The document discusses gastroschisis, omphalocele, and Hirschsprung's disease. It defines gastroschisis as a birth defect where abdominal contents protrude through an abdominal wall defect to the right of the umbilicus without a protective sac. Omphalocele is defined as a birth defect where abdominal contents protrude through a defect at the umbilicus, covered by a sac. The document discusses the epidemiology, pathophysiology, clinical presentation, diagnosis, management, and nursing care of these conditions.
Appendicitis is when your appendix becomes sore, swollen, and diseased. It is a medical emergency. You must seek care right away. It happens when the inside of your appendix gets filled with something that causes it to swell, such as mucus, stool, or parasites.Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go.
feeling sick (nausea)
being sick.
loss of appetite.
constipation or diarrhoea.
a high temperature
Appendicitis is when your appendix becomes sore, swollen, and diseased. It is a medical emergency. You must seek care right away. It happens when the inside of your appendix gets filled with something that causes it to swell, such as mucus, stool, or parasites.Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go.
feeling sick (nausea)
being sick.
loss of appetite.
constipation or diarrhoea.
a high temperature
Perforation of the gastrointestinal tract may be suspected based upon the patient’s clinical presentation, or the diagnosis becomes obvious through a report of extra luminal “free” gas or fluid or fluid collection on diagnostic imaging performed to evaluate abdominal pain or another symptom. Clinical manifestations depend somewhat on the organ affected and the nature of the contents released (gas, succus entericus, stool), as well as the ability of the surrounding tissues to contain those contents. Intestinal perforation can present acutely or in an indolent manner (e.g., abscess or intestinal fistula formation). A confirmatory diagnosis is made primarily using abdominal imaging studies, but on occasion, exploration of the abdomen (open or laparoscopic) may be needed to make a diagnosis. Specific treatment depends upon the nature of the disease process that caused the perforation. Some etiologies are amenable to a nonoperative approach, while others will require emergent surgery.
An intestinal obstruction occurs when your small or large intestine is blocked. The blockage can be partial or total, and it prevents passage of fluids and digested food. If intestinal obstruction happens, food, fluids, gastric acids, and gas build up behind the site of the blockage.
The esophageal duplication cyst is a congenital defect of the digestive tract. It has an estimated prevalence of 0.012%, with higher predominance in males. Although it is a common fi nding in children, diagnosis of an esophageal duplication in adults is rare. Following ileal duplication, esophageal is the second most common duplication of the gastrointestinal tract, representing the 10-15% of all gastrointestinal duplication defects. For esophageal duplication, there are two main variants: cystic and tubular, the latter being the least common. They are usually developed during the third to fifth week of gestation due to failure of the vacuolar coalescence. Duplication cysts are commonly located in the distal third of the esophagus.Treatment should always be surgical, even at the asymptomatic stage
of disease, given the possibility of symptom development and complication appearance. Here we present a case of an adult patient presenting with an esophageal duplication cyst with a brief literature review.
Perforation of the gastrointestinal tract may be suspected based upon the patient’s clinical presentation, or the diagnosis becomes obvious through a report of extra luminal “free” gas or fluid or fluid collection on diagnostic imaging performed to evaluate abdominal pain or another symptom. Clinical manifestations depend somewhat on the organ affected and the nature of the contents released (gas, succus entericus, stool), as well as the ability of the surrounding tissues to contain those contents. Intestinal perforation can present acutely or in an indolent manner (e.g., abscess or intestinal fistula formation). A confirmatory diagnosis is made primarily using abdominal imaging studies, but on occasion, exploration of the abdomen (open or laparoscopic) may be needed to make a diagnosis. Specific treatment depends upon the nature of the disease process that caused the perforation. Some etiologies are amenable to a nonoperative approach, while others will require emergent surgery.
An intestinal obstruction occurs when your small or large intestine is blocked. The blockage can be partial or total, and it prevents passage of fluids and digested food. If intestinal obstruction happens, food, fluids, gastric acids, and gas build up behind the site of the blockage.
