ABDOMINAL WALL DEFECTS:GASTROSCHISIS, OMPHALOCELE.pptx
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An abdominal wall defect is a congenital anomaly characterized by an opening in the abdomen through which various abdominal organs can protrude. This condition can usually be diagnosed early in fetal development, usually between the tenth and fourteenth weeks of pregnancy. The most common types of abdominal wall defects are Gastroschisis and Omphalocele.
ABDOMINAL WALL DEFECTS:GASTROSCHISIS, OMPHALOCELE.pptx
- 1. ABDOMINAL WALL DEFECTS Mr. Pradeep Abothu, M.Sc (N), PhD Scholar, Associate Professor Dept. Of Child Health Nursing ASRAM College Of Nursing
- 2. An abdominal wall defect is a congenital anomaly characterized by an opening in the abdomen through which various abdominal organs can protrude. This condition can usually be diagnosed early in fetal development, usually between the tenth and fourteenth weeks of pregnancy. DEFINITION
- 3. ◦ The exact causes of abdominal wall defects are not fully understood, but multiple genetic and environmental factors likely influence the development of this disorder. ◦ A family history of abdominal wall defects can increase the risk. ◦ These defects are associated with certain genetic syndromes, such as Beckwith- Wiedemann syndrome. ◦ Folic acid deficiency during pregnancy. ◦ Younger mothers, particularly those under 20 years old. ◦ Smoking, alcohol consumption, substance abuse (such as marijuana and cocaine), and certain medications during pregnancy (e.g., NSAIDs). ETIOLOGY
- 4. The most common types of abdominal wall defects are I. Gastroschisis and II. Omphalocele. TYPES
- 6. Gastroschisis: Gastroschisis is a congenital abdominal wall defect characterized by an opening, through which the abdominal contents protrude without a protective sac. It is usually located to the right of the umbilical cord. It occurs in approximately 1 in 10,000 live births Pathophysiology: In gastroschisis, the abdominal wall fails to close during fetal development, leading to exposure of the intestines to amniotic fluid. This exposure can cause inflammation and damage to the bowel, resulting in complications such as intestinal atresia or malrotation. GASTROSCHISIS
- 7. Clinical Features: • Protruding abdominal contents right side of the umbilicus at birth. • Size of the defect typically ranges from 1 to 5 cm. • No protective membrane covering the organs • Possible associated complications, including: prematurity, low birth weight, • Feeding difficulties, • Electrolyte imbalances. • Visible abdominal deformity at the time of delivery.
- 8. Omphalocele: Omphalocele is a congenital abdominal wall defect in which abdominal organs, such as the intestines, liver, and spleen, protrude into the base of the umbilical cord, covered by a thin, protective membrane. It has an incidence of about 1 in 5,000 live births. Pathophysiology: An omphalocele occurs due to an error in embryonic development, specifically involving the intestinal tract. During fetal development, the midgut temporarily herniates through the umbilicus, but it should later re-enter the abdomen as the abdominal wall closes. In omphalocele, this process fails, resulting in the midgut remaining outside the abdomen. OMPHOLOCELE
- 9. Clinical Features: ◦ Protrusion of abdominal contents at the base of the umbilicus, often visible at birth ◦ The defect can vary in size, from small to large, i.e. 4- 12 cms. ◦ Presence of a protective sac covering the herniated organs
- 10. ◦ Large omphalocele can cause dystocia and injury to the liver ◦ Small and undeveloped abdominal and thoracic cavities ◦ Possible associated anomalies, including: cardiac defects, gastrointestinal malformations, chromosomal abnormalities.
- 11. Diagnostic Evaluation: Prenatal Tests: Blood Tests: Elevated levels of maternal alpha-fetoprotein (AFP) during pregnancy can indicate gastroschisis. Ultrasonography: Both gastroschisis and omphalocele are usually diagnosed before birth through routine prenatal ultrasonography. These defects are immediately visible after birth.
- 12. MANAGEMENT
- 13. Immediate Management after Birth: • Maintain the infant in a sterile, warm environment to prevent hypothermia and infection. • Cover the exposed abdominal contents with sterile saline-soaked gauze and a plastic wrap or silo. • Position the infant supine with legs slightly elevated to reduce pressure on exposed organs. ◦ Place NG tube to decompress the intestines. ◦ Place the baby under a radiant warmer. MANAGEMENT
- 14. • Monitor vital signs, fluid balance, and urine output continuously. • Provide intravenous fluids and electrolytes to prevent dehydration and maintain homeostasis. • Administer prophylactic antibiotics and prepare for surgical intervention. MANAGEMENT
- 15. Surgical Management: Both gastroschisis and omphalocele require surgical intervention to return the herniated abdominal contents to the abdominal cavity and close the abdominal wall defect. • Primary Closure: When the abdominal cavity is large enough to accommodate the herniated organs without excessive pressure, the herniated organs are carefully returned to the abdominal cavity, and the abdominal wall defect is closed.
- 16. • Staged Closure: When the abdominal cavity is too small to accommodate the herniated organs at once, especially in large defects, a staged approach is used. A Silastic silo is placed over the exposed organs (in gastroschisis) or the omphalocele sac is managed conservatively, allowing gradual reduction of the organs into the abdominal cavity over time. Skin may be closed initially, with delayed closure of the fascia (muscle layer) over weeks to months as the abdominal cavity expands.: Once the organs are reduced, the abdominal wall defect is closed surgically.
- 17. Postoperative Care: ◦ Administer prescribed analgesics to manage postoperative pain and antibiotics to prevent infections. ◦ Monitor the surgical site for signs of infection, such as redness, swelling, or discharge. ◦ Regularly assess vital signs and monitor for complications like ileus or bowel obstruction, and observe for normal bowel function and passing of flatus. ◦ Gradually reintroduce feeding, starting with clear fluids and advancing to full feeds. ◦ Educate parents on proper wound care, hygiene, signs of complications, and when to seek medical attention.