Protruding intestines. Gastroschisis: Causes, Symptoms, and Treatment of Abdominal Wall Defect in Newborns

29.09.197706.11.2021 by alexxlab

What is gastroschisis and how does it affect newborns. What are the risk factors for gastroschisis. How is gastroschisis diagnosed during pregnancy. What treatment options are available for babies born with gastroschisis. How common is gastroschisis and is it becoming more prevalent. What long-term complications can arise from gastroschisis. How can expectant mothers reduce the risk of gastroschisis.

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Understanding Gastroschisis: A Congenital Abdominal Wall Defect

Gastroschisis is a rare but serious birth defect affecting the abdominal wall of newborns. This condition occurs when the baby’s intestines and sometimes other abdominal organs protrude outside the body through a hole near the umbilicus (belly button). Unlike some other abdominal wall defects, the exposed organs in gastroschisis are not covered by a protective sac, leaving them vulnerable to damage from exposure to amniotic fluid during pregnancy.

The exact causes of gastroschisis remain largely unknown, but researchers have identified several risk factors and potential contributing factors. Understanding this condition is crucial for expectant parents and healthcare providers to ensure proper management and care for affected infants.

Key Features of Gastroschisis

Occurs early in fetal development
Involves a defect in the abdominal wall, usually to the right of the umbilicus
Results in externalized intestines and possibly other organs
Requires surgical intervention after birth
Can lead to various complications and long-term health issues

Prevalence and Trends in Gastroschisis Cases

How common is gastroschisis? According to the Centers for Disease Control and Prevention (CDC), approximately 1,871 babies are born with gastroschisis each year in the United States. This translates to roughly 1 in 2,000 births being affected by this condition.

Interestingly, several studies have observed an increasing trend in the prevalence of gastroschisis, particularly among younger mothers. This upward trend has sparked concern among healthcare professionals and researchers, prompting further investigation into potential environmental or lifestyle factors that may be contributing to this rise.

Gastroschisis Prevalence by Maternal Age

Highest risk: Teenage mothers
Moderate risk: Mothers in their early 20s
Lower risk: Mothers over 25

Why is gastroschisis becoming more common? While the exact reasons for the increase are not fully understood, researchers speculate that changes in environmental exposures, dietary habits, and lifestyle factors among younger women may play a role. Ongoing studies aim to identify specific risk factors and potential preventive measures.

Risk Factors and Potential Causes of Gastroschisis

While the precise cause of gastroschisis remains elusive in most cases, researchers have identified several risk factors that may increase the likelihood of this birth defect. Understanding these factors is crucial for both healthcare providers and expectant parents in assessing and managing potential risks.

Known Risk Factors for Gastroschisis

Young maternal age (particularly teenage mothers)
Maternal alcohol consumption during pregnancy
Maternal smoking during pregnancy
Possible genetic predisposition
Environmental exposures (under investigation)
Certain medications or dietary factors (research ongoing)

What role do genetics play in gastroschisis? While some cases of gastroschisis may be linked to genetic factors, most instances appear to be sporadic, without a clear hereditary component. Researchers continue to investigate potential genetic markers that may increase susceptibility to this condition.

How do environmental factors contribute to gastroschisis risk? Environmental exposures, including certain chemicals or toxins, may play a role in the development of gastroschisis. However, more research is needed to identify specific environmental risk factors and their mechanisms of action.

Diagnosing Gastroschisis: Prenatal and Postnatal Detection

Early detection of gastroschisis is crucial for proper pregnancy management and preparation for the infant’s care after birth. Fortunately, advancements in prenatal screening and imaging techniques have made it possible to diagnose many cases of gastroschisis before birth.

Prenatal Diagnosis Methods

Maternal serum screening: Abnormal results may indicate increased risk
Ultrasound examination: Can visualize externalized organs
Fetal MRI: Provides detailed images in complex cases
Genetic testing: May be recommended in some situations

What are the signs of gastroschisis on ultrasound? During a prenatal ultrasound, healthcare providers look for the presence of abdominal organs floating freely in the amniotic fluid outside the fetal abdomen. The defect is typically located to the right of the umbilical cord insertion site.

How accurate is prenatal diagnosis of gastroschisis? While prenatal screening methods have high sensitivity for detecting gastroschisis, it’s important to note that no screening test is 100% accurate. Some cases may not be diagnosed until birth, highlighting the importance of thorough newborn examinations.

Postnatal Diagnosis

In cases where gastroschisis is not detected prenatally, the condition is immediately apparent at birth. The externalized intestines and potentially other organs are visible upon examination of the newborn. Prompt recognition and appropriate management are critical to ensure the best possible outcomes for affected infants.

