Omphalocele and Gastroschisis.pptx GROUP 5 FINAL COPY.pptx
- 2. GROUP MEMBERS • Martha Satumba • Integrity Banda • Thandizo Lungu • Funny Makhumbiza • Hope Mkwanda • Tamandani Chilinda • Mercy Jere
- 3. BROAD OBJECTIVE • By the end of this presentation student nurses should acquire knowledge about omphalocele and gastroschisis
- 4. SPECIFIC OBJECTIVES By the end of this presentation student nurses should be able to: • Describe omphalocele and gastroschisis • State the incidence of the omphalocele and gastroschisis • State the etiology omphalocele and gastroschisis • State the predisposing factors • Describe the pathophysiology of omphalocele and gastroschisis
- 5. SPECIFIC OBJECTIVES • Explain the clinical manifestations of omphalocele and gastroschisis • Desribe how gastroschisis and omphalocele is diagnosed • State the nursing diagnosis and nursing mananagement • Describe the medical and surgical management of omphalocele and gastroschisis • Explain the patient teachings about omphalocele and gastroschisis
- 6. SPECIFIC OBJECTIVES • State the complications of omphalocele and gastroschisis
- 7. DEFINITION OF TERMS • Gastro "belly"or "abdomen" • -schisis ‘to split,to separate’ • "omphalo-", refers to the umbilicus • -cele meaning pouch
- 8. DESCRIPTION • Gastroschisis and omphalocele are two of the most common congenital abdominal wall defects. • In gastroschisis an infant’s intestines, and sometimes other abdominal organs like the stomach or liver, protrude through a hole in the abdominal wall next/lateral to the umbilicus (Hockenberry et al., 2019).
- 9. DESCRIPTION • In omphalocele an infant's abdominal organs, such as the intestines, liver, and sometimes other organs, protrude outside the abdominal cavity through the base of the umbilical cord. • Unlike gastroschisis, the organs in omphalocele are covered by a thin, translucent sac made of peritoneum and amniotic membrane.
- 11. INCIDENCE • Lack of data on the prevalence in Malawi • 60% mortality in Malawi • Incidence 2-5 per 10000 births (Stevens et al., 2016).
- 12. AETIOLOGY • The exact aetiology of gastroschisis/omphalocele is not fully understood • It is believed to result from a combination of genetic, environmental, and maternal factors. • Multiple risk factors have been identified.
- 13. PREDISPOSING FACTORS Genetic factors • Gastroschisis associations with certain gene mutations, but there is no clear pattern of inheritance • Omphalocele is often associated with genetic conditions and chromosomal abnormalities, such as:
- 14. PREDISPOSING FACTORS • Trisomy 13 (Patau syndrome) • Trisomy 18 (Edwards syndrome) • Trisomy 21 (Down syndrome) • It can also occur as part of genetic syndromes like Beckwith- Wiedemann syndrome.
- 15. PREDISPOSING FACTORS Maternal smoking • Increased risk of gastroschisis in mothers who smoke during pregnancy. Drug and alcohol use • Recreational drug use (especially cocaine) and alcohol consumption have also been linked to gastroschisis.
- 16. PREDISPOSING FACTORS Exposure to environmental toxins • Certain environmental chemicals and agricultural pesticides may be associated with the condition. Maternal age • Gastroschisis is more common in younger mothers < 20 (Raitio et al., 2020). May involve biological, social, or environmental factors unique to younger women.
- 17. PREDISPOSING FACTORS Nutritional factors • Poor maternal nutrition • Vitamins deficiencies .e.g. folic acidSocioeconomic factors Lower socioeconomic status Potentially related to lifestyle factors, limited prenatal care, and higher exposure to environmental toxins
- 18. DIFFERENCES IN RISK FACTORS Maternal Age • Gastroschisis is more common in younger mothers, while omphalocele is more common in older mothers. • Omphalocele is frequently associated with genetic syndromes and chromosomal abnormalities, whereas gastroschisis typically occurs as an isolated condition.
- 19. DIFFERENCES IN RISK FACTORS Environmental Exposures: • Gastroschisis has stronger links to environmental factors .e.g. smoking, drug use, and poor nutrition, while omphalocele is more associated with genetic factors.
- 20. PATHOPHYSIOLOGY • Gastroschisis involves an abnormal development of the abdominal wall during early embryogenesis • The abdominal wall normally forms by the fusion of lateral body folds that meet at the midline around the 6th week of gestation. • In gastroschisis, this process is disrupted, leading to a small defect (usually to the right of the umbilicus) through which the intestines herniate.
