chapter 62 fetal anterior abdominal wall

Question 1

abdominal wall defects occur during the ____ trimester

Answer 1

first trimester

Question 2

the midgut usually returns into the abdominal cavity by week

Answer 2

11-12

Question 3

most common types of abdominal wall defects

Answer 3

• gastroschisis
• omphalocele
• umbilical hernia

Question 4

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

Answer 4

omphalocele

Question 5

omphalocele: AFP levels:

Answer 5

normal or slightly elevated

Question 6

two types of omphalocele:

Answer 6

1. contains liver in the sac

2. contains bowel w/o liver

Question 7

this type of omphalocele has a higher risk for chromosomal abnormalities

Answer 7

bowel omphalocele

Question 8

this omphalocele affects the abdominal wall muscles, fascia, and skin

Answer 8

liver omphalocele

Question 9

fetal mortality with isolated omphalocele

Answer 9

10%

Question 10

fetal mortality increases to ____% when more than 1 abnormality exists

Answer 10

80%

Question 11

bowel omphaloceles appear ____

Answer 11

echogenic

Question 12

bowel omphaloceles must be distinguished from umbilical hernia, this is done by:

Answer 12

checking the cord insertion: normal cord insert suggests umbilical hernia

Question 13

assosciated anomalies with omphalocele:

Answer 13

• cardiac
• gastrointestinal
• neural tube defects
• genitourinary tract

Question 14

Periumbilical defect, opening in the layers of the abdominal wall with herniation of bowel.

Answer 14

gastroschisis

Question 15

gastroschisis is almost always located:

Answer 15

to the right of the umbilicus

Question 16

gastroschisis infrequently involves:

Answer 16

• stomach
• genitourinary organs
• rarely involves liver

Question 17

theoretically, gastroschisis is a consequence of

Answer 17

atrophy of the right umbilical vein or distruption of the omphalomesentric artery

Question 18

gastroschisis size:

Answer 18

2-4cm

Question 19

umbilical cord insertion in fetuses with gastroschisis:

Answer 19

normal

Question 20

_____ is always found in the herniation of gastroschisis

Answer 20

small bowel

Question 21

AFP levels with gastroschisis

Answer 21

highly elevated

Question 22

why are AFP levels elevated in gastroschisis

Answer 22

because it is an open defect–exposed bowel

Question 23

gastroschisis is more common in

Answer 23

males

Question 24

Gastroschisis is sonographically detectable after ___ weeks gestation

Answer 24

12 weeks

Question 25

notably dilated bowel may suggest :

Answer 25

infarction or bowel atresia

Question 26

rupture of the amnion which leads to the entrapment/entanglement of fetal parts:

Answer 26

amniotic band syndrome

Question 27

How do you differentiate an omphalocele from gastroschisis

Answer 27

- presence of membrane(gastro doesn't have one) - look at cord(gastroschisis will have a normal cord) - omphalocele often occurs with chromosomal anomalies

Question 28

Rare group of disorders that involves macroglossia, omphalocele, visceromegaly(enlarged abdominal organs)

Answer 28

Beckwith-Weidmann syndrome

Question 29

defect in the lower abdominal wall & anterior wall of the bladder

Answer 29

bladder exstrophy

Question 30

protrusion of bladder through the abdominal wall defect

Answer 30

bladder exstrophy

Question 31

bladder exstrophy is accompanied with

Answer 31

``` omphalocele inguinal hernia chrytorchidism -anal problems genital malformations ```

Question 32

in bladder exstrophy, the urinary bladder is ___

Answer 32

not visible

Question 33

soft tissue mass that represents the exposed bladder mucosa seen on the surface of the lower abdominal wall:

Answer 33

bladder exstrophy

Question 34

occurs in early development with involvement of primitive gut and persistent cloaca

Answer 34

cloacal exstrophy

Question 35

extrophy of badder in which two hemibladders are separated by intestinal mucosa

Answer 35

cloacal exstrophy

Question 36

cloacal exstrophy involves

Answer 36

- lower abdominal wall defect below the cord insertion including extrophy of bladder and protrusion of intestines - lower limb abnormalities - spinal defects - anal atresia

Question 37

primary finding in cloacal exstrophy

Answer 37

anterior abdominal wall defect

Question 38

cloacal extrophy may also have abnormally ____ cord insert

Answer 38

low

Question 39

Rare, association of all 5 defects: 1. cleft in distal sternum 2. Diphragmatic defect 3. Midline anterior ventral defect 4. Defect of apical pericardium with communication into peritoneum 5. internal cardiac defect

Answer 39

Pentalogy of Cantrell

Question 40

usual primary finding in Pentalogy of Cantrell

Answer 40

high or superumbilical omphalocele

Question 41

Exposed heart presents outside chest through a cleft sternum:

Answer 41

ectopia cordis

Question 42

ectopia cordis is associated with these anomalies;

Answer 42

- omphalocele - cardiovascular malformations - craniofacial defects

Question 43

occurs with fusion of amnion and chorion

Answer 43

limb-body-wall complex

Question 44

limb-body-wall defects: more commonly affects what side:

Answer 44

affects the left side 3x more than the right

Question 45

associated with - large cranial defects - facial clefting - body wall complex defects involving throrax and abdomen - limb defects - scoliosis - various internal malformations

Answer 45

limb-body-wall complex

Question 46

with limb-body-wall complex, the umbilical cord is:

Answer 46

short and adherent to placental membranes or absent

Question 47

limb-body-wall complex sonographically:

Answer 47

- large defects - involve abdomen and thorax - bizarre appearing mass entangled with membranes