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Dysmorphology
Abdomen
| Question | Answer |
|---|---|
| What time of gestation is there rapid growth of the abdomen? | 1st month |
| What happens during the first month of gestation in regards to the abdomen? | the size of the vitelline duct decreases |
| Origin of the abdominal tissue | mesenchymal |
| Allantois | during embryogenesis it extends into the connecting stalk. Joins the embryo to the placenta |
| Landmarks & Measurements | *Lower rib margin to upper edge of pelvic bone *Laterally to the paraspinal muscles of the flanks *Umbilicus: located midway between xiphoid notch and pubc symphysis |
| The intestines... out at X and in at X | Out at 7, in at 11 |
| Examination techniques of the abdomen | 1. Inspection 2. Auscultation 3. Palpation 4. Percussion |
| Inspection | 1. Symmetry 2. Muscle tone 3. Major abdominal wall defect 4. Note umbilicus position |
| Auscultation | 1. Bowel sounds 2. Bruits |
| Palpation | 1. Abdominal wall defect 2. Liver-size and consistency 3. Kidneys- esp. in infants 4. Unusual masses |
| Percussion | 1. Size of liver and spleen |
| Minor variants-spectrum variants | 1. Diastasis recti 2. umbilical hernias |
| Minor anomalies | 1. Ventral hernia 2. SUA 3. Unusual umbilical position |
| Deformations | 1. Umbilical cord length (long, short) 2. Umbilical cord knot |
| Disruptions | 1. Absence of abdominal muscles/"Prune belly" |
| Dysplasias | 1. Size/consistency of liver & spleen -Hepatosplenomegaly - Shrunken liver |
| Malformations of the anterior abdominal wall | 1. Omphalocele 2. Hernia in the UC 3. Gastroschesis |
| Malformations (other) | 1. Inguinal hernias 2. Situs inversus 3. Meckel's diverticulum 4. Urachus |
| Diastasis recti | (minor variant) -Varies in degree -Bulges when small children cry - A small one is common/benign |
| Umbilical hernias | -if smaller than 1 cm diameters if a NORMAL VARIANT and closes by 2-3 years -Incarcerated umbilical hernias need surgical correction |
| Ventral hernia | -Minor anomaly -Lateral to midline -Usually unilateral - Margins may be difficult to feel |
| SUA | -Most common minor anomaly - 1% of newborns -Higher proportion with congenital anomalies |
| Unusual umbilical position | -Minor anomaly -Early abd. development -Caudal placement- inadequate migration of mesenchymal tissue |
| Umbilical cord length | -Deformation -Long: influence due to tension from fetal movement/over 90 cm -Short: extreme interuterine immobility, as small as 20 cm, early placental separation or avulsion at delivery |
| Umbilical cord knot | -Deformation - true knot= long cord + active fetus |
| Prune Belly | -Malformation -Obstruction of distal urethra |
| Clinical findings of prune belly | - Flaccid -Thin abd. wall -Can see bowel |
| Size/consistency of liver/speeln | -Hepatosplenomegaly -Storage DOs -Shrunken liver- metabolic DOs and ex. Wilson disease (copper) |
| Omphalocele | -Malformation -Layer of amnion covering it -Intestinal malrotation common, eventration possible |
| Hernia into UC | -Malformation of adb. ventral wall -intestinal loops retract normally, but reemerge later -Inadequate ventral migration of mesenchyme - Covered by peritoneum and amniotic sheath - Large with eventration possible |
| Gastroschisis | - Malformation of abd. ventral wall - Abdominal contents through anterior defect -No covering - Unilateral deficit of mesenchymal migration -Opening PARAMEDIUM- umbilical cord to the side |
| Two types of inguinal hernias (malformations) | -Indirect -Direct |
| Indirect inguinal hernia | -Follows the pathway that testicles take during fetal dev - Pathway normally closes -Tests can be undescended - "Inguinal" |
| Direct inguinal hernia | -Athletic males -Rarely protrudes into the scrotum - Occurrence increased with age |
| Situs Inversus | -Malformation -Major organs are reversed -Totalis = heart on right side -Abdominus= organs below diaphragm are reversed -Polysplenia/asplenia possible |
| Meckel's diverticulum | -Malformation -Remnant of the vitelline duct or "yolk stalk" -Usually asymptomatic -2% of population |
| Urachus: three types (malformations) | 1. Sinus 2. Cyst 3. Fistula |
| Urachal sinus | -Dilation -Into the bladder or at the umbilicus |
| Urachal cyst | -Remnant of epithelial lining of urachus (canal that connects the bladder and the umbilicus) - Usually small and undetected |
| Urachal fistula | - No closure/completely open tube - Urine drainage |
Created by:
KChatham
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