"Gastroschisis is a congenital defect of the abdominal wall involving evisceration of abdominal contents. The incidence of gastroschisis is approximately 1.4 per 10,000 pregnancies and is rarely associated with other congenital anomalies." http://www.medscape.com/viewarticle/458475
This picture shows the intestines and stomach protruding from gastroschisis defect.
Gastroschisis is a defect in the abdominal wall causing evisceration of abdominal contents. The small and large intestines are usually the organs that protrude outside the abdominal wall. The spleen and liver have a low incidence of protruding.
"Gastroschisis, a paraumbilical defect of the abdominal wall resulting in the evisceration of abdominal contents into the amniotic cavity, is a rare birth defect (3.7 per 10,000 at birth) occurring before the 10th week of gestation. Studies have found that the prevalence has increased in many parts of the world in the last 2-3 decades. Very rare familial clusters have been reported. Some epidemiologic studies suggest that environmental factors may play a role in the etiology of gastroschisis. Of the risk factors for gastroschisis, the most striking epidemiologic observation is young maternal age, especially those aged less than 20 years. In addition, gastroschisis occurred more frequently among the offspring of smoking women, alcohol drinkers, recreational drug users, and women with low socioeconomic status." http://aje.oxfordjournals.org/content/168/1/73.full Am. J. Epidemiol. (2008) 168 (1): 73-79. doi:
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10.1093/aje/kwn098 First published online: April 23, 2008. "The etiology of gastroschisis is uncertain. Some hypothesis's proposed are: 1) The first hypothesis is that gastroschisis may result from a vascular disruption of the right lateral fold allowing the abdominal contents to herniate outside the abdominal cavity. 2) The second is that the defect results from occlusion of the omphalomesenteric artery in utero. This occlusion may weaken the abdominal wall causing it to rupture. 3) The third hypothesis is that premature atrophy or abnormal persistence of the right umbilical vein leads to mesenchymal damage and failure of the epidermis to differentiate. This damage or differentiation failure results in a defect of the abdominal wall. 4) The fourth and last hypothesis is that a gastroschisis defect may be the end result of an intrauterine rupture of a small omphalocele with the absorption of the sac." http://www.medscape.com/viewarticle/458475
Signs and Symptoms:
The signs and symptoms of gastroschisis are: small abdominal cavity, herniated intestines, swollen intestines and an opening in the abdominal wall.
SALT LAKE CITY, June 26 -- The risk of gastroschisis rises four-fold in women who report a sexually transmitted disease and a urinary tract infection around the time of conception, a case-control study of 10 birth defects surveillance systems suggested. Mothers of offspring with gastroschisis were almost twice as likely to report a genitourinary infection just before or shortly after conception, compared with women with healthy babies, Marcia L. Feldkamp, Ph.D., of the University of Utah, and colleagues reported in the June 20 issue of the BMJ.
The combination of an STD and a UTI proved to be especially hazardous, increasing the risk,
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albeit low, of the congenital malformation that leads to abdominal organ prolapse though the fetal abdominal wall.
Explain to interested patients that the congenital malformation gastroschisis has been associated with genitourinary infection around the time of conception.
Note that the findings were based on self-reported information, whose reliability could not be assured.