The esophageal duplication cyst is a congenital defect of the digestive tract. It has an estimated prevalence of 0.012%, with higher predominance in males. Although it is a common fi nding in children, diagnosis of an esophageal duplication in adults is rare. Following ileal duplication, esophageal is the second most common duplication of the gastrointestinal tract, representing the 10-15% of all gastrointestinal duplication defects. For esophageal duplication, there are two main variants: cystic and tubular, the latter being the least common. They are usually developed during the third to fifth week of gestation due to failure of the vacuolar coalescence. Duplication cysts are commonly located in the distal third of the esophagus.Treatment should always be surgical, even at the asymptomatic stage
of disease, given the possibility of symptom development and complication appearance. Here we present a case of an adult patient presenting with an esophageal duplication cyst with a brief literature review.
Neonatal meningitis , it is for masters off neonatal nursing or neonatal nurse practitioner coarse. It is presentation slides on meningitis , medicine, perinatology, neonatology.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Neonatal nursing care for GZIT[Autosaved].ppt
1. 12/28/2023
1
ARBAMINCH UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCE
SCHOOL OF NURSING
DEPARTMENT NEONATAL NURSING
INDIVIDUALASSIGNMENT ON NN TWO
BY:-AMBAYE BERHANU
ID.NO. PRHMS/011/2015
SUBMITTED TO: MR.AGEGNEHU B
SUBMISSION DATE: - DECEMBER 16, 2023
3. Learning objectives
At the end of this unit, students will be able to:
Discuss the two most common abdominal wall
defects and hirchispring diseases.
Identify the risk factors/causes of gastroschise,
omphalocele and hirchispring diseases.
Explain the pathophysiology of gastroschise,
omphalocele and hirchispring disease.
12/28/2023
3
4. Cont..
Differentiate the characteristics b/n Gastroschisis and
Omphalocele.
Discuss about clinical manifestation of
omphalocele,gastroschise and hirschisprung disease.
Provide appropriate nursing intervention for
gastroschis,omphalocele and hirshusprung disease.
Manage neonates with gastroschis,omphalocele and
hirchispring disease.
12/28/2023
4
5. Introduction
Abdominal wall defects are a type of birth defect that
allow the digestive organs such as the stomach or
intestines to protrude through an abnormal opening in
the abdomen.
Omphalocele and gastroschisis are the two main
types of abdominal wall defects and the result of
errors during embryologic development of the fetal
abdominal wall.
12/28/2023
5
6. Cont….
The represent unique disorders that have different
clinical manifestation
Hirschsprung's disease (also called congenital a
ganglionic mega colon) occurs when some of your
baby’s intestinal nerve cells don’t develop properly,
delaying the progression of stool through the
intestines.
12/28/2023
6
7. History of Gasroschisi and omphalocele
1733 –James Calder(scottish neonatal surgeon) first
described Gastroschisis.
Gastroschise is derived from Greek word
“Gaster”(Gastro)meaning belly and “schisis”
meaning to tear or split from”
In 1634-Ambroise Pare(French barber surgeon)first
described Omphalocele.
Omphalocele derived from Latin word
“Omphalos” meaning prominence or navel.
12/28/2023
7
8. Gastroschisis
Definition
Gastroschise is a herniation of abdominal contents
through abdominal defect located to right of umbilicus.
Gastroschisis is a congenital abdominal wall defect
characterized by the complete lack of closure of the
abdominal musculature.
12/28/2023
8
9. Cont…
There is no transparent sac to protect the intestine in
gastroschisis.
It may be associated with other gastrointestinal
abnormalities such as mal rotation, atresia or
stenosis.
Not commonly associated with other organ
anomalies.
Infants have a high proportion of intrauterine growth
restriction.
12/28/2023
9
10. Epidemiology of gastroschise
The prevalence of gastrooschis is approximately 3 to
4 per 10,000 live births.
The incidence of gastroschisis between male infants
is similar to that of females infants.
The incidence of gastroschise is higher in singleton
than in twin gestations, and higher in offspring of
non-Hispanic White mothers than non-Hispanic Black
mothers.
12/28/2023
10
11. Studies of worldwide have consistently reported that
under 20 years age women have higher rate of
offspring with gastroschisis than the general obstetric
population.
This is likely related to lifestyle factors that are more
common in young people (e.g., cigarette smoking, use
of recreational drugs, alcohol consumption, low body
mass index, increased frequency of genitourinary
infection).
