BIOMED
Pathophysiology
Everything be alphabetical here (except for Homeostasis at the bottom) 😘
(& Mental Health, Lmao)
There are a lot of neonatal conditions covered, seen in high level NICU/NCCU Units.
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Table of Contents:
1 | Ageing
2 | Canc...
Gastroschisis is a similar defect to the omphalocele (see chap for more info), where there is a herniation of bowel and other abdominal contents through an abdominal wall defect to the right of the umbilicus. However unlike the omphalocele, in gastroschisis, the herniated contents is not protected by a peritoneal membrane, exposing it to the amniotic fluid in utero which is toxic and can cause intestinal injury.
Incidence is around every one in 2'000 births, and develops early in pregnancy during weeks 4-8. It is thought to be caused by a weakness in the fetal abdominal wall muscles near the umbilical cord, however the exact cause is unknown, and it is not believed to be inherited. Gastroschisis is not usually associated with other malformations or abnormalities.
Severity is cordoned into two categories. These being:
☞ Simple gastroschisis, where only the bowel herniates out of the abdominal opening, and
☞ Complicated gastroschisis, where there is one or more of these complications:
☞ Intestinal atresia (underdeveloped bowel or intestinal obstruction) ☞ Necrosis of the bowel outside the body, or necrosis from twisted/tangled portions of bowel ☞ other organs herniating also, such as the stomach or liver.
Diagnosis & Evaluation >90% of gastroschisis is detected prenatally by ultrasound around 18-20 weeks gestation. These patients are referred for specialist care to determine severity of the gastroschisis and a plan of perinatal care.
MRI or fetal echocardiogram will likely be done to assess heart function, and counselling with maternal fetal medicine (MFM), paediatric surgeon and neonatologist.
Gastroschisis in Pregnancy Gastroschisis cannot be treated in utero, and thus, surgical treatment begins immediately after birth, as neonates cannot survive with herniated bowel and/or organs.
An assessment is done to determine severity, and decide on a repair.
Treatment & Surgical Options Initially, the objective is to stabilise the baby. Manage the airway, breathing, and cardiovascular instability, and ensure the herniating abdominal contents remain wrapped and supported. Reassessment of bowel status should be undertaken regularly to ensure there is no twisting.
Vascular access will be established—minimum of two peripheral IVCs, and antibiotics will be administered.
The baby will be critically assessed for other congenital anomalies, and there will be continued thermal control to maintain a safe temperature. Baby may have a nasogastric tube (NGT) on free drainage with aspirates, and hydration assessments will be attended.
Surgically speaking, primary repair is performed in simple gastroschisis, returning herniated contents to the abdomen and closing the opening. This is preferably undertaken on the day of birth.
When a baby develops in utero with a significant herniation, the belly does not develop properly. Staged repair occurs in instances where the baby has complicated gastroschisis with a significant portion of herniated bowel, when there is swollen or damaged bowel, and/or when the baby's abdomen is unable to support and and hold the herniated contents.
This means that bowel will be returned to the body in stages which takes places over several days up to 2 weeks. In his case, a silo is placed around the bowel and attached to the belly to gently tighten and encourage the herniated contents back into the abdomen in a gradual manner. Once the contents are inside, the silo is removed and the belly closed. Note, two thirds of babies require respiratory support for days after the surgery/surgeries.
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Complications in Gastroschisis Around 10% of babies born with gastroschisis have a portion of their bowel that is not developed correctly. These babies may experience:
☞ Bowel resection to remove damaged bowel ☞ Colostomy ☞ Short bowel syndrome, where a large portion of the intestine does not function normally ☞ Intestinal transplantation. This is rare.
Follow Up Due to adapting to new function intra-abdominally, babies with gastroschisis may experience feeding challenges in the first few weeks of life. These babies will receive IV nutrition, as well as medications for pain and comfort, antibiotics, and monitoring for body temperature. Breast milk or specialised formula will begin after 2-3 weeks once the bowel is functioning correctly.
Discharge from hospital is usually between 30-50 days or more, once baby is feeding well and the bowel appears to be functioning normally.
Follow up is required with a neonatologist and/or paediatric surgeon to assess feeding, development, surgery site, and monitoring for obstructions.
Prognosis These babies are generally smaller than average and may take time to catch developmental milestones. However experiences depend on the severity of the gastroschisis.
After recovery, most babies can go on to live normal, healthy lives without complications.
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