Although the cause and mechanisms remain unclear, environmental and maternal factors have been implicated, and several recent international reports have documented an apparent increased occurrence rate of gastroschisis. These findings, if confirmed, suggest a role for genitourinary infection as a risk factor for gastroschisis, the authors said. http://www.medpagetoday.com/OBGYN/Pregnancy/9939 ByÂ Charles Bankhead, Staff Writer, MedPage TodayPublished: June 26, 2008ReviewedÂ byÂ Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
"Gastroschisis is an abdominal wall defect that results in all or part of the small intestine and other internal organs protruding outside of the abdomen.Â One out of every 3,000 children in California is born with gastroschisis.Â The defect occurs 5-8 weeks after conception and is thought to be caused by a disruption in the blood flow to the developing abdominal wall.Â Studies have linked certain medications and environmental chemicals that are known to alter blood flow to increases in gastroschisis." http://www.healthandenvironment.org/birth_defects/peer_reviewed
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The infant with gastroschisis typically presents with a small, underdeveloped abdominal cavity caused by evisceration of the intestines. Although the distal portions of the colon, liver, and other solid organs have the potential to protrude through the abdominal wall defect, these organs usually remain in the abdominal cavity. Malrotation occurs almost universally because of the protrusion of the intestines outside the abdominal wall. Exposure to amniotic fluid can cause the uncovered bowel to become inflamed, thickened, and edematous. The affected bowel can also appear as a matted mass with no identifiable loops. A peel over the serosal surface of the bowel can occur as a result of amniotic fluid exposure. This, in conjunction with a chemical peritonitis, may impede reduction of the intestine into the abdominal cavity. http://www.medscape.com/viewarticle/458475
Management of the newborn with gastroschisis often occurs before birth, with the decision on the mode of delivery. Postnatal management includes presurgical stabilization and evaluation, surgical repair, and postsurgical care and follow-up. http://www.medscape.com/viewarticle/458475
Most newborns with gastroschisis diagnosed before birth are delivered via c-section. The reason C-section is thought to be better than vaginal delivery is to prevent infection of the protrusion. Eventually the newborn will need surgery to place the protruding organs back inside of the stomach.
"Obese mothers had up to a two-fold greater likelihood of giving birth to an infant with one of seven structural birth defects than non-obese women, "D. Kim Waller, Ph.D., of the
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University of Texas here, and colleagues, reported in the August issue of the Archives of Pediatric & Adolescent Medicine." The seven defects included spina bifida, heart defects, anorectal atresia, hypospadias, limb reduction (missing toes, fingers, or limbs), diaphragmatic hernia, and omphalocele.
On the other hand, mothers of offspring with the abdominal wall defect gastroschisis were significantly less likely to be obese than mothers of controls, the researchers said. http://www.medpagetoday.com/OBGYN/Pregnancy/6352
ByÂ Judith Groch, Senior Writer, MedPage Today
Published: August 07, 2007
ReviewedÂ byÂ Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
Subjective and Objective Data:
Subjective could be the fear of the unknown for the infant's family. Objective data would be that the infant needs surgery to repair the gastroschisis.
The most common presurgical studies ordered include a baseline chest x-ray, complete blood count (CBC) with differential and platelets, arterial blood gas, serum electrolytes, blood glucose level, total protein, and a blood type and cross match.
Gastroschisis Pg. 6
Gastroschisis may be suspected when the alpha feto protein (AFP) blood work is elevated. This blood test may also be referred to as a triple screen. The diagnosis is confirmed by ultrasound.
Broad-spectrum antibiotics such as ampicillin and gentamicin are started to decrease the risk of infection from bacterial contamination of the exposed bowel. Pain medication will be ordered post-surgery as well to relieve pain in the infant.
Acute Pain related to surgical procedure.
Administer analgesics, as ordered.
Check dressing for drainage and incision for redness and swelling.
Administer antibiotics, if appropriate.
NICU, Family Support, Medical Doctor-to write medication orders and follow care, Pharmacist: Fill Medications needed, Nurse: Assess, give medications, vitals, patient care and education.
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Prevention and Teaching:
Currently there is no way to prevent gastroshisis from occurring. The best prevention for anything in pregnancy is for a mother to have prenatal care during her pregnancy and to take her pregnancy multi-vitamins and folic acid and to eat a healthy diet before and during the pregnancy. Based on the available literature of short- and long-term outcomes of infants with gastroschisis, the overall survival rate is high.
In conclusion: Gastroschisis is a rare, but complex, defect of the abdominal wall. There are numerous complications that may occur secondary to the evisceration of the intestines, requiring long-term follow-up. The use of a multidisciplinary team is necessary to generate a more optimal outcome for the infant with gastroschisis. With the advances seen in neonatal medicine, including surgical techniques, parenteral nutrition, respiratory support, and control of infection, these infants may go on to lead healthy and productive lives.
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