Omphalocele vs Gastroschisis

Summary

The video by MEDSECTION delves into the intricacies of two congenital abdominal wall defects: omphalocele and gastroschisis. It starts with the anatomical process of the lateral folding of the trilaminar disc and the physiological herniation of the midgut. Omphalocele occurs when this herniated bowel fails to return to the abdominal cavity due to incomplete lateral folding, leading to the bowel being sealed within the umbilical cord. This defect is often associated with genetic syndromes such as Trisomy 13, 18, and 21. On the other hand, gastroschisis is a lateral wall defect with the bowel protruding outside the abdomen and exposed to amniotic fluid, leading to inflammation and no genetic abnormality associations. With better prognosis due to the absence of genetic issues, gastroschisis has different treatment outcomes compared to omphalocele.

Highlights

• Omphalocele results when the bowel doesn't return to the abdominal cavity, staying sealed in the umbilical cord. 🚼
• Gastroschisis occurs due to a flaw in the abdominal wall, leading to bowel exposure. 🌐
• Genetic associations are a significant concern with omphalocele. 🧬
• Gastroschisis has a generally better prognosis due to the absence of genetic anomalies. ✅
• Both conditions derive from issues during fetal development, but vary greatly in outcomes. 🌱

Key Takeaways

• The lateral folding process is essential for normal abdominal development in embryos. 🤰
• Omphalocele involves the gut sealed within the umbilical cord, often linked with genetic syndromes. 🧬
• Gastroschisis results in the bowel protruding and exposed to amniotic fluid, with fewer genetic ties. 🌊
• Omphalocele and gastroschisis differ significantly in genetics and prognosis. 🏥
• Understanding these defects helps in managing and diagnosing related syndromes early. 🔍

Overview

The video opens with a scientific dive into one of the early developmental stages of the embryo, the lateral folding of the trilaminar disc. Viewing this through the lens of ventral wall defects, the narrative transitions into how these processes affect the midgut's growth and displacement. The physiological herniation of the midgut through the umbilical cord is detailed as a normal part of development, paving the way for understanding the pathology of omphalocele and gastroschisis.

Omphalocele is highlighted as a condition where the bowel fails to return, sealed within membranes, due to ineffective lateral folds. This anomaly ties strongly to genetic syndromes like Trisomies 13, 18, and 21, leading to potential complexities in prognosis and management. The structural anomalies give rise to challenges but do not directly cause bowel pathology, rather they are co-occurring with genetic factors.

Conversely, gastroschisis is introduced as a defect where the bowel extrudes through a weakness next to the umbilicus and remains uncovered by the usual protective layers. This exposure can lead to inflammation but lacks genetic links, making it generally more favorable in terms of prognosis compared to omphalocele. This distinction anchors the discussion on the importance of early detection and understanding of congenital conditions.

Chapters

• 00:00 - 00:30: Introduction to Ventral Wall Defects The chapter provides an introduction to ventral wall defects, focusing on omphalocele and gastroschisis. It emphasizes the importance of understanding the lateral folding of the trilaminar disc, describing the role and transformation of the amniotic cavity and lateral folds. As these folds migrate and fuse, they close off the gut tube, leaving the umbilical cord as the only opening. This process is crucial in understanding how defects are formed when these steps do not occur properly.
• 00:30 - 01:40: Lateral Folding and Midgut Development This chapter covers the embryological development of the midgut, specifically focusing on the process of physiological herniation. It explains how, during normal development, the midgut herniates through the umbilical cord at around the sixth week. This process is attributed to the rapid enlargement of the liver, which occurs concurrently, and the limited capacity of the abdominal cavity at this stage.
• 01:40 - 02:40: Physiological Herniation and Rotation The chapter discusses the physiological herniation and rotation during embryonic development. It explains that the liver becomes too large to be contained in the abdominal cavity, causing the midgut to herniate through the umbilical cord. This process is described as a normal and expected part of development, contrasting with pathological hernias seen in adults. The herniated bowel eventually returns to the abdominal cavity.
• 02:40 - 04:30: Understanding Omphalocele Chapter on 'Understanding Omphalocele' explains the crucial developmental processes between the 10th and 12th weeks of gestation. During this time, the lateral folds of the fetus expand to reintegrate the herniated bowel into the abdominal cavity. This process is followed by a counterclockwise rotation of the bowel around the superior mesenteric artery. Any abnormalities in either the physiological herniation or the rotation can result in congenital pathologies, such as omphalocele.
• 04:30 - 06:00: Exploring Gastroschisis In the chapter 'Exploring Gastroschisis', the physiological process of herniation in the mid gut is discussed. Initially, the mid gut protrudes through the umbilical ring due to the rapid enlargement of the liver between the 10th and 12th weeks of development. Normally, the mid gut returns to the abdominal cavity, rotating counterclockwise around the superior mesenteric artery. This sets the stage for a discussion on lymphalosiums, focusing on the bowel that has herniated.
• 06:00 - 09:00: Comparing Omphalocele and Gastroschisis The chapter discusses the comparison between Omphalocele and Gastroschisis. It explains that in Omphalocele, the bowel remains inside the umbilical cord because the lateral folds fail to migrate around it, resulting in the bowel being sealed within the peritoneum and amnion. This is highlighted by the mnemonic 'empharosil seal' which implies that it is sealed within the protective layers as if it were inside the abdominal cavity. In contrast, this condition does not typically lead to bowel pathologies.
• 09:00 - 10:00: Conclusion The chapter discusses a medical condition where a portion of the liver herniates through the umbilical ring, sealing it within the umbilical cord along with the bowel. This condition is termed 'liver complicated omphalocele.' The chapter highlights that the primary concern with omphaloceles is their association with several genetic abnormalities, notably Trisomy 13 (Patau syndrome), Trisomy 18 (Edward syndrome), and Trisomy 21 (Down syndrome).

