Omphalocele & Gastroschisis

Michelle D. Nguyen MD

7th edition .Anatomy   Congenital defect in anterior abdominal wall closure Abdominal contents externally herniated Miller s Anesthesia.

the gut returns to the abdominal cavity Amnion: membrane covering abdominal contents Protection from infection Prevents loss of extracellular fluid  Omphalocele: abdominal contents fail to return to abdominal cavity .Embryology    5th 10th week of fetal life: abdominal contents extruded into the extraembryonic coelom By 10th week.

chemical peritonitis. trisomy 21.Gastroschisis vs. diseasebladder exstrophy. usually to the right Edema. inflammation of exposed abdominal contents. spinal defects syndrome) Associated findings Location of defect Problems associated with defect No hernia sac Lateral to the umbilicus. cardiac (VSD) & bladder malformations Have a hernia sac Within the umbilical cord. imperforate anus. at the base Congenital heart disease-20%. Omphalocele Gastroschisis Pathophysiology Omphalomesenteric artery occlusion leading to ischemia/atrophy of layers of abdominal wall at base of umbilical cord (develops later than omphalocele) 1/15. premature delivery due to irritation of abdominal contents with uterine lining .g. exstrophy. hypoglycemia. gigantism. OEIS (omphalocele. BeckwithBeckwithWiedemann syndrome (macroglossia. diaphragmatic hernia. hyperviscosity).000 births 10-15% 10Omphalocele Failiure of gut migration from the yolk sac into abdomen (During 5th to 10th week of fetal development) Incidence Associated anomalies 1/6000 births 40-60% 40E.

Diagnosis  High maternal serum alpha-fetoprotein (AFP) alphaNormal protein in fetal tissues When abdominal wall and neural tube closes. large amts of AFP will be prevented from being released Gastroschisis levels usually higher than omphalocele   Antenatal ultrasound Can also dx cardiac abnormalities Elective c/s at 38 weeks Prevent trauma to exposed bowel Surgical teams prepared in advance  Surgical repair .

Associated Problems  Severe dehydration and fluid losses from exposure (especially with gastroschisis) and third space losses from bowel obstruction  Heat losses  Difficulties in surgical closure  Incidences of associated abnormalities .

Anesthetic Considerations: Pre-Op Pre    Optimize fluid and electrolyte balance Adequate IV access Correct hypoglycemia slowly with glucose infusion Staged closure Primary closure can cause abdominal compartment syndrome Silastic silo gradual closure over period of 7-10 days. 7with reduction of silo occurring one to two times daily .

muscle relaxant +/Maintenance anesthetic with volatile and narcotics Routine monitors. arterial line. +/.CVP +/Avoid nitrous oxide: do not want bowel distention Need muscle relaxant when placing bowel inside abdominal cavity Watch for hypotension: can be due to tension on organs such as liver or IVC compression .Anesthetic Considerations        NGT placement: decompress stomach Intubation: awake/asleep +/.

with ventilator weaning over period of 1-2 days 1Give time for abdominal wall to stretch to accommodate visceral contents .Anesthetic Considerations  Replacement of third space fluid losses  Keep intubated.

oliguria.Anesthetic Considerations: Post-Op Post Increased abdominal pressure (>20-25 cm H20) (>20if tight closure Compromise hepatic function Alter drug metabolism Abdominal compartment syndrome  Increased abdominal pressure leading to organ dysfunction: decreased cardiac output. restriction in pulmonary ventilation  Bowel is most sensitive organ  Must reopen and decompress  Hypertension: due to decreased circulation to kidneys Causes renin release .

Anesthesiology. Clinical Anesthesiology. Anesthesia. Clinical Anesthesia . 7th edition. R ed. P ed.  Morgan. . Miller s Anesthesia. ed.  Miller. Anesthesiology Review.References  Barash. edition. 3rd Review. 6th edition.  Faust. ed.

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