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Published byDelilah Higgins Modified over 8 years ago
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Gastroschisis Betty Lew Winter 2016
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Gastroschisis: What is it? Neonate’s stomach and bowel are formed outside of the body Opening usually right side of umbilical cord < 2 in. in size Bowel is unprotected so it could be swollen and irritated Occurs approximately 4th week of pregnancy Rare birth defect, cause unknown
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Risks Gastrointestinal abnormality: Malrotation - bowel not in correct position Atresia - passage blocked Volvulus - twisting of bowels may cut off blood supply Infarction - blood supply to an area is cut off and damaged Increased chance of stillbirth (~10%) & growth restriction (75%)
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Diagnosis Ultrasound Loops of bowel floating freely should be seen, possibly liver as well Discuss method of delivery with physician Select medical center to properly treat newborn May suggest C-section ~36 weeks once lungs are mature
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Diagnosis Alpha-Fetoprotein Screening AKA “triple screen” or “quad screen” Blood test performed at 15-18th week to detect birth defect Abnormally high AFP may suggest gastroschisis Test not completely accurate
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Surgical Procedures “Primary surgery” - neonate has small amount of bowel outside of body that may only need one repair “Staged repair” - neonate has large amount of bowel outside of body that requires several repairs Repair occurs 3-10 days or longer Plastic pouch (“silo”) placed around bowel & attached to belly Silo tightened daily, gently pushing some bowel inside When all bowel is inside, silo’s removed and belly is surgically closed
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Signs of Improvement Bowel sounds Spontaneous passing of stool Decreased drainage coming from tube of neonate’s stomach
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Management Postoperative Ventilate until neonate able to breathe spontaneously (~3 days) Keep pressure off diaphragm NGT/OGT used to suction applied to keep stomach empty Central IV line for nourishment - vitamins, minerals, calories & fat
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Management Postoperative Arterial line: IV fluid & medications Monitor blood pressure Remove blood for lab work Antibiotics and pain medication
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