1 Abdominal Wall DefectsOmphalocele vs. Gastroschisis
Joanna Thomson MS3
March 13 2007
2 Embryology Review
The Midgut gives rise to
Duodenum distal to the bile duct
Hepatic flexure of the colon
Proximal two-thirds of transverse colon.
3 Week 6Physiological Umbilical Herniation
As a result of rapid growth and expansion of the liver the abdominal cavity temporarily becomes too small to contain all the intestinal loops.
The intestinal loops enter the extraembyronic cavity within the umbilical cord during the sixth week of development.
As herniation occurs the loop undergoes a 90 degree counterclockwise rotation around the superior mesenteric artery.
Source Langmans Medical Embryology. Ninth Edition. 4 Week 10Return to Abdominal Cavity
During 10th week of development herniated intestinal loops begin to return to the abdominal cavity.
Undergoes additional 180 degree counterclockwise rotation about the superior mesenteric artery.
Factors responsible for this return are not precisely known... It is thought that regression of the mesonephros (kidney) reduced growth of the liver and expansion of the abdominal cavity all play roles.
Source Langmans Medical Embryology. Ninth Edition. 5 Omphalocele
Herniation of abdominal viscera through an enlarged umbilical ring.
Failure of the bowel to return to the body cavity following physiological umbilical herniation. Defective mesodermal growth causes incomplete central fusion and persistent herniation of the midgut.
Extruded viscera may include LIVER small and large intestines stomach spleen or bladder.
Covered by amnion and peritoneum
(May rupture before or at time of delivery)
6 Source Omphalocele and Gastroschisis. eMedicine. 7 Gastroschisis
Herniation of intestinal loops through the anterior abdominal wall.
Defect lateral to the umbilicus (rightgtleft)
Abnormal involution of the right umbilical vein or vascular accident involving the omphalomesenteric artery causes localized abdominal wall weakness.
No sac covers the extruded viscera.
Having been bathed in the amniotic fluid and with compression of the mesenteric blood supply at the abdominal defect the bowel wall may be inflammed and edematous. May appear to have a thick shaggy membrane and loops may appear shortened and matted together.
8 Source Omphalocele and Gastroschisis. eMedicine. 9 Prenatal Diagnosis
Elevated maternal serum alpha fetoprotein
Source Fetal Diagnosis and Treatment. The Childrens Hospital of Philadelphia. 10 Epidemiology
Omphalocele 1/5000 births
Gastroschisis 1/10000 births
Increasing in frequency especially in young women.
Related directly to presence of chromosomal and other abnormalities
Source Langmans Medical Embryology Ninth Edition. 11 Omphalocele Associated Anomalies
Chromosomal abnormalities (50)
Trisomies 13 18 21
Congenital heart disease (50)
Neural tube defects (40)
LGA hyperinsulinism visceromegaly of kidneys adrenal glands and pancreas macroglossia hepatorenal tumors cloacal extrophy
Source Langmans Medical Embryology Ninth Edition. 12 Gastroschisis Associated Anomalies
Additional gastrointestinal problems (25)
Including atresia volvulus stenosis
Loss of bowel secondary to ischemia
Compromised bowel function
Source Langmans Medical Embryology Ninth Edition. 13 Initial Management
Acute management aimed at maintaining circulation to bowel and preventing infection while stabilizing infant (temperature/fluids)
Cover the defect with sterile dressing soaked in warm saline to prevent fluid loss
IV fluids with glucose
14 Surgical Treatment
Surgery performed to return the viscera to the abdominal cavity and close the defect.
Primary Surgical Closure Success dependent on size of the defect and size of the abdominal and thoracic cavities.
Staged Closure Gradual reduction of the contents into the abdominal cavity using an extra-abdominal extension of the peritoneal cavity (termed a silo) and using gentle pressure. Usually requires 1-3 weeks after which the defect is then primarily closed.
15 Source Omphalocele and Gastroschisis. eMedicine.
PowerShow.com is a leading presentation/slideshow sharing website. Whether your application is business, how-to, education, medicine, school, church, sales, marketing, online training or just for fun, PowerShow.com is a great resource. And, best of all, most of its cool features are free and easy to use.
You can use PowerShow.com to find and download example online PowerPoint ppt presentations on just about any topic you can imagine so you can learn how to improve your own slides and presentations for free. Or use it to find and download high-quality how-to PowerPoint ppt presentations with illustrated or animated slides that will teach you how to do something new, also for free. Or use it to upload your own PowerPoint slides so you can share them with your teachers, class, students, bosses, employees, customers, potential investors or the world. Or use it to create really cool photo slideshows - with 2D and 3D transitions, animation, and your choice of music - that you can share with your Facebook friends or Google+ circles. That's all free as well!
For a small fee you can get the industry's best online privacy or publicly promote your presentations and slide shows with top rankings. But aside from that it's free. We'll even convert your presentations and slide shows into the universal Flash format with all their original multimedia glory, including animation, 2D and 3D transition effects, embedded music or other audio, or even video embedded in slides. All for free. Most of the presentations and slideshows on PowerShow.com are free to view, many are even free to download. (You can choose whether to allow people to download your original PowerPoint presentations and photo slideshows for a fee or free or not at all.) Check out PowerShow.com today - for FREE. There is truly something for everyone!