Gastroschesis

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Definition

-  Open peri-umbilical paramedian full-thickness abdominal fusion defect of newborns

 

Features

-  1:10,000 births, no genetic links

-  Usually right sided

-  10% mortality

 

Gastroschisis

 

Risks

-  Increased in young mothers (<20)

-  Prematurity

-  IUGR

 

Associated S/S

-  Exposed bowel --> nutrient loss: IUGR (40-80%)

-  50% SGA

-  20% have 1+ of

-  Intestinal atresia

-  Gall bladder agenesis

-  Renal agenesis

-  Polyhydramnios

-  Eviseration of small intestine & ascending colon

-  Matted & thick bowel

 

Complications

-  Necrotising eterocolitis (NEC)

-  Bowel perforation

 

Ix

-  Prenatal ultrasound (fetal morphology scan)

-  Alpha fetoprotein: elevated maternal serum or amniotic fluid 77-100%

 

DDx

-  Oomphalocoele: membrane over herniation, Ultrasound

 

Mx

-  Warm fluid impermeable dressing over defect

-  NGT: decompression

-  Fluid resussitation: fluid requirements 2.5x normal

-  Blood culture: sepsis

-  Abx: Amoxycillin, Gentamicin

-  TPN

-  Surgical repair 1st day of life