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13 Cards in this Set
- Front
- Back
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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 |
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Results of Gastroschisis |
Peritonitits, extracellular fluid loss, significant heat loss. - umbilical cord norma. Fascial sect 2-5cm Only involves small and large intestines |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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Preoperative Management |
Norm temp. Abd contents covered with warm,saline soaked gauze/plastic bowel bag. **PREVENT ASPIRATION - decompression of these stomach with OG tube |
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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. |
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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 |