- 21. PATHOPHYSIOLOGY Omphalocele • The intestines temporarily protrude outside the abdominal cavity into the umbilical cord due to rapid growth of the liver and intestines, a process known as physiological herniation. • By the 10th to 12th week, the intestines are supposed to return to the abdominal cavity as it enlarges. • In omphalocele, this process fails, and the organs remain outside the abdomen, enclosed in a thin sac of peritoneum and amnion (Zahouani & Mendez, 2021).
- 23. CLINICAL MANIFESTATIONS • Visible abdominal wall defect (usually to the right of the umbilicus) • Exposed intestines with no protective membrane • Inflamed and thickened intestines (due to exposure to amniotic fluid) • Delayed or absent bowel movements (delayed meconium passage) • Feeding intolerance (difficulty in feeding, vomiting) • Abdominal distension
- 24. CLINICAL MANIFESTATIONS • Malrotation of the intestines (abnormal twisting or positioning) • Bowel atresia (absence or narrowing of sections of the intestine) • Dehydration (fluid loss from exposed intestines) • Electrolyte imbalances • Respiratory distress (in severe cases due to increased abdominal pressure)
- 25. CLINICAL MANIFESTATIONS IN OMPHALOCELE • Organs covered by a protective membrane (peritoneum and amnion). • Large or small abdominal herniation, depending on the size of the defect. • Associated congenital anomalies (e.g.heart defects, neural tube defects). • Chromosomal abnormalities (e.g.Trisomy 13, 18, 21) often associated (Pijpers et al., 2023).
- 26. NURSING ASSESSMENT AND DIAGNOSTIC TESTS • History • Physical examination • Prenatal Diagnostic Testss.g. Ultrasound Detects abdominal wall defects and herniated organs. early diagnosis, planning treatment, and managing associated conditions.
- 27. DIAGNOSTIC TESTS • Amniocentesis Used primarily for omphalocele to screen for chromosomal abnormalities. • Fetal Echocardiogram Performed in cases of omphalocele due to the high risk of congenital heart defects.
- 28. DIAGNOSTIC TESTS • Postnatal Diagnostic Tests: Physical Examination • Visual confirmation of the abdominal defect. X-rays/Abdominal Radiographs • Blood Tests To check for electrolyte imbalances, dehydration, and infection (especially in gastroschisis).
- 29. DIAGNOSTIC TESTS • CT Scan or MRI For detailed imaging in severe or complex cases. • Genetic Testing For chromosomal anomalies, especially in omphalocele.
- 30. NURSING DIAGNOSIS AND MANAGEMENT • Risk for infection related to the presence of an exposed abdominal sac • Goal: The patient will remain free from signs of infection, as evidenced by normal body temperature after nursing interventions
- 31. NURSING DIAGNOSIS AND MANAGEMENT • Risk for fluid volume deficit related to exposed abdominal organs and potential fluid loss. • Goal: • The patient will maintain adequate fluid and electrolyte balance as evidenced by stable laboratory values, urine output, and normal vital signs.
- 32. NURSING DIAGNOSIS AND MANAGEMENT Interventions: Monitor the integrity of the abdominal sac • Rationale: To identify early signs of rupture or infection. Maintain sterile dressings over the sac • Rationale: Prevent contamination of the exposed sac, which is highly susceptible to infection. Administer prophylactic antibiotics as prescribed • Rationale: To reduce the risk of infection in an open area.
- 33. NURSING DIAGNOSIS AND MANAGEMENT Monitor vital signs, especially temperature and heart rate • Rationale: Fever and tachycardia can be early signs of infection. Prepare the family for surgical repair by educating them about the procedure and postoperative care • Rationale: Early surgery is essential to protect the exposed organs, and family understanding can promote compliance and reduce anxiety.
- 34. NURSING DIAGNOSIS AND MANAGEMENT • Impaired skin integrity related to exposed abdominal organs. Goal: • The patient's skin and underlying tissue will remain intact without signs of injury or infection.
- 35. NURSING DIAGNOSIS AND MANAGEMENT Interventions: Apply a sterile, non-adherent dressing to the omphalocele sac • Rationale: To protect the exposed organs and prevent friction or trauma. Position the infant to avoid pressure on the sac Rationale: Protects the sac from rupturing and causing further complications.
- 36. NURSING DIAGNOSIS AND MANAGEMENT Maintain hydration by administering IV fluids • Rationale: To maintain adequate circulation and tissue perfusion, promoting healing and reducing the risk of skin breakdown Assess for any changes in the sac's appearance (color, size, or leakage) • Rationale: Changes may indicate deterioration or rupture, necessitating immediate medical attention.
- 37. NURSING DIAGNOSIS AND MANAGEMENT • Risk for fluid volume deficit related to exposed abdominal organs and potential fluid loss. Goal: • The patient will maintain adequate fluid and electrolyte balance as evidenced by stable laboratory values, urine output, and normal vital signs.