12/28/2023
11
12. Cont….
In 10% of cases, gastroschisis is associated with
anomalies outside the GI tract.
Higher risk of preterm delivery in pregnancies with
gastroschisis (28%) compared with those without
gastroschisis (6%).
12/28/2023
12
13. Cont.…
It does not appear to be inherited. Having one baby
with gastroschisis does not make it more likely that
you would have another baby with the condition
Environmental exposure like tobacco use,cigerete
smocking and alcohol drinking.
Low socio economic status.
Low maternal age (age of mother below 20 years).
12/28/2023
13
14. Pathophysiology of gastroschise
During the fourth week of human embryonic
development, the lateral body wall folds of the
embryo meet at the midline and fuse together to form
the anterior body wall.
However, in gastroschisis and other anterior body
wall defects, this fails to occur by either one or both
of the lateral body wall folds not moving properly to
meet with the other and fusing together.
12/28/2023
14
15. This incomplete fusion results in a defect that allows
abdominal organs to protrude through the abdominal
wall, and the intestines typically herniate through
the rectus abdominis muscle, lying to the right of
the umbilicus.
Several hypotheses have been proposed to explain the
pathogenesis of gastroschisis; all involve defective
formation or disruption of the body wall in the
embryonic period, with subsequent herniation of
bowel .
12/28/2023
15
16. Cont.…
Major hypotheses include:
Failure of mesoderm to form in the body wall
Rupture of the amnion around the umbilical ring
and with subsequent herniation of bowel.
Abnormal involution of the right umbilical vein
leading to weakening of the body wall
Disruption of the right vitelline(yolk sac) artery
with subsequent body wall damage and gut
herniation.
12/28/2023
16
17. Ethology of gastroschise
The cause of gastroschisis is less clear
Gastroschisis is caused by a failure of the formation
and development of the ventral body wall during
embryogenesis, resulting in herniation of the bowel.
Rupture of Omphalocele.
Folic acid deficiency.
Drug exposures, for
example,aspirin,acetominophen and ibuprofen.
17
12/28/2023
18. Risk Factors of gastroschise
Maternal smoking (possibly due to placental
insufficiency and abnormal development of the
vascular system)
Maternal age <20 years old
Environmental exposures e.g. Nitrosamines
In take of aspirin and ibuprofen during pregnancy
Alcohol consumption.
Socio-economic status.
12/28/2023
18
19. Clinical Features of gastoschise
Defect to the right of intact umbilical cord allowing
extrusion of abdominal content
No covering sac
Bowels often thickened ,matted, and edematous
Evisceration of the bowel leads to mal-rotation
Constriction of the base may cause intestinal stenosis,
atresia, and volvulus.
Undescended testicles
12/28/2023
19
20. Complication of gastroschise
Reduced bowel motility and absorption
Related vascular compromise caused by the
herniated bowel.
Intestinal stenosis, short bowel, intestinal
atresia,perforation,necrosis or volvulus.
Necrotizing Enter colitis
Electrolyte imbalance
Clinical features of sepsis and anemia
20
12/28/2023
21. Diagnosis of gastroschise
Gastroschisis can be diagnosed during pregnancy or
after the baby is born.
During pregnancy, there are screening test (prenatal
tests) to check for birth defects and other conditions.
Gastroschise can be detected by the end of the first
trimester (11 to 14 weeks) and certainly in the second
trimester.
Prenatal detection rates of gastro chis are over 90%
as a result of routine second-trimester.
12/28/2023
21
22. Cont..
Ultrasound
Maternal serum alpha-fetoprotein
(MSAFP) assessment performed in Neural
tube defect, Abdominal wall defects,
duodenal or esophageal atresia.
Magnetic resonance imaging(MRI)
12/28/2023
22
24. Management of gastroschise
Pregnancy Management
Once gastroschisis is diagnosed, fetal growth and
amniotic fluid volume are charted via ultrasound at
3 to 4-week intervals starting at 24 weeks
gestation.
Oligohydramnios may be related to fetal growth
restriction and is a risk for cord compression,
while polyhydramnios may be predictive of bowel
atresia.
