Gastroschisis

Question 1

Gastroschisis is a full thickness abdominal wall defect in which foetal organs protrude outside the abdomen _____ a protective membrane covering them

Answer 1

without

Question 2

In gastroschisis, how are the protruding abdominal organs covered?

Answer 2

Direct intestinal exposure to amniotic fluid leads to chemical reaction, creating a thick inflammatory film over the bowel

Question 3

The exact mechanism of gastroschisis is unknown but theories include compromised vascular supply to the anterior abdominal wall, a defect in the p_____ u_______ r___, or abnormal involution of the right umbilical vein creating a weakened point at risk of rupture.

Answer 3

primordial umbilical ring

Question 5

What are risk factors for gastroschisis

Answer 5

Maternal smoking during pregnancy
Maternal age <20
Environmental exposures eg nitrosamines
Maternal cyclooxygenase inhibitors eg aspirin and ibuprofen

Question 6

Which scan may detect gastroschisis?

Answer 6

20 week anomaly scan

Question 7

Which side is the opening of the abdominal cavity (in gastroschisis) often found in relation to the umbilical cord?

Answer 7

Right of umbilicus

Question 8

Do membranes cover the abdominal contents in gastroschisis?

Answer 8

No

Question 9

How may the intestines appear in gastroschisis?

Answer 9

Swollen, inflamed, thickened, short.

Question 10

Gastroschisis is associated with i______ m_____ and i_______ a_______

Answer 10

intestinal malrotation
intestinal atresia

Question 11

Are extra-intestinal or structural abnormalities commonly associated with gastroschisis?

Answer 11

No
(But they are in omphalocele)

Question 12

Most infants with gastroschisis are affected by m______ and h______ leading to delayed bowel function

Answer 12

malabsorption
hypomotility

Question 13

What lab tests are done as part of antenatal screening to identify abdominal wall defects?

Answer 13

Alpha-fetoprotein (raised possibly due to direct protein loss from intestine into amniotic fluid).

Question 14

If gastroschisis is detected on scans, how does the birth plan change?

Answer 14

Often the mother is induced at 37 weeks at a tertiary care centre for immediate neonatal and surgical care.

Question 15

What immediate management is done post-birth of an infant with gastroschisis?

Answer 15

Immediate fluid resuscitation and maintaining adequate temperature.
Sterile, clear covering is placed over the herniated contents to prevent evaporation, heat loss and infection. Infant placed on right side.

Question 16

Why is an infant with gastroschisis placed on their right side following birth?

Answer 16

To prevent kinking of mesenteric vessels

Question 17

What is definitive management for gastroschisis?

Answer 17

Surgery to reduce the protruding organs and close the abdominal wall.
An NG tube is inserted to decompress the bowel and parenteral feeding is started while the inflammatory peel recovers and bowel starts functioning.

Question 18

What are complications of gastroschisis?

Answer 18

Abdominal compartmental syndrome
Persistent bowel dysfunction
Wound infection
Necrotising enterocolitis
Short gut syndrome (malabsorption disorder)