A power point presentation on gastroschisis vividly describing the congenital malformation/ condition

1. GASTROSCHISIS
BY: DAVIS MACHILA
5TH YEAR MBCHB
CBU

2. INTRODUCTION
01
EPIDEMIOLOGY
02
BRIEF EMBRIOLOGY
03
PATHOPHYSIOLOGY
CLINICAL
MANIFESTATION
04
DIFFERENCES WITH
OOMPHALOCELE
DIAGNOSIS &
MANAGEMENT
05
1. INVESTIGATIONS
2. MEDICAL
3. SURGICAL
COMPLICATIONS
06
TABLE OF CONTENTS

3. INTRODUCTION
This is a congenital malformation in which a
defect in the abdominal wall allows portions of
the abdominal contents to herniate outside the
abdominal cavity.
primarily small and large intestines herniates,
other organs include the stomach and liver.

4.  Incidence 4 per 10000 live births
 M:F ratio is 1:1
 10 -15 percent associated with other congenital anomalies such as
CHD(VSD), cleft palate and intestinal atresia, malrotation of intestines, stenosis,
diverticulum.
 40 % are associated with Premature deliveries.
EPIDEMIOLOGY

5. 3 factors have been implicated in the pathophysiology of Gastroschisis
 Gastroschisis arises due to failure of migration and fusion of the lateral folds of
the embryonic disc on the 3rd -4th week of gestation.
 Disruption of the right omphalomesenteric artery as Midgut returns to abdomen
by the 10th week of gestation causing ischemia of the abdominal wall and
weakness then herniation.
 Rupture of omphalocele
PATHOPHYSIOLOGY

6.  Younger age: Teenage mothers may be more likely to have a baby with
gastroschisis than older mothers.
 Alcohol and tobacco: Women who consumed alcohol or smoked before or
during early pregnancy may be more likely to have a baby with gastroschisis.
 Genitourinary infections: Women who reported a genitourinary infection
within three months before or three months after becoming pregnant had an
increased chance of having a baby with gastroschisis compared to women
who reported a genitourinary infection during the second or third trimester
of pregnancy.
RISK FACTORS

7.  Defect to the right of an intact umbilical cord
 Opening usually < 5cm
 No sac covering
 Evisceration usually contains intestinal loops
only
 Bowel usually thickened, matted and
edematous
 10-15% have associated anomalies
 40% are premature babies
CLINICAL PRESENTATION

8. OMPHLOCELE VS GASTROSCHISIS

9. 90% of the cases can be diagnosed
prenatally through the following
parameters
 Maternal AFP are elevated
 Prenatal ultrasound after 14 weeks of
gestation ( confirmatory test)
DIAGNOSIS & MANAGEMENT

11. Post Delivery
 Assess perfusion of the herniated contents
If bowel ischemia or infarction is suspected
immediate surgery is indicated.
 If visceral is well perfused: a clear plastic bag
over the exposed bowel as a temporary covering
should be placed.
To minimise heat and fluid loss.
MANAGEMENT

12. Pre-operative
1. ABC
- Airway and breathing: Rsepiratory distress associated with high
intra abdominal pressure.
- Circulation: circulation compromise; capillary refill time, skin
color, heart rate and changes in respiratory patterns
1. Heat management: Regulating Room temperature using
warmers
2. Sterile wrap or sterile bowel bag
3. Fluid management
- Iv bolus 20ml/kg RL or NS
- D10% 2-3 Maintenance rate
5. Nutrition
- Central venous line
6. Abdominal distention
- NGT
- Urinary Catheter
7. Infection Control

13. The goal of the repair is the safe reduction os the eviscerated contents and eventual
closure of the abdominal wall.
 Primary closure
Involves the use of own baby umbilical stump as a biological dressing to seal
gastroschisis defect without attempting a primary facial closure.
- Effective when there is adequate abdominal space in the abdominal cavity and
all the contents can fit
 Staged repair
This involves the use of a silo pouch (bag). The silastic is used to creat an artificial
sac to cover the abdominal contents while they gradually go back into the cavity as
the abdominal space increases.
Surgical management

15.  Infections: sepsis
 Respiratory distress
 Nutrient deficiency
 Psychological disturbance on the part of the mother
COMPLICATIONS

16. American Academy of Pediatrics (AAP). (2017). Gastroschisis:
Clinical practice guidelines for the perioperative management of
patients with gastroschisis. Pediatrics, 140(6), e20170987.
6. Molina, M., Acherman, R., & Arriola, Y. (2019). Prenatal diagnosis
and management of gastroschisis: A review for prenatal counseling.
Journal of Ultrasound in Medicine, 38(12), 3193-3204.
7. Feldkamp, M. L., Carey, J. C., Sadler, T. W., & O'Leary, L. A.
(2007). Development of gastroschisis: Review of hypotheses, a novel
hypothesis, and implications for research. American Journal of
Medical Genetics Part A, 143A(7), 639-652
REFERENCES

17. Mayo Clinic. (2021). Gastroschisis. Retrieved
from https://www.mayoclinic.org/diseases-
conditions/gastroschisis/symptoms-causes/syc-20351737
National Organization for Rare Disorders (NORD). (2021).
Gastroschisis. Retrieved from https://rarediseases.org/rare-
diseases/gastroschisis
Centers for Disease Control and Prevention (CDC). (2021).
Gastroschisis. Retrieved
from https://www.cdc.gov/ncbddd/spanish/birthdefects/gastroschi
sis.html

18. THANK YOU !