Omphalocele vs Gastroschisis Transcription

• 00:00 - 00:30 welcome to this video about ventral wall defects and follow Seals versus gastroschisis first we need to understand the lateral folding of the trilaminar disc here we have the amniotic cavity it will form natural folds on each side each will then migrate downwards on each side on the right of the picture we have the vital induct which will then become obliterated the lateral foldings will then fuse together this closes off the gut tube and the only opening left to the gut tube will be the umbilical cord
• 00:30 - 01:00 below the vitalin duct in the embryo the GI tract is divided into three parts the four got the midgut and the hind gut let's talk more about the mid gut a very important process happens called physiological herniation this is where the developing mid gut would herniate through the umbilical cord at around the sixth week this happens because as part of the normal development of the liver around that time the liver will enlarge very rapidly the abdominal cavity is
• 01:00 - 01:30 still not large enough to house the rapidly enlarging liver and the developing mid gut and so the liver will then Force the mid gut to herniate through the umbilical cord before we continue it's very important to note that this herniation is physiological so it's part of the normal development unlike the hernia week we find in adults which is pathological now the herniated bowel should return back into the abdominal cavity at around
• 01:30 - 02:00 the 10th to 12th week this happens because the lateral folds would enlarge to pretty much swallow the herniated bowel back into the abdominal cavity the bowel would then rotate around the superior mesenteric artery counterclockwise these two processes physiological herniation and rotation are extremely important any abnormality in these two processes would lead to congenital pathology
• 02:00 - 02:30 here is a picture of physiological herniation as we can see the mid gut has herniated through the umbilical ring because the liver has enlarged very rapidly over here at the 10th to 12th week the mid gut should return back into the abdominal cavity and it would rotate counterclockwise around the superior mesenteric artery now we are ready to talk about lymphalosiums what happens here is basically the bowel that has herniated
• 02:30 - 03:00 does not go back into the abdominal cavity this is because the lateral folds fail to migrate around the herniated bowel and so the bowel would remain inside the umbilical cord it would be sealed within peritoneum and amnion an easy way to remember this is that if you look at the word empharosil seal so it's sealed within the peritoneum and amnion as if it were inside the abdominal cavity and so and fallacies don't really lead to bowel pathologies
• 03:00 - 03:30 sometimes a portion of the liver also herniates through the umbilical ring and so we can see the liver sealed within the umbilical cord along with the bowel this is called liver complicated infallocele now the real problem with infalloceles is that it's associated with a bunch of genetic abnormalities mainly Trisomy 13 that spato syndrome Trisomy 18 that's Edward syndrome trisomy 21 that's down syndrome and also
• 03:30 - 04:00 a bunch of other defects now gastroschisis can be thought of as the equivalent of adult herniation in the embryo so you know how if you have a weakness in the abdominal wall a portion of the bowel would then herniate through that weakness the same thing happens here but in the embryo there is a weakness in the lateral wall so there's lateral wall defect mainly to the right of the umbilicus and then the bowel would extrude through that weakness to the right of the umbilicus this time the developing Mitten gut is not covered by
• 04:00 - 04:30 peritoneum and amnion and so the the bowel is exposed to amniotic fluid which then leads to inflammation and edema of the bowel and so this is associated with atresia and stenosis mainly in the jejunum and ilium however gastroschisis is not associated with any genetic abnormalities this alone makes the prognosis of gastroschisis better than anthaloceles
• 04:30 - 05:00 so just a picture here to help us highlight the differences between the two we can see here an unfollow seal the gut is sealed within the umbilical cord we can see the remnants of the umbilical cord over here meanwhile in gastroschisis it's not covered by anything a table here to highlight the key differences in the fallacil the gut
• 05:00 - 05:30 herniates through the umbilical cord while in gastroschisis herniates to the right of the umbilicus and emphaticil it's covered by peritoneum and amnion as we showed in the picture gastroschisis is not covered by a neon or peritoneum and so this leads to abnormal GI function in gastroschisis if you're actually able to solve the GI problems there are no genetic abnormalities and so it's a better prognosis than umpharosil and in fallacy we have genetic associations in gastroschisis we
• 05:30 - 06:00 don't and emphatically the problem is that the gut fails to or the herniated bowel fails to return meanwhile in gastroschisis physiological herniation and returning back into the abdominal cavity happened normally but any time a defect in the lateral wall led to a herniation of a portion of the developing bowel through the that defect mainly to the right of the foreign thank you for watching