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13 Cards in this Set

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GastRoschisis

Defect of anterior abdominal wall to the right of the umbilical




NO SAC- bowel is exposed to the intrauterine environment




Bowel is matted, thickened,covered with an inflammatory coating

Results of Gastroschisis

Peritonitits, extracellular fluid loss, significant heat loss. - umbilical cord norma. Fascial sect 2-5cm




Only involves small and large intestines

GastRoschisis incidence

Vascular event resulting from an abnormality of right omphalomesenteric artery or right umbilical vein




results in ischemia to right paraumbilical area and dysplastic abdominal growth




Weakened area ruptures as abdominal organs grow

Omphalocele

Central Defect of umbilical ring/base of umbilical cord.




WITHIN a SAC- abdominal contents and umbilical cord embedded in sac.




contain stomach, large/small intestines and liver

Omphalocele incidence

failure to gut to return to abdominal cavity



in embryo - week 7-12 midgut herniates into umbilical cord and week 12 abd cavity lets gut reenter

Key Difference GastRochisis vs Omphalocele

Gastro less common. Isolated lesion. Lateral defect/umbilical cord normal. Bowel exposed-thickened/edematous




Omphalocele - more common. Has Associated anomalies. Central Defect. Umbilical cord within defect. Sac covers organs and bowel is normal

Surgical Management

Replacing the viscera and repairing the defect.




Primary close- peritoneal cavity must be able to accommodate abdominal viscera without comprising ventilation and circulation

What happens if surgical correction and a to tight of closure

Impairs diaphragmatic excursion (poor vent)




Impedes venous return (low bp)




Aortocaval compression - bowel ischemia, decreased CO

Surgical Management - 4 things unsafe for primary closure

1. intragastric pressure>20


2.change in CVP> 4 above baseline


3.ETCO2>50


Peak insp. peak >35

Fluid Management in these cases

Massive fluid loss expected - see dehydration, metabolic acidosis, and hypovolemic shock.




Maintenance - D5 or D10 in .22


Replacement - Isotonic at 2-4 times maintenance


urine output 1-2 measure labs

Preoperative Management

Norm temp. Abd contents covered with warm,saline soaked gauze/plastic bowel bag.




**PREVENT ASPIRATION - decompression of these stomach with OG tube

Anesthetic Management

2 Pulse Ox - Preductal - RUE and Postductal LLE


2 IV's above the diaphragm




AVOID N2O




O2 95-97% , PaO2 50-70 in infants.

Post-op Management

Mechanical Ventilation for 24-48 hours**- great improvement in resp compliance.




watch for cyanotic lower limb and bowel ischemia


ileum from TPN