Treatment Approaches for Infants with Gastroschisis

The primary treatment for gastroschisis involves surgical intervention to return the externalized organs to the abdominal cavity and repair the abdominal wall defect. The specific approach depends on the severity of the condition and the individual patient’s circumstances.

Surgical Management Options

Primary closure: For small defects with minimal organ protrusion
Staged reduction: For larger defects or significant organ involvement
Silo placement: Temporary protection of organs before final closure

What is the typical timeline for gastroschisis repair? In cases of small defects, surgery may be performed within hours of birth. For more complex cases requiring staged reduction, the process may take several days to weeks to complete.

How do surgeons determine the best approach for each patient? The decision depends on factors such as the size of the defect, the amount of externalized tissue, the condition of the exposed organs, and the overall health of the infant. A multidisciplinary team of neonatologists, pediatric surgeons, and other specialists collaborates to develop the most appropriate treatment plan.

Supportive Care Measures

Intravenous nutrition to support growth and healing
Temperature regulation to prevent hypothermia
Antibiotic therapy to prevent infections
Pain management and sedation as needed
Careful monitoring of fluid and electrolyte balance

Why is specialized care crucial for infants with gastroschisis? The complex nature of this condition requires a high level of expertise and resources. Treatment in a specialized neonatal intensive care unit (NICU) with experience in managing gastroschisis cases offers the best chance for optimal outcomes.

Long-Term Outcomes and Potential Complications

While advances in surgical techniques and neonatal care have significantly improved outcomes for infants with gastroschisis, these patients may still face various challenges throughout their lives. Understanding potential long-term complications is essential for ongoing care and management.

Common Long-Term Issues

Feeding difficulties and nutritional challenges
Growth delays
Gastrointestinal motility problems
Adhesions and potential bowel obstructions
Cosmetic concerns related to abdominal scarring

What percentage of children with gastroschisis experience long-term complications? While exact figures vary, studies suggest that up to 30-40% of children with gastroschisis may experience some form of long-term gastrointestinal or nutritional issue. However, many patients achieve excellent outcomes with appropriate care and follow-up.

How does gastroschisis affect quality of life in the long term? With proper management and support, many individuals born with gastroschisis go on to lead healthy, productive lives. However, some may require ongoing medical care or face challenges related to their condition. Psychosocial support and comprehensive follow-up care are important aspects of long-term management.

Importance of Long-Term Follow-Up

Regular medical check-ups and monitoring are crucial for individuals born with gastroschisis. These follow-up visits allow healthcare providers to:

Assess growth and development
Address any emerging complications promptly
Provide nutritional guidance and support
Offer psychosocial support for patients and families
Plan for any necessary interventions or treatments

Ongoing Research and Future Directions in Gastroschisis Management

The field of gastroschisis research continues to evolve, with scientists and clinicians working to improve understanding, prevention, and treatment of this condition. Several areas of ongoing research hold promise for advancing care and outcomes for affected individuals.

Current Research Focus Areas

Identifying specific environmental risk factors
Exploring genetic markers associated with increased susceptibility
Developing improved prenatal diagnostic techniques
Investigating potential preventive strategies
Refining surgical techniques and postoperative care protocols
Studying long-term outcomes and quality of life measures

What new treatments for gastroschisis are on the horizon? While current management primarily involves surgical repair, researchers are exploring innovative approaches such as tissue engineering and regenerative medicine techniques. These cutting-edge technologies may offer new possibilities for repairing abdominal wall defects and improving outcomes in the future.

How might advances in prenatal care impact gastroschisis management? Improved prenatal diagnostic capabilities may allow for earlier detection and potentially enable fetal interventions in some cases. Additionally, better understanding of risk factors could lead to more targeted preventive strategies for high-risk pregnancies.

The Role of Patient Registries and Collaborative Research

Large-scale, multi-center studies and patient registries play a crucial role in advancing gastroschisis research. These collaborative efforts allow researchers to:

Gather data on a larger number of cases
Identify trends and patterns in risk factors and outcomes
Develop and refine best practices for management
Facilitate the sharing of knowledge among healthcare providers
Accelerate the pace of discovery and innovation in gastroschisis care

Support and Resources for Families Affected by Gastroschisis

Coping with a diagnosis of gastroschisis can be challenging for expectant parents and families. Fortunately, various support systems and resources are available to help navigate this journey.

