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Abdominal Wall

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L.Zanin - MS213 - Abdominal Wall. 5. Normal Cord Insertion Site. 6/20/09 ... L.Zanin - MS213 - Abdominal Wall. 9. Ectopia Cordis ... – PowerPoint PPT presentation

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Title: Abdominal Wall


1
Abdominal Wall
2
Stomach
3
Abdominal Measurement
4
Abdomen Circumference
5
Normal Cord Insertion Site
6
Fetal Gallstone
7
CORD INSERTION
8
Abdominal Wall Defects
  • Ectopia cordis
  • All or part of the heart is located outside of
    the chest cavity
  • It is associated with intracardiac anomalies and
    omphaloceles
  • By ultrasound, you can see the heart beating
    outside the thorax

9
Ectopia Cordis
  • By ultrasound, you can see a small thorax with
    tissue noted outside the thoracic cavity
  • The prognosis is very poor
  • Associated with facial and skeletal deformities,
    and meningoceles

10
Ectopia Cordis
11
Ectopia Cordis
12
Ectopia Cordis
13
Ectopia Cordis
14
Ectopia Cordis
15
Anterior Abdominal Wall Defects
  • Abdominal wall defects can be R/O with abdominal
    circumference measurements
  • Omphalocele
  • Results from a failure of the intestines to
    return to the abdomen during the second stage of
    intestinal rotation
  • May consist of a single loop of bowel or may
    contain most of the intestines, liver, etc.
  • Most frequent ventral wall defect
  • A weakness in the abdominal wall muscles
    specifically the rectus abdominus muscle
  • Incidence of 2-2.5 fetus per 10,000 live births

16
Omphalocele
  • 90 are associated with abnormal chromosomal
    defects which include trisomy 13, 18 and 21,
    triploidy and Turners Syndrome
  • Incidence of chromosomal abnormalities is lower
    if the omphalocele contains liver and the
    incidence is higher if it contains only bowel

17
Omphalocele
  • Midline and smooth walled
  • It occurs at the level of the umbilical cord
    insertion site where the cord inserts into the
    outpouching
  • These fetuses are at high risk for other
    abnormalities that include
  • Cardiac anomalies (47)
  • Genitourinary abnormalities (40)
  • Neural tube defects (39)
  • Trisomies (35-58)

18
Omphalocele
  • AFP increased but not as high as with
    gastroschisis
  • Ultrasound appearance outpouching of the
    abdominal wall at the level of cord insertion
    site
  • The outpouching may contain liver and bowel, it
    can also contain the spleen, stomach and bladder

19
Omphalocele
  • It is covered by peritoneum
  • Fetal ascites should be visualized only with an
    omphalocele because the absence of a covering
    membrane in gastroschisis allows ascites to
    escape into the surrounding amniotic fluid
  • It is associated with chromosomal abnormalities

20
Omphalocele
  • It is important to distinguish between
    omphaloceles and gastroschisis because
    omphaloceles are usually associated with
    underlying chromosomal abnormalities
  • Cord inserts into the enclosed herniation of
    abdominal content

21
Omphalocele
22
Omphalocele
23
Omphalocele
24
Omphalocele
25
Omphalocele
26
Omphalocele
27
Omphalocele
28
Gastroschisis
  • Essentially an isolated entity rarely associated
    with anomalies other than various types of bowel
    atresia
  • Protrusion of intestines into amniotic cavity
    through an open defect in the anterior abdominal
    wall
  • Incidence of 0.8-2.5 fetuses in 10,000 live births

29
Gastroschisis
  • Uncommonly associated with other fetal anomalies
    hence the prognosis is better than an omphalocele
    because it is usually an isolated anomaly
  • Usually only the bowel is eviscerated, when you
    see gastroschisis with the evisceration of other
    organs other than bowel, the amniotic band
    syndrome should be considered and the spine and
    extremities carefully examined for anomalies

30
Gastroschisis
  • Usually located just to the right of the
    umbilical cord
  • Bowel loops float freely in the amniotic fluid
  • High AFP and polyhydramnios
  • Umbilical cord will be seen displaced laterally
  • No membrane is seen containing organs
  • C-section is done to prevent trauma and the
    prognosis is excellent

31
Gastroschisis
32
Gastroschisis
33
Gastroschisis
34
Gastroschisis
35
Gastroschisis
36
Gastroschisis
37
Gastroschisis
38
Gastroschisis
39
Gastroschisis
40
Gastroschisis
41
Gastroschisis
42
Gastroschisis
43
Gastroscschisis
44
Prune Belly Syndrome
  • Due to an obstructive lesion
  • Absence of the rectus abdominus muscle
  • The skin is intact, it is just that the muscle
    doesnt form
  • This is a Triad Syndrome, that includes
  • Anterior abdominal wall distention
  • Urinary tract obstruction
  • Cryptorchidism

45
Prune Belly Syndrome
  • Greatly dilated bladder and ureter
  • Hydronephrosis
  • Large abdominal circumference
  • May see ascites
  • May see descended loops of bowel
  • Amniotic fluid is variable
  • May occur due to radiation during the 5th-12th
    weeks of development

46
Prune Belly Syndrome
47
Prune Belly Syndrome
48
Prune Belly Syndrome
49
Prune Belly Syndrome
50
Prune Belly Syndrome
51
Prune Belly Syndrome
52
Prune Belly Syndrome
53
Prune belly syndromedistended bladder
54
Prune belly dilated ureter
55
Prune Belly Syndrome
56
Prune Belly Syndrome
57
Prune Belly Syndrome
58
Prune Belly Syndrome
59
Fetal Hydrops
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