12/28/2023
24
25. After delivery management
The perfusion of the herniated contents should be
carefully evaluated. If bowel ischemia or
infraction 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.
12/28/2023
25
26. Cont..
An orgiastic tube should be inserted to decompress the
stomach.
Placement of peripheral intravenous access to provide
antibiotics and maintenance fluid is performed.
Intravenous fluids are administered and started in 80-
120ml/kg due to the exposed bowel fluid losses.
The airway should be evaluated and maintained.
12/28/2023
26
29. Cont.…
Surgical Management of Gastroschisis
The primary goal of gastro chis is repair to
return the exposed bowel and new organs to the
abdominal cavity while minimizing intestinal
injury or increased intra-abdominal pressure.
Two treatment options are present for
gastroschisis. The first is primary repair, and the
second is delayed closure
12/28/2023
29
30. Cont.…
Primary repair is a procedure of choice if the
abdominal contents will fit into the abdominal cavity.
12/28/2023
30
31. Cont.…
Staged closure,(repair)
In 1969 Allen and wrenn adapted schusters
technique to treat gastroschisis
A synthetic material is used to create a sac to cover
the abdominal contents.
12/28/2023
31
33. Poste operative care of gastroschise
Monitoring of vital signs, cardiovascular and
respiratory status.
Fluid and electrolyte balance.
Pain management.
Wound care
Monitoring bowel function.
Administer antibiotics.
Gastric decompression.
12/28/2023
33
34. Nursing intervention of gastrioschise
Monitor gastroschisis defect and oxygen saturation
of new born.
Monitor neonate's central and peripheral perfusion
every 15 minutes prior to surgery.
Ensure Nasogastric Tube (NGT) is placed on free
drainage and aspirated hourly.
Document accurate fluid balance and undertake
regular assessment of hydration status.
12/28/2023
34
36. Omphalocele
Definition
Omphalocele is herniation of umbilicus through
which abdominal contents protrude.
Omphalocele is an opening in the center of the
abdominal wall where the umbilical cord meets the
abdomen
.
12/28/2023
36
37. Omphalocele is a midline abdominal wall defect
at the level of the umbilical cord, from which
abdominal content herniates.
The defect is covered by a three-layer sac of
amion, Wharton's jelly and peritoneum.
Omphalocele is classified into three categories:
small, giant and ruptured . The term “giant
omphalocele” (GO) is defined as an abdominal
wall defect that measures ≥5 cm or that contains
≥75% of the liver.
37
12/28/2023
38. Epidemiology of omphalocele
Omphalocele and gastroschisis are the most common
fetal abdominal wall defects in the world, with
prevalence of approximately 2 and 4 per 10,000 live
births, respectively consistent with the worldwide
omphalocele prevalence of 2.6 per 10,000 births.
The prevalence of gastroschisis appears to be
increasing at a faster rate than that of omphalocele.
12/28/2023
38
39. Cont.…
The prevalence is slightly higher in Black than White
patients.
Modest associations between occurrence of
omphalocele in offspring and maternal obesity and in
utero selective serotonin reuptake inhibitor (SSRI)
exposure have also been reported in some studies,
while others have found no association.
12/28/2023
39
40. Cont..
Omphalocele has also been associated with male sex
and multiple births.
The occurrence of omphalocele appears to be more
common in offspring of mothers at the extremes of
reproductive age
Omphalocele associated with congenital anomalies
such as bowel atresia, Imperforated anus, Trisomy's
13,18,21,Neural tube defect and cleft lip/palate.
12/28/2023
40
42. Ethology of omphalocele
No know exact causes of omphalocele, but its
development has been linked with several genetic
and chromosomal abnormalities.
It might also be influenced by other factors, such
as the mother’s habits during pregnancy, or it could
happen due to a combination of reasons
12/28/2023
42
43. Riske factors of omphalocele
These factors can increase the risk of an
omphalocele in the fetus:
Alcohol use. Alcohol consumption during
pregnancy is linked to omphalocele.
Tobacco use. Women who use tobacco while
pregnant are at an increased risk of their unborn
child developing omphalocele.
