ped git surgery 2

Question 2

What is an omphalocele?

Answer 2

A congenital defect of the abdominal wall at the umbilicus, where abdominal contents herniate into a sac covered by peritoneum and amnion.

Question 3

What are the contents of an omphalocele sac?

Answer 3

Usually liver, stomach, intestines, and sometimes other organs.

Question 4

What is gastroschisis?

Answer 4

A congenital full-thickness abdominal wall defect, typically to the right of the umbilicus, through which intestines freely protrude without a covering sac.

Question 5

What covers the herniated bowel in gastroschisis?

Answer 5

Nothing — the bowel is exposed directly to amniotic fluid.

Question 6

What is the incidence of omphalocele?

Answer 6

Approximately 1 in 4000–6000 live births.

Question 7

What is the incidence of gastroschisis?

Answer 7

Approximately 1 in 2000–3000 live births.

Question 8

Which is more commonly associated with other anomalies: omphalocele or gastroschisis?

Answer 8

Omphalocele.

Question 9

Which abdominal wall defect is more associated with chromosomal anomalies?

Answer 9

Omphalocele.

Question 10

Which abdominal wall defect is more often isolated?

Answer 10

Gastroschisis.

Question 11

What chromosomal anomalies are commonly associated with omphalocele?

Answer 11

Trisomy 13, 18, and 21.

Question 12

What syndromes are associated with omphalocele?

Answer 12

Beckwith-Wiedemann syndrome, pentalogy of Cantrell.

Question 13

What is the embryological basis of omphalocele?

Answer 13

Failure of the midgut to return to the abdominal cavity during week 10 of gestation.

Question 14

What is the embryological cause of gastroschisis?

Answer 14

Vascular disruption of the right omphalomesenteric artery leading to abdominal wall disruption.

Question 15

What maternal serum marker is elevated in both omphalocele and gastroschisis?

Answer 15

Alpha-fetoprotein (AFP).

Question 16

Which defect is more associated with low birth weight and prematurity?

Answer 16

Gastroschisis.

Question 17

How are omphalocele and gastroschisis diagnosed prenatally?

Answer 17

Ultrasound.

Question 18

What does prenatal US show in omphalocele?

Answer 18

Midline abdominal wall defect with a membrane-covered sac containing abdominal contents.

Question 19

What does prenatal US show in gastroschisis?

Answer 19

Free-floating loops of bowel outside the abdomen, usually to the right of the umbilicus.

Question 20

How should an omphalocele be managed at birth?

Answer 20

Cover sac with sterile, non-adherent dressing

Question 21

How should gastroschisis be managed at birth?

Answer 21

Cover exposed bowel with warm saline-soaked gauze and plastic wrap

Question 22

What initial investigations are needed in omphalocele?

Answer 22

Echocardiography, renal US, karyotyping, assessment for associated anomalies.

Question 23

What anomalies must be excluded in omphalocele?

Answer 23

Cardiac, renal, neural tube defects, and chromosomal anomalies.

Question 24

What is the treatment for small omphalocele?

Answer 24

Primary closure.

Question 25

How is a giant omphalocele managed?

Answer 25

Staged silo reduction followed by delayed closure or epithelialization with topical therapy.

Question 26

How is gastroschisis typically repaired?

Answer 26

Primary closure if possible

Question 27

Why is staged repair sometimes needed in gastroschisis?

Answer 27

Because the abdominal cavity is small and bowel is often edematous.

Question 28

What complication is common in gastroschisis?

Answer 28

Prolonged ileus, malabsorption, and necrotizing enterocolitis.

Question 29

Why is TPN often required postoperatively in gastroschisis?

Answer 29

Due to bowel dysmotility and feeding intolerance.

Question 30

What is umbilical hernia?

Answer 30

A midline defect at the umbilical ring allowing protrusion of abdominal contents, covered by skin.

Question 31

What is the incidence of umbilical hernia?

Answer 31

Common — occurs in ~10% of infants.

Question 32

What is the usual management of umbilical hernia?

Answer 32

Observation — most close spontaneously by age 2–3 years.

Question 33

When is surgery indicated for umbilical hernia?

Answer 33

If persists beyond 4–5 years or is symptomatic/incarcerated.

Question 34

What is prune belly syndrome?

Answer 34

A syndrome with deficiency of abdominal wall musculature, urinary tract anomalies, and bilateral cryptorchidism.

Question 35

What is the urachus?

Answer 35

A remnant of the allantois that connects the fetal bladder to the umbilicus.

Question 36

What is a patent urachus?

Answer 36

Persistence of the urachal lumen, forming a direct connection between bladder and umbilicus.

Question 37

What is the presentation of a patent urachus?

Answer 37

Urine drainage from the umbilicus.

Question 38

What is an urachal sinus?

Answer 38

Blind-ending tract from the umbilicus — no communication with the bladder.

Question 39

What is the treatment for urachal anomalies?

Answer 39

Surgical excision of the urachal remnant.

Question 40

What is the omphalomesenteric duct?

Answer 40

Embryologic connection between yolk sac and midgut.

Question 41

What is Meckel’s diverticulum?

Answer 41

Remnant of the omphalomesenteric duct on the ileum — may cause bleeding or obstruction.

Question 42

What is an omphalomesenteric fistula?

Answer 42

Complete patency of the duct — fecal drainage from umbilicus.

Question 43

How are omphalomesenteric duct anomalies treated?

Answer 43

Surgical resection.

Question 44

What is bladder exstrophy?

Answer 44

A defect in the lower abdominal wall and bladder resulting in exposed bladder mucosa through the abdominal wall.

Question 45

What is cloacal exstrophy?

Answer 45

Severe defect where bladder, intestines, and genital structures are exposed on the abdominal surface.

Question 46

What anomalies are associated with cloacal exstrophy?

Answer 46

Imperforate anus, spinal defects, ambiguous genitalia.

Question 47

How is bladder exstrophy managed?

Answer 47

Staged surgical reconstruction.

Question 48

What prenatal sign suggests exstrophy?

Answer 48

Non-visualized bladder on ultrasound.

Question 49

What’s the key difference between gastroschisis and omphalocele in terms of sac?

Answer 49

Omphalocele has a sac, gastroschisis does not.

Question 50

What’s the key difference between gastroschisis and omphalocele in location?

Answer 50

Gastroschisis is right of umbilicus

Question 51

Which has higher risk of chromosomal anomalies: omphalocele or gastroschisis?

Answer 51

Omphalocele.

Question 52

Which has a better prognosis: omphalocele or gastroschisis?

Answer 52

Gastroschisis if isolated and repaired successfully.