Key Support Resources

Specialized medical teams and genetic counselors
Patient advocacy organizations (e.g., Avery’s Angels)
Online support groups and forums
Educational materials and webinars
Financial assistance programs for medical expenses

How can families connect with others facing similar challenges? Patient advocacy organizations often facilitate connections between families affected by gastroschisis. These connections can provide valuable emotional support, practical advice, and a sense of community for those navigating this rare condition.

What role do support groups play in gastroschisis management? Support groups offer a platform for sharing experiences, coping strategies, and information about the latest research and treatment options. They can be an invaluable resource for both emotional support and practical guidance throughout the journey of caring for a child with gastroschisis.

Empowering Families Through Education

Knowledge is power when it comes to managing gastroschisis. Healthcare providers and support organizations strive to educate families about:

The nature of the condition and its potential impacts
Treatment options and what to expect during hospitalization
Long-term care considerations and follow-up needs
Strategies for addressing potential complications
Available resources and support systems

By equipping families with comprehensive information and support, healthcare providers and advocacy groups aim to empower parents and caregivers to be active participants in their child’s care and to navigate the challenges of gastroschisis with confidence and resilience.

Facts about Gastroschisis | CDC

Gastroschisis (pronounced gas-troh-skee-sis) is a birth defect of the abdominal wall. The baby’s intestines are found outside of the baby’s body, exiting through a hole beside the belly button.

What is Gastroschisis?

Gastroschisis is a birth defect of the abdominal (belly) wall. The baby’s intestines are found outside of the baby’s body, exiting through a hole beside the belly button. The hole can be small or large and sometimes other organs, such as the stomach and liver, can also be found outside of the baby’s body.

Gastroschisis occurs early during pregnancy when the muscles that make up the baby’s abdominal wall do not form correctly. A hole occurs which allows the intestines and other organs to extend outside of the body, usually to the right side of belly button. Because the intestines are not covered in a protective sac and are exposed to the amniotic fluid, the intestines can become irritated, causing them to shorten, twist, or swell.

Occurrence

The Centers for Disease Control and Prevention (CDC) estimates that about 1,871 babies are born each year in the United States with gastroschisis, but several studies show that recently this birth defect has become more common, particularly among younger mothers.^1-3

Causes and Risk Factors

The causes of gastroschisis among most infants are unknown. Some babies have gastroschisis because of a change in their genes or chromosomes. Gastroschisis might also be caused by a combination of genes and other factors, such as the things the mother comes in contact with in the environment or what the mother eats or drinks, or certain medicines she uses during pregnancy.

Like many families affected by birth defects, CDC wants to find out what causes them. Understanding factors that are more common among babies with birth defects will help us learn more about the causes. CDC funds the Centers for Birth Defects Research and Prevention, which collaborate on large studies such as the National Birth Defects Prevention Study (NBDPS; births 1997-2011) and the Birth Defects Study To Evaluate Pregnancy exposureS (BD-STEPS, which began with births in 2014), to understand the causes of and risks for birth defects, like gastroschisis.

Recently, CDC researchers have reported important findings about some factors that affect the risk of having a baby with gastroschisis:

Younger age: teenage mothers were more likely to have a baby with gastroschisis than older mothers.^2,3
Alcohol and tobacco: women who consumed alcohol or were a smoker were more likely to have a baby with gastroschisis.^4,5

CDC continues to study birth defects like gastroschisis in order to learn how to prevent them. If you are pregnant or thinking about getting pregnant, talk with your doctor about ways to increase your chance of having a healthy baby.

Diagnosis

Gastroschisis can be diagnosed during pregnancy or after the baby is born.

During Pregnancy

During pregnancy, there are screening tests (prenatal tests) to check for birth defects and other conditions. Gastroschisis might result in an abnormal result on a blood or serum screening test or it might be seen during an ultrasound (which creates pictures of the baby’s body while inside the womb).

After the Baby is Born

Gastroschisis is immediately seen at birth.

Treatments

Soon after the baby is born, surgery will be needed to place the abdominal organs inside the baby’s body and repair the defect.

If the gastroschisis defect is small (only some of the intestine is outside of the belly), it is usually treated with surgery soon after birth to put the organs back into the belly and close the opening. If the gastroschisis defect is large (many organs outside of the belly), the repair might done slowly, in stages. The exposed organs might be covered with a special material and slowly moved back into the belly. After all of the organs have been put back in the belly, the opening is closed.

Babies with gastroschisis often need other treatments as well, including receiving nutrients through an IV line, antibiotics to prevent infection, and careful attention to control their body temperature.

Other Resources

The views of this organization are its own and do not reflect the official position of CDC.

