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Dysmorphology

Abdomen

QuestionAnswer
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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