Bladder exstrophy is a congenital (present at birth) abnormality of the bladder. It happens when the skin over the lower abdominal wall (bottom part of the tummy) does not form properly, so the bladder is open and exposed on the outside of the abdomen. In epispadias, the urethra does not form properly.
Bladder exstrophy is a congenital (present at birth) abnormality of the bladder. It happens when the skin over the lower abdominal wall (bottom part of the tummy) does not form properly, so the bladder is open and exposed on the outside of the abdomen. In epispadias, the urethra does not form properly.
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it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
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MATATAG CURRICULUM: ASSESSING THE READINESS OF ELEM. PUBLIC SCHOOL TEACHERS I...NelTorrente
In this research, it concludes that while the readiness of teachers in Caloocan City to implement the MATATAG Curriculum is generally positive, targeted efforts in professional development, resource distribution, support networks, and comprehensive preparation can address the existing gaps and ensure successful curriculum implementation.
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2. Introduction
Abdominal wall defects are a type of congenital
defects that allows the stomach , the intestines ,
or other organs to protrude through an unusual
opening that forms on the abdomen . During the
development of the fetus , many unexpected
changes occur inside the womb .
5. OMPHALOCELE
Definition
It is a defect in abdominal wall musculature
and skin with protrusion of abdominal viscera
contained within a membranous sac.
6. Incidence
Small omphalocele 1:5,000
Large omphalocele 1:10,000
Male to female ratio 1:1
Pacific Islanders have low risk for omphalocele
70% associated with congenital anomalies
such as Bowel atresia , Imperforated anus ,
Trisomes 13, 18, 21, Beckwith – Wiedman
Syndrome
7. Etiology
Due to failure of midgut to return to abdomen by
the 10th week of gestation during midgut
rotation
9. Risk Factors
Increased maternal age more than 40 years
Twins
High gravida
Consecutive births
10. Clinical Features
Covered clinical defects of the umbilical ring
Defects may vary from 2-10cm
Sac is composed of amnion, Wharton’s jelly
& peritoneum
The umbilical cord insert directly into the sac
in an apical or lateral position
Small one contains intestinal loops only
Large one contains liver , spleen , bladder ,
testes/ovary
11. Diagnosis
o About 90% of Omphalocele & Gastroschisis
diagnosed prenatally
o Alpha – feto – protein synthesised in fetal liver &
excreted by fetal kidney & crosses placenta by 12th
weeks.
o Prenatal ultrasound after 14th week gestation is the
confirmatory test
12. Prenatal Ultrasound
Findings are
Abdominal organs herniated outside the
abdominal cavity with an abnormal insertion
of umbilical cord into the membrane rather
than into abdominal wall
The mass contents are intestinal loops , liver ,
spleen , gonads etc
13. Management
Evaluation for associated anomalies &
monitoring of fetal growth
Echocardiography: high risk for CHD
Prenatal monitoring of fetal growth : high risk
of IUGR
Other specific evaluation for associated
pulmonary hypoplasia
Prenatal counseling about the expected
hospital course & the long term prognosis
14. After Delivery
The initial evaluation & resuscitation to a babies
with an omphalocele is
Follow same protocol & sequence of all
newborns
Should be handled carefully to prevent the
omphalocele membrane from tearing
After initial stabilization for the newborn should
be inspected to confirm that it is intact & then
covered with a non adherent dressing to protect
the sac
15. Primary closure
Small defects (<4cm) excision of the sac and
closure of the fascia and skin over the
abdominal contents
16. Mesh patch
o Medium defects(6-8cm)
Consecutive
o Large defects (1o-12cm)apply topical application –
Beta-dine ointment or silver sulfadiazine to make
intact sac till the baby is bigger & more able to
tolerate major operations
17. Long Term Outcomes
Small will recovery well
The outcomes determine by the severity of
associated anomalies , so babies with giant
omphalocele have increased morality &
morbidity
GERD
Hernias
Respiratory infection
Failure to thrive
18. GASTROSCHISIS
Definition
• It is the defect in the abdominal wall was
displaced to the right of the umbilicus and
eviscerated bowel was not covered by a
membrane
20. Etiology
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 10th week of
gestation causing ischemia of the abdominal wall
and weakness then herniation
Rupture of omphalocele
Folic acid deficiency
21. Pathophysiology
Abnormal involution of right umbilical vein
Rupture of a small omphalocele
Failure of migration and fusion of the lateral
folds of the embryonic disc on 3rd -4th week of
gestation
23. Clinical Features
o Defect to the right of intact umbilical cord
allowing extrution of abdominal content
o No covering sac
o Bowels often thickened, matted, and edematous
o Evisceration of the bowel leads to malrotation
o Constriction of the base may cause intestinal
stenosis , atresia , and volvulus
o Undecended testicles
24. Diagnosis
About 90% of Gastroschisis & Omphalocele
diagnosed prenatally
Polyhydramnios
MSAFP
Amniocentesis
25. Prenatal Ultrasound
• The diagnostic prenatal ultrasound findings of
Gastroschisis are extra abdominal loops of
bowel without covering sac
26. Management
After Delivery
• The perfusion of the herniated contents should
be carefully evaluated . If bowel ischemia or
infarction suspected immediate surgical
consultation is indicated .
• If the viscera are well perfused, it is important
to next place a clear plastic bag over the
exposed bowel as a temporary covering to
minimize evaporative heat and fluid loss .
28. • Nutrition
-TPN(central venous line)
• Abdominal Distention
-OG/NG tube
-urinary catheter
• Infection control
-Broad spectrum antibiotics
• Closure of the defect
• ABC
29. Surgical Management
Skin flabs
Primary closure : Use of own baby umbilical
stump as biological dressing to seal
gastrochisis defect without attempting a
primary fascial closure
Staged closure : In 1969 ,Allen and Wrenn
adapted Schuster’s technique to treat
gastroschisis
30. Long Term Outcomes
• Almost always with intestinal malformation
• Hernias at the site of repair
• Intestinal atresia
• Short bowel syndrome
31. Conclusion
Abdominal wall defects are type of congenital
defect that allows the stomach , the intestines ,or
other organs to protrude through an unusual
opening that forms on the abdomen.