Increased maternal age more than 40 years
12/28/2023
43
44. Consecutive birth
Selective serotonin-reuptake inhibitors
(SSRIs) use during pregnancy are more
likely to have a baby with omphalocele.
SSRIs are usually found in medications like
antidepressants.
Twins and
Obesity.
12/28/2023
44
45. Clinical Manifestation of Omphalocele
Central abdominal wall defect
Extrusion of intra-abdominal organs through the
umbilicus
Herniated organs are usually small bowel and may
include large bowel and/or liver.
The cord inserts into the apex of the sac
Ascites may be seen in the sac or the abdomen.
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46. Cont…
Organs are covered by peritoneum
The umbilical cord insert directly in to the sac in an
apical or lateral position
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47. Diagnosis of omphalocele
Prior to delivery
Perinatal ultrasound is diagnostic in 95% of cases
Prenatal ultra sound after 14weeks gestation is the
confirmatory test
Increased maternal AFP( alpha-fetoprotein),This may
be as a result of direct protein loss from the intestine
into the surrounding amniotic fluid.
After delivery : Clinically
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48. Differential diagnosis of omphalocele
Gastroschisis: gastroschisis is the major disorder to
consider in differential diagnosis of omphalocele.
Umbilical cord hernia.
Ectopia cords.
Limb-body wall complex.
Cloacal exstrophy and
Pentalogy of Cantrell.
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49. Complication of omphalocele
Sepsis
Gastroesophagal reflux disease
Necrotizing entercolitis
Intestinal atresia
Short gut syndrome
Renal vein thrombosis
Respiratory failure
Renal failure and Complication of total parenteral
nitration
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50. Management of omphalocele
Pregnancy management
Fetal surveillance
In fetal surveillance monitoring fetal growth and
amniotic fluid volume.
When growth is appropriate and amniotic fluid
volume is normal, we begin weekly no stress
testing or biophysical profile monitoring at 32
weeks of gestation to assess fetal well-being.
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51. Cont.…
We increase the frequency of fetal surveillance in
pregnancies with additional complications, such as
growth restriction, oligohydramnios, or non isolated
omphalocele.
Timing of birth
In the absence of standard indications for early
delivery, expectant management is reasonable until
spontaneous labor or at least 39 weeks of gestation.
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52. Cont.…
Preterm birth offers no advantage to affected
neonates and is associated with increased morbidity
and mortality.
Route of birth
We perform a cesarean birth in selected cases,
including fetuses with giant omphalocele
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53. Cont.…
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
Avoid clamping the umbilical sac.
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54. Cont.…
After initial stabilization for the new born
should be inspected to confirm that it is intact &
then covered with anon adherent dressing to
protect the sac.
Covering the defect with a sterile dressing
soaked with warm saline to prevent fluid loss.
NGT decompression
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55. Cont.…
IV fluids and glucose
Antibiotics
Keep NPO until the surgical opinion obtained
Urgent surgical consultation
Surgical management
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56. Cont.…
Primary closure
In infants with small defects,.
Small defects (2 to 3 cm) can be repaired in the first
24 to 72 hours of life by primary closure of both
fascia and skin.
Some surgeons prefer to place a patch in the
abdominal wall and close the skin over the patch
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58. Cont..
In infants with large defects
Involves some type of silo in the first 24 hours of
life and delayed closure.
Reducing a large defect or one that contains an
anatomically kinked liver can be done with Doppler
ultrasound guidance to ensure the vena cava and
hepatic outflow are not compromised during the silo
reduction.
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59. Cont.…
Omphaloceles (i.e., containing >75 percent of the
liver or defect greater than 5 cm) may be managed
by a combination of silo, a cellular dermal patch, and
skin graft or by promoting formation of an amniotic
sac escher by application of a sclerosing solution
(topical povidone-iodine), with delayed hernia repair.
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60. Poste operative care of omphalocele
Monitoring of vital signs, cardiovascular and
respiratory status.
Fluid and electrolyte balance.
Pain management.
Wound care
Monitoring bowel function and urine out put.
Administer antibiotics.
Gastric decompression.
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63. Hirsch sprung disease(congenital a ganglionic
mega colon)
Definition
Hirschsprung disease (HD) is a motor disorder of the
colon, which is caused by the failure of neural crest
cells (precursors of enteric ganglion cells) to migrate
completely during intestinal development during fetal
life.
