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ABDOMINAL WALL DEFECTS

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Anterior abdominal wall defect at the base of the umbilical cord ... 50% have accompanying liver, spleen, testes/ovary 50% have associated defects. Location: ... – PowerPoint PPT presentation

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Title: ABDOMINAL WALL DEFECTS


1
ABDOMINAL WALL DEFECTS
  • Dr. Catherine B. Canete

2
OMPHALOCOELE
  • Anterior abdominal wall defect at the base of the
    umbilical cord with herniation of the umbilical
    contents

3
Incidence
  • Small omphalocoele 15000
  • Large omphalocoele 110000
  • Male to female ratio 11
  • Pacific Islanders have low risk for omphalocoele

4
Pathophysiology
  • Failure of the midgut to return to abdomen by the
    10th week of gestation

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Clinical Findings
  • Covered clinical defect of the umbilical ring
  • Defect may vary from 2-10 cm
  • Sac is composed of amnion, Whartons jelly and
    peritoneum

8
  • 50 have accompanying liver, spleen, testes/ovary
  • gt50 have associated defects
  • Location
  • Epigastric
  • Central
  • Hypogastric
  • Cord attachment is on the sac

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GASTROSCHISIS
  • Defect of the anterior abdominal wall just
    lateral to the umbilicus

11
Incidence
  • 120,000-30,000
  • Sex ratio 11
  • 10-15 have associated anomalies
  • 40 are premature/SGA

12
Pathophysiology
  • Abnormal involution of right umbilical vein
  • Rupture of a small omphalocoele
  • Failure of migration and fusion of the lateral
    folds of the embryonic disc on the 3rd-4th week
    of gestation

13
  • Lateral folds
  • Form
  • Lateral abdominal wall
  • Future umbilical ring

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Clinical Findings
  • Defect to the right of an intact umbilical cord
    allowing extrusion of abdominal content
  • Opening ? 5 cm
  • No covering sac

16
  • Bowels often thickened, matted and edematous
  • 10-15 with intestinal atresia

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MANAGEMENT
  • ABC
  • Heat Management
  • Sterile wrap or sterile bowel bag
  • Radiant warmer
  • Fluid Management
  • IV bolus 20 ml/kg LR/NS
  • D10¼NS 2-3 maintenance rate

19
  • Nutrition
  • NPO and TPN
  • Gastric Distention
  • OG/NG tube
  • Infection Control
  • Ampicillin and Gentamicin
  • Associated Defects

20
  • Conservative treatment
  • Reduction by squeezing the sac
  • Painting sac with escharotic agent
  • 0.25 Silver nitrate
  • 0.25 Merbromin (Mercurochrome)

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  • Surgical Management
  • Skin Flaps
  • Primary Closure
  • Staged Closure
  • Staged repair using silo pouch

23
Skin Flaps
24
Primary Closure
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Staged Closure
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34
UMBILICAL HERNIA
  • Defect in linea alba, subcutaneous tissue and
    skin covering the protruding bowel
  • Frequent in premature infants

35
PRUNE BELLY SYNDROME
  • Thin, flaccid abdominal wall
  • Dilation of bladder, ureter and renal collecting
    system
  • 130,000-50,000
  • 95 are male

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BLADDER EXTROPHY
  • Defective enfolding of caudal folds
  • 3.3 in 100,000 births
  • Associated with prolapsed vagina or rectum,
    epispadias, bifid clitoris or penis

38
PENTALOGY OF CANTRELL
  • Omphalocoele
  • Anterior diaphragmatic hernia
  • Sternal cleft
  • Ectopia Cordis
  • Intracardiac defect

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BECKWITH-WIEDEMANN SYNDROME
  • Macrosomia
  • Macroglossia
  • Organomegaly
  • Abdominal wall defects
  • Embryonal tumors

41

Omphalocoele Gastroschisis

Incidence 16,000-10,000 120,000-30,000
Delivery Vaginal or CS CS
Covering Sac Present Absent
Size of Defect Small or large Small
Cord Location Onto the sac On abdominal wall
Bowel Normal Edematous, matted
42

Omphalocoele Gastroschisis

Other Organs Liver often out Rare
Prematurity 10-20 50-60
IUGR Less common Common
NEC If sac is ruptured 18
Associated Anomalies gt50 10-15
Treatment Often primary Often staged
Prognosis 20-70 70-90
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