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Radiology
Gastroschisis
Built from Obstetric Imaging
What’s inside
9 sections · 86 slides
Overview
- What this deck covers
What gastroschisis is
A hole in the fetal belly wall, and bowel with nothing over it
- A hole in the belly wall, beside the cord
- Unpacking the words
- What comes out, and what stays in
- Scan and diagram of the defect
- Anatomy around the defect
- Why the missing cover matters
- The two ways the gut gets hurt
How common it is, and who it affects
A worldwide rise, then a fall — and one strong risk factor
- Rates rose across the world
- Up threefold, then back down again
- Evidence that the rise was real
- Young age is the standout risk factor
- Habits and medicines under suspicion
- What two risk-factor studies found
- How to read the associations table
- Associations Linked to Gastroschisis and the Weight of Evidence
- Associations Linked to Gastroschisis and the Weight of Evidence (continued)
- Chromosomes and other anomalies
- Does it run in families?
Why it happens
Six decades of hypotheses, and the two newest ones
- Broken later, or built wrong?
- Six decades of competing ideas
- Proposed Hypotheses Describing Events Leading to Development of Gastroschisis
- Why the vascular idea dominated
- Idea one: a body fold that fails
- Idea two: the yolk sac escapes
- Escape of the yolk sac, step by step
Finding it before birth
A blood marker, then the scan that makes the diagnosis
- The blood test that raises the flag
- How reliably scans pick it up
- The classic ultrasound picture
- Normal cord insertion with the defect beside it
- Free-floating loops of fetal bowel
- The cauliflower appearance
- Floating bowel loops late in pregnancy
- Why the loops stand out so clearly
- Wait for the normal hernia to go back
- Normal gut herniation at 11 weeks, sagittal view
- Normal gut herniation at 11 weeks, transverse view
- Amniotic fluid volume
- These babies grow small
- Estimating fetal weight is genuinely hard
- Dilated bowel: a marker people argue about
- Dilated where? It changes the meaning
- Vanishing gastroschisis
- Serial scans of vanishing gastroschisis
- Dilated bowel loops inside the abdomen
- Where MRI fits
- “
The look-alikes
Omphalocele first, then eight others worth knowing
- Gastroschisis versus omphalocele
- Why omphalocele must be excluded first
- Nine things that can mimic it
- The normal one, and the sac ones
- The chest and midline ones
- What else to look for anyway
Managing the pregnancy
Nothing to treat before birth — so surveillance and timing are everything
- There is no treatment before birth
- What the animal work showed
- How centres watch these pregnancies
- Should you deliver early? The trial says no
- Where and how to deliver
After the baby is born
Wrap, position, decompress — then close the wall
- The first minutes
- Delivery room priorities
- A small defect with dusky bowel
- Newborn with a herniated fallopian tube
- Simple or complicated?
- The preferred way to close it
- Spring-loaded silo on day one of life
- When theatre is needed
- Closing the skin
- Biologic closure with the cord remnant
- The wall right after the bowel goes back
- How these babies do
- The long game
Bringing it together
What to tell the referrer, and the points worth memorising
- What the referring clinician needs to know
- Key points: what it is
- Key points: cause and diagnosis
- Key points: treatment and outcome
- Suggested further reading
- Suggested further reading (continued)
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition