenatally

Ultasound
High levels of maternal AFP
Bowel loops floating freely in the amniotic fluid

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Treatment non surgical for gastroschisis

Early delivery to reduce exposure of bowel loops to amniotic fluid
IV Fluids 
NG decompression 
Bowel soaked in saline
Viscera covered in bag

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Surgical treatment of gastroschisis

primary closure- mesh
Intraabdominal pressure > 10-15 mmHg =ischemia use silo-

staged closure - silo- covering placed over the abdominal organs on the outside of the baby. Gradually, the organs are squeezed by hand through the silo into the opening and returned

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define meckel’s diverticulum

Outpouching in the wall of the intestine due to a remnant of the embryologic vitelline
duct (connects the fetal gut with the yolk sac)

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what is the clinical presentation of meckel’s diverticulum

Bleeding- Episodic painless rectal bleeding, melena, anemia
intestinal obstruction-intususseption,volvulus
diverticular inflammation- stasis of contents inside

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how is meckel’s diverticulum diagnosed

Meckel radionuclide scan

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How is meckel diverticulum treated

resection by diverticulectomy or ileal resection with anastomosis

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define Intussusception

most frequent cause of bowel obstruction
in infants and toddlers. It is an invagination of
the proximal bowel into the distal bowel

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Pathophysiology of Intussusception

bowel drags mesentery with it & produces arterial & venous obstruction & mucosal necrosis→ classic “black currant jelly” stool.

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What is primary Intussusception

hypertrophy of peyer’s patches in bowel due to an infection (UTRI)

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What is secondary intussusception

A leading point ( meckel’s diverticulum, polyps, appendix) causes proximal bowel to enter distal bowel helped by peristaltic activity

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What is the clinical presentation of intussusception

abdominal pain- has attacks where the pain is sudden and child pulls legs towards abdomen, holds breath, vomits, between attacks child appears comfortable
Currant jelly stools
palpable sausage shaped abdominal mass
prolapse of proximal bowel through anus- bad sign

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What is seen on the imaging of intussusception

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xray- abnormal distribution of gas and fecal contents, air-fluid levels
US- doughnut lesion>alternating rings
of low and high echogenicity

What is the nonsurgical treatment of intussusception

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IV fluid, NG tube
Hydrostatic reduction- catheter is inserted into the rectum and under fluoroscopic guidance, air or water is put into the large bowel.
air reduction- pressures in the region of 60-100 mmHg are used which may reduce the intussusception back to the ileocaecal valve

when is surgical treatment of intussusception used

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Nonoperative reduction is unsuccessful
There are signs of peritonitis
Symptoms last more than 48h

What technique is used for intussusception

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open/laparoscopic

define hypertrophic pyloric stenosis

Thickening of the pylorus muscle resulting in obstruction of gastric contents

clinical signs of hypertrophic pyloric stenosis

nonbilious, projectile vomiting , starts infrequently then is after every feeding. content =recent digested milk dehydration- sunken fontanelle, wrinkles visible peristaltic waves

physical examination of hypertrophic pyloric stenosis

visible peristaltic waves in stomach region | palpable pyloric mass under liver

imaging in hypertrophic pyloric stenosis

US: muscle thickness of ≥4 mm and a pyloric length of ≥16 mm

Differential diagnosis of HPS

``` GERD, gastroenteritis, increased intracranial pressure metabolic disorders. gastric tumors, ```

What is the treatment of HPS non surgical

Hydration and electrolytes to correct hypochloremic, hypokalemic metabolic alkalosis

What is the surgical treatment of HPS

pyloromyotomy: open and laproscopic

define appendicitis

inflammation on appendix

What are the causes of appendicitis

``` obstruction of the appendix lumen with: stool lymphoid hyperplasia neoplasm bacteria,virus ```

Clinical signs of appendicitis

``` begins with anorexia and periumbilical pain pain radiates to right lower abdomen nausea, vomitting Diarrhea in perforated appendicitis fever ```

Physical examination of appendicitis

pain when pressing mcburney point RLQ Rovsing - pain on right when pressing left obturator sign- RLQ pain with rotation of right hip Psoas sign-RLQ pain when right leg extended

imaging in appendicitis

xray- fecolith US- Fluid filled appendix >6mm diameter ct-

What is the differential diagnosis of appendicitis

``` GI: Crohn meckel diverticulum gastroenteritis pancreatitis GU UTI renal stones wilm's tumour ovarian torsion/cyst testicular torsion ```

treatment of nonperforated appendicitis

Fluids broad spectrum antibiotics appendectomy (not encourged)

treatment of perforated appendicitis

triple antibiotic therapy- ampicillin, gentamicin , clindamycin, nasogastric drainage IV fluids

Treatment of gangrenous appendicitis

IV antibiotics, enema, peritoneal drainage

complications of appendicitis

Infection Postoperative occlusion fever, abdominal pain, vomitting

define inguinal hernia

bulge or protrusion that is seen or felt in the groin area or the scrotum

Cause of indirect inguinal hernia

most common type in children Testis descend from abdomen to scrotum via the inguinal canal . In this, the canal does not close> abdominal organs go through this canal.

Cause of direct hernia

weakness in the abdominal wall that allows intestines to protrude through

classification of inguinal hernia

MDs don’t LIe: o Medial to inferior epigastric vessels = Direct hernia o Lateral to inferior epigastric vessels = Indirect hernia

clinical presentation of inguinal hernia

1. A bulge in the inguinal area or scrotum. This bulge may reduce in a supine position. 2. Usually, painless, severe pain raises concern for a strangulated hernia. 3. Bowel sounds in the scrotum . 4. Silk glove sign: gently pass the fingers over the pubic tubercle to reveal a patent process vaginalis.

Diagnosis of inguinal hernia

Treatment of inguinal hernia

For open hernia repair surgery, a single long incision is made in the groin. direct hernia-, the bulge is pushed back into place.(indirect)- the hernia sac is either pushed back or tied off and removed.

define hydrocele

fluid in the scrotum or inguinal canal in | boys or in the inguinal/labial area in girls

classification of hydrocele

Non-communicating hydrocele- no connection between scrotum and abdomen reactive hydrocele- type of non-communicating hydrocele caused by trauma, infection or testicular torsion. communicating hydrocele - canal connecting abdomen to scrotum fails to completely close , the fluid is able to travel back and forth through the canal, size of scrotum changes may also cause inguinal hernia hydrocele of the cord -fluid collecting along the spermatic cord

abdominal wall defects Flashcards

(50 cards)