It is the result of a ganglionic segment of the colon
fails to relax, causing a functional obstruction.
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64. Hirschsprung's disease (also called congenital a
ganglionic mega colon) occurs when some of your
baby’s intestinal nerve cells (ganglion cells) don’t
develop properly, delaying the progression of stool
through the intestines.
The intestine becomes blocked with stool, and your
baby or child will be constipated. Often, a serious
infection called entercolits can occur, which causes
fever, pain, and diarrhea.
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65. Cont.…
In a healthy bowel, ganglion cells are present
throughout the large intestine. In Hirschsprung’s
disease, ganglion cells don’t develop properly in the
rectum, delaying the progression of stool.
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66. Epidemiology of HD
HD occurs in approximately 1 in 5000 live births,
with an overall male: female ratio of 3:1 to 4:1 .
The sex ratio decreases with more extensive
aganglionosis, approaching 1:1 for total colon
aganglionosis.
There is familial clustering for nonsyndromic HD,
with an overall recurrence risk of approximately 3
percent in siblings for short-segment disease or up to
17 percent if the proband has long-segment disease.
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68. Ethology OF HD
There is no known clear idea why the ganglion
cells don’t migrate down to the end of the rectum
completely. However, genetic factors may be
involved, especially when longer lengths of
intestine are involved or when someone else in
the family also has the condition.
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69. Cont.…
For instance, there is an increased chance that a
couple will have a child with Hirschsprung's
disease if one of the parents has the disease. (The
chances are higher if the mother is the one with
Hirschsprung's disease).
If a family has a child with Hirschsprung's
disease, there is a 3 to 12 percent chance that
another baby from the same parents will also
have the disease.
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70. Cont.…
Hirschsprung's disease occurs five times more
frequently in boys than in girls.
Children with Down syndrome have a higher risk as
well.
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71. Clinical manifestation of HD
In neonate and infants
Failure to pass meconium in 48 hours.
Abdominal distention
Bile stained vomiting.
Episodes of diarrhea and constipation
Poor feeding.
Tight anal sphincter with an empty rectum
Shock and jaundice
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72. Cont..
Older infants or children
Constipation with abdominal distention
When stool passed foul smelling and liquid
in consistency.
Malnourished and anemic.
Poor feeding.
Fecal impaction and
Failure to thrive.
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74. Diagnosis of HD
Hirschsprung disease can be diagnosed by taking a
medical and family history, doing a physical exam,
and ordering tests. Although Hirschsprung disease
develops before birth, doctors cannot diagnose the
disease until after an infant is born.
About half the people with Hirschsprung disease are
diagnosed in their first year of life.
About 80% of people with Hirschsprung disease are
diagnosed by age 7, and more than 90% are
diagnosed by age 13.
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75. Cont.…
Medical and family history.
Physical exam
During a physical exam, a doctor typically
Reviews your child’s height and weight
Examines your child’s abdomen or belly for
swelling.
Performs a digital rectal exam having
no stool in the rectum or having explosive
stool after a rectal exam may be signs of
Hirschsprung disease
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76. Cont.…
During a physical exam, a doctor typically
examines your child’s abdomen for swelling
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77. Cont..
To diagnose Hirschsprung disease use a
combination of :
Imaging tests
Anorectal manometer and
Rectal biopsies.
Imaging tests
To check for signs of Hirschsprung disease,
doctors may use imaging tests such as x-ray
and ultrasound to view large intestine.
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78. Cont.…
Anorectal manometer
Anorectal manometer is a test that checks how
well your child’s rectum is working.
During the procedure, the doctor inflates a
small balloon inside your child’s rectum.
Normally, the muscles in the rectum will relax.
If the muscles don’t relax, the doctor may
suspect your child has Hirschsprung disease.
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79. Cont.…
Rectal biopsy
Doctors typically use rectal biopsies to confirm
or rule out a diagnosis of Hirschsprung disease.
During a rectal biopsy procedure, a doctor will
take small pieces of tissue from the rectum.
A pathologist will examine the tissue under a
microscope to look for signs of Hirschsprung
disease.
