Ultrasound chapter 61

Sonographic findings of an omphalocele are

-Central abdominal wall defect -Evisceration of bowel or liver and bowl into base of cord -Continuity of cord into omphalocele -Covered by membrane -Ascites -hydramnios 1/3

Sonographic appearance of gastroschisis?

-right paraumbilical defect -free floating bowel

The incidence of omphaloceles is roughly

1 in 4,000

Gastroschisis is not known to be genetically transmitted although the recurrence risk is at __%

3.5

Chromosomal anomalies occur in __% to __% of omphaloceles

35 to 60

Fusion of the killing begins during the ___ week of development and is completed by the ___ week

7th, 8th

Perinatal mortality with an omphalocele approaches ___ when more than one fetal abnormality exists

80%

Umbilication hernia of the bowel occurs during the ___ week of development

8th

During which weeks of development does the fetal bowel normally migrate into the umbilical cord from the abdominal cavity

8th to 12th

The membrane thay covers the omphalocele consists of the

Amnion and peritoneum

Gastroschisis is found more commonly in

Males

What may be seen with gastroschisis outside the abdominal cavity in the area of the cord

Multiple loops of bowel

The insertion is ___ for gastroschisis

Normal

Develops when there is a midline defect of the abdominal muscles, fascia, and skin that results in herniation of intra abdominal structures into the base of umbilical cord

Omphalocele

When the bowel loops fail to return to the abdomen, a bowel containing ___ occurs

Omphalocele

The three most common defects of abdominal wall in utero

Omphalocele, gastroschisis, and umbilical hernia

To differentiate between an omphalocele and gastroschisis look for:

Presence of membrane, gastroschisis doesn't have one, look at umbilical cord because the cord goes through omphalocele and gastroschisis is found to the right of cord, determine which organs are eviscerated, determine of bowel is normal in texture, and look for other anomalies because omphaloceles often occur with chromosomal abnormalities

___ ___ is always found in the herniation with gastroschisis

Small bowel

Gastroschisis is an opening in the layers of thr abdominal wall with Evisceration of the bowel and infrequently the ___ and rarely the ___

Stomach, liver

Gastroschisis is located where in relation to the cord

To the right of cord

When a chromosomal abnormality and other major anomalies predict no chance of survival the baby will usually be delivered how

Vaginally

A normal cord insertion suggests

Hernia

The normal embryologic herniation of bowel permits the development of ____ organs and allows necessary ____ rotation

Intra abdominal, bowel

Ascites is/isn't present with gastroschisis?

Is not

Omphaloceles are characterized into two types:

1. Those that contain liver within the sac 2. those that contain a variable amount of bowel without the liver

Occurrence of gastroschisis is

1.75 to 2.5 in 10,000

Without other anomalies the mortality rate is approximately __% with isolated omphalocele

10

The midgut usually returns into the abdominal cavity by the ___ week

11th

The sonographer is able to detect gastroschisis after __ weeks gestation

12

Gastroschisis has an incidence of

12 in 10,000

Intestines return to the abdominal cavity by the ___ week of gestation

12th

Gastroschisis defects are small (__-__) cm

2 to 4

When organomegaly and macroglossia are observed what syndrome is suspected

Beckwith Wiedemann

Liver omphaloceles may contain a ___

Bowel

To prevent bowel damage and contamination the baby is usally delivered how

C section

Fetuses that have an omphalocele that contains only bowel have a higher risk for what

Chromosomal abnormalities and other anomalies

Almost all infants that have an omphalocele will die when there is what else is present

Chromosomal or major heart defect

3 main characteristics of omphalocele

Covered by a membrane, herniation into the base of the cord, AFP levels are slightly elevated

By the end of the 5th week of development and embryo is a flat disk consisting of 3 layers:

Ectoderm, mesoderm, endoderm

Other types of abdominal ventral wall defects include:

Ectopia cordia, bladder and coacal exstrophy, amniotic band syndrome, limb body wall complex

The prognosis for an infant with uncomplicated gastroschisis is

Excellent

AFP levels are significantly higher in gastroschisis due to

Exposed bowel

In the 6th week a process called ___ occurs to help the embryo transform itself into a cylindrical shape

Folding

Peri umbilical defect that nearly always located to the right of the umbilicus

Gastroschisis