- 38. NURSING DIAGNOSIS AND MANAGEMENT Interventions: Monitor fluid and electrolyte levels regularly • Rationale: Exposed organs increase fluid loss, making it crucial to monitor for imbalances.
- 39. NURSING DIAGNOSIS AND MANAGEMENT Administer IV fluids and electrolytes as ordered • Rationale: To replace fluid losses and prevent dehydration and electrolyte imbalances. Measure urine output hourly • Rationale: Urine output is a reliable indicator of fluid status and kidney function.
- 40. NURSING DIAGNOSIS AND MANAGEMENT Maintain a sterile, moist dressing over the exposed organs • Rationale: Prevent dehydration of the exposed organs and minimize fluid loss. Collaborate with a surgical team for prompt repair of the defect • Rationale: Early surgical closure is key to reducing ongoing fluid losses.
- 41. MEDICAL AND SURGICAL MANAGEMENT Immediate Postnatal Care Protection of Exposed Organs Temperature Regulation Fluid and Electrolyte Management Keep NPO NGT for drainage TPN
- 42. MEDICAL AND SURGICAL MANAGEMENT Intake and output chart Antibiotics Respiratory Support Preoperative Monitoring and Stabilization • Monitoring for Complications • Stomach Decompression via nasogastric tube
- 43. SURGICAL MANAGEMENT Primary Surgical Closure • If the abdominal cavity can accommodate the exposed organs without causing excessive pressure on the lungs or other organs, a primary closure is performed. • The surgeon returns the intestines and other exposed organs to the abdominal cavity and closes the abdominal wall defect in one operation.
- 44. MEDICAL AND SURGICAL MANAGEMENT Staged (Delayed) Surgical Closure In many cases, the intestines are swollen and cannot fit back into the abdominal cavity at once so a staged or delayed approach is used A silo (a sterile, protective, mesh-like bag) is placed over the intestines. This allows the intestines to be gradually returned to the abdomen over several days (Davenport, 2018)
- 46. PATIENT TEACHING • Explain the condition in simple terms • Pre-surgery care: explain that the exposed organs are wrapped in sterile, moist dressings to protect them until surgery. • Explain that surgical repair is needed • Nutrition: Initially, the baby will be kept NPO and receive nutrition intravenously(TPN). • Oral or tube feedings will be introduced gradually after surgery
- 47. PATIENT TEACHING • Wound care: Teach parents how to clean and care for the surgical site after discharge. • Joining support groups or seeking counseling can help with coping.
- 48. PATIENT TEACHING • Follow the guidance on feeding, wound care, and monitoring for complications. • Regular pediatric checkups to monitor growth and development • Teach the parents signs to report: Fever, lack of bowel movements, vomiting, or swelling at the surgical site • Emphasiese importance of attending all follow-up care appointments
- 49. COMPLICATIONS • Bowel dysfunction .e.g. Malrotation • Bowel inflammation, ischemia or necrosis • Infection • Electrolyte abnormalities .e.g. Hypokalemia,Hyponatremia Sepsis • Omphalocele may have associated congenital anomalies.e.g. cardiac defects
- 50. REFERENCES Davenport, M. (2018). Paediatric Surgery. Oxford Univ Press. Frolov, P., Alali, J., & Klein, M. D. (2010). Clinical risk factors for gastroschisis and omphalocele in humans: a review of the literature. Pediatric Surgery International, 26(12), 1135–1148. https://doi.org/10.1007/s00383-010- 2701-7 Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2019). Wong’s nursing care of infants and children (11th ed.). Elsevier.
- 51. REFERENCES Pijpers, A. G. H., de Beaufort, C. M. C., Maat, S. C., Broers, C. J. M., Straver, B., van Heurn, E., Gorter, R. R., & Derikx, J. P. M. (2023). Additional Anomalies in Children with Gastroschisis and Omphalocele: A Retrospective Cohort Study. Children, 10(4), 688. https://doi.org/10.3390/children10040688 Raitio, A., Tauriainen, A., Leinonen, M. K., Syvänen, J., Kemppainen, T., Löyttyniemi, E., Sankilampi, U., Gissler, M., Hyvärinen, A., & Helenius, I. (2020). Maternal risk factors for gastroschisis: A population based case–control ‐ study. Birth Defects Research, 112(13), 989–995. https://doi.org/10.1002/bdr2.1703
- 52. REFERENCES Stevens, P., Muller, E., & Becker, P. (2016). Gastroschisis in a developing country: Poor resuscitation is a more significant predictor of mortality than postnatal transfer time. South African Journal of Surgery, 54(1), 4–9. https://www.scielo.org.za/scielo.php?script=sci_arttext&pid =S0038-23612016000100000rg/10.3390/children10040688 Zahouani, T., & Mendez, M. D. (2021). Omphalocele. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519010/