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80. Differential diagnosis of HD
Meconium ileus.
Anorectal stenosis and
Pelvic tumors.
Anorectal malformation.
Neonatal sepsis.
Intestinal atresia,
Anorectal anomalies,
Duodenal atresia and pyloric stenosis.
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81. Management of HD
Medical management
Intravenous hydration,
Intestinal and gastric decompression.
Administration of isotonic enema.
Administration of stool softeners
Low residue diet
Antibiotics and
Rectal irrigation.
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82. Cont.…
Pre operative management of HD
Assess complete history of new born
After the diagnosis counseling the family
Nurse thought about giving isotonic enema,
suppositories and stool softeners.
Monitor vital sign and abdominal girth of child.
Keep the child in semi fowlers position.
Keep NPO and insert NG tube.
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83. Cont.…
Surgical management .
Surgery to bypass or remove the affected part of
the colon is necessary for the patient to have proper
bowel movements. Several options exist for
surgical treatment of HD.
A pull-through surgery removes the diseased part
of the colon or bowel.
The section with nerve cells is then pulled through
the colon and replaces the lost area.
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85. Ostomy(colostomy) surgery is an additional first step
in very sick patients who cannot yet have the pull-
through procedure.
The ostomy method removes the abnormal portion of
the colon while the healthy colon is routed to a
surgical opening or “stoma” on the abdomen
Ostomy pouches are then attached to this abdominal
port from which the stool is passed, collected and
emptied.
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86. Cont.…
Once the colon has had time to heal in this position,
the stoma is closed and the pull-through procedure is
completed.
If severe damage has occurred due to inflammation,
the ostomy pouch system may be a permanent
solution to prevent further damage.
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87. Cont.…
An ostomy is performed to allow patients to pass
digestive waste as the bowel heals from Hirschsprung
disease
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88. Cont.…
Poste operative management
Monitor vital signs, observe abdominal bleeding.
Keep NPO, so administer Iv fluids as ordered
Monitor bowel sound
Colostomy care is to be done which include to
Observe for bleeding, purulent drainage, edema and
apply zinc oxide ointment on skin around stoma.
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89. ` Cont..
Frequently empty the collecting bag.
Keep colostomy clean and dry
Educate parents about colostomy care
Encouraging and supporting the family during this
stressful time is the key intervention of nurse.
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90. Nursing Interventions of HD
Improving Breathing Pattern
Administer oxygen, as ordered, to support
respiratory status
Relieving Pain
Providing Adequate Nutrition
Controlling Constipation in the Older Child
Preventing Complications Related to Colostomy
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91. Summery
Abdominal wall defects are type of congenital
defect that allows the stomach, intestines, or
other organs to protrude through unusual
opening that forms on the abdomen.
Omphalocele and gastrischisis are the
commonest congenital abdominal wall defects.
The disease do have embryological origin is the
current most accepted theory for Omphalocele is
failure of the midgut to return back to the cavity
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92. Cont.….
Primary closure or staged closure can be used by
using different criteria's for both condition
Hirschsprung’s disease is a congenital
malformation which is characterized by a lack of
ganglion cells in the intestine which prevents
peristaltic activity through the bowel.
Abdominal distension, bilious vomiting and/or
enterocolitis and an X-ray that suggests distal
bowel obstruction may suggest Hirschsprung’s
disease.
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93. Cont.…
Diagnosis is confirmed by rectal examination,
and suction rectal biopsy.
The most commonly used surgical procedure to
treat Hirschsprung’s Disease at the Children’s
Hospital at West mead is the Soave procedure
where normal intestine is “pulled through” to the
anus
Long segment or complex disease may be
initially managed with a stoma.
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94. Cont.…
Once the colon has had time to heal in this position,
the stoma is closed and the pull-through procedure is
completed.
If severe damage has occurred due to inflammation,
the ostomy pouch system may be a permanent
solution to prevent further damage.
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95. References
Nelson Textbook of Pediatrics 21 edition
Neonatal Clinical Practice Guidelines .
Up to date.
Medscape.
Aschcraffs pediatric surgery 6th edition.
Lippincott manual of nursing practice 10th edition.
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