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OMPHALOCELE-
Omphalocele,
also known as exomphalos, is a birth defect of the abdominal wall. The infant's
intestines, liver, or other organs herniate outside of the abdomen through the
umbilicus. The organs are covered in a thin, nearly transparent sac that hardly
ever is open or broken.
omphalocele forms when there is a failure of lateral infolding
of the embryo (3 to 4 weeks gestation), resulting in an inadequate abdominal
cavity with containment of the abdominal organs only by a thin clear membrane
called the omphalocele sac.
Smaller omphaloceles, also referred to as “hernia of the cord,”
form later (8 to 11 weeks gestation) after normal infolding of the embryo
occurs, when the umbilical ring fails to close around the umbilical cord
resulting in a small defect that usually contains only intestine.
SIGN
AND SYMPTOMS OF OMPHALOCELE
OMPHALOCELE can be identified immediately by presence of
exomphalus sac outside the abdominal wall. This is the only sign no other sign
or symptom needed to diagnose it.
Diagnostic
investigations of OMPHALOCELE
Observation and physical examination just after delivery and
presence of exomphalus sac outside the abdominal wall is diagnostic feature of
omphalocele.
It can be diagnosed by ultrasound before birth
( intrauterine diagnosis )
TREATMENT
OF OMPHALOCELE
Surgical repair of the omphalocele takes place soon after birth.
The type of omphalocele treatment is determined by the overall health of the
baby, especially his respiratory status, the size of the omphalocele and the
degree of liver involvement. Babies with small omphaloceles are monitored
closely until they are ready to undergo primary repair. This means
the herniated organs are placed back into the abdominal cavity and the defect
is completely closed in one operation.
For babies with giant omphalocele that contain the liver and
other organs, a staged repair (involving several steps) is
needed to gradually return the abdominal contents. This gradual process
provides time for the abdominal wall to stretch to accommodate the viscera, and
ensures that the lungs can continue to grow and expand without immediate
pressure of surgical closure.
NURSING
MANAGEMENT OF OMPHALOCELE
Ø -
Preoperatively vital signs should be monitored and recorded.
Ø - The
exomphalus sac should be prevented from injury and infection.
Ø -
Nasogastric tube insertion may be needed to decompress the stomach. So frequent
suctioning of the tube and tube care is provided.
Ø IV
fluid may be required for prevention of hydro-electrolyte imbalance.
Ø -
Parents are explained about the
disorder, treatment procedure and all
questions are answered to alleviate anxiety.
Ø -
Minimum movement of the baby is ensured.
Ø -
After surgery proper observation and vital signs monitoring should be done.
Ø -
Watch out for abdominal distension, bleeding and should be reported
immediately.
Ø - IV
Fluids should be maintained as per doctors order.
Ø Surgical
site should be prevented form infection and injury.
Ø - Parents are explained about follow up and care after discharge. Specially in case
of staged repair.
Ø Other
Nursing interventions – includes all nursing care of
hospitalized child that we have discussed in previous lecture under heading
Nursing care of hospitalized child in the lecture “Child Health Nursing”.
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