Avery’s Angelsexternal icon
Avery’s Angels is a foundation that helps children and families affected by gastroschisis. The website has resources for connecting with other families and ways to raise awareness about gastroschisis.

References

Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, et al; for the National Birth Defects Prevention Network. Updated national birth prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Res A Clin Mol Teratol. 2010;88(12):1008-16.
Kirby RS, Marshall J, Tanner JP, et al.; for the National Birth Defects Prevention Network. Prevalence and correlates of gastroschisis in 15 states, 1995 to 2005. Obstet Gynecol. 2013 Aug; 122 (2 Pt 1):275-81.
Jones AM, Isenburg J, Salemi JL, et al.; for the National Birth Defects Prevention Network. Increasing prevalence of gastroschisis—14 States, 1995-2012. MMWR morb Mortal Wkly Rep. 2016 Jan 22;65(2):23-6.
Bird TM, Robbins JM, Druschel C, Cleves MA, Yang S, Hobbs CA, & the National Birth Defects Prevention Study. Demographic and environmental risk factors for gastroschisis and omphalocele in the National Birth Defects Prevention Study. J Pediatr Surg. 2009;44:1546-1551.
Feldkamp ML, Reefhuis J, Kucik J, Krikov S, Wilson A, Moore CA, Carey JC, Botto LD and the National Birth Defects Prevention Study. Case-control study of self reported genitourinary infections and risk of gastroschisis: findings from the National Birth Defects Prevention Study, 1997-2003. BMJ. 2008; 336(7658): 1420-3.

The images are in the public domain and thus free of any copyright restrictions. As a matter of courtesy we request that the content provider (Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities) be credited and notified in any public or private usage of this image.

Facts about Omphalocele | CDC

Omphalocele (pronounced uhm-fa-lo-seal) is a birth defect of the abdominal (belly) wall. The infant’s intestines, liver, or other organs stick outside of the belly through the belly button. The organs are covered in a thin, nearly transparent sac that hardly ever is open or broken.

What is Omphalocele?

Omphalocele, also known as exomphalos, is a birth defect of the abdominal (belly) wall. The infant’s intestines, liver, or other organs stick outside of the belly through the belly button. The organs are covered in a thin, nearly transparent sac that hardly ever is open or broken.

As the baby develops during weeks six through ten of pregnancy, the intestines get longer and push out from the belly into the umbilical cord. By the eleventh week of pregnancy, the intestines normally go back into the belly. If this does not happen, an omphalocele occurs. The omphalocele can be small, with only some of the intestines outside of the belly, or it can be large, with many organs outside of the belly.

How Many Babies are Born with Omphalocele?

Researchers estimate that about 1 in every 4,200 babies is born with omphalocele in the United States.¹ Many babies born with an omphalocele also have other birth defects, such as heart defects, neural tube defects, and chromosomal abnormalities.²

Causes and Risk Factors

The causes of omphalocele among most infants are unknown. Some babies have omphalocele because of a change in their genes or chromosomes. Omphalocele might also be caused by a combination of genes and other factors, such as the things the mother comes in contact with in the environment or what the mother eats or drinks, or certain medicines she uses during pregnancy.

Like many families affected by birth defects, we at CDC want to find out what causes them. Understanding factors that are more common among babies with a birth defect will help us learn more about the causes. CDC funds the Centers for Birth Defects Research and Prevention, which collaborate on large studies such as the National Birth Defects Prevention Study (NBDPS; births 1997-2011), to understand the causes of and risks for birth defects, such as omphalocele.

Recently, CDC researchers have reported important findings about some factors that can affect the risk of having a baby with an omphalocele:

Alcohol and tobacco: Women who consumed alcohol or were heavy smokers (more than 1 pack a day) were more likely to have a baby with omphalocele.³
Certain medications: Women who used selective serotonin-reuptake inhibitors (SSRIs) during pregnancy were more likely to have a baby with an omphalocele.⁴
Obesity: Women who were obese or overweight before pregnancy were more likely to have a baby with an omphalocele.⁵

CDC continues to study birth defects such as omphalocele and how to prevent them. If you are pregnant or thinking about getting pregnant, talk with your doctor about ways to increase your chances of having a healthy baby.

Diagnosis

An omphalocele can be diagnosed during pregnancy or after a baby is born.

During Pregnancy

During pregnancy, there are screening tests (prenatal tests) to check for birth defects and other conditions. An omphalocele might result in an abnormal result on a blood or serum screening test or it might be seen during an ultrasound (which creates pictures of the baby).

After a Baby Is Born

In some cases, an omphalocele might not be diagnosed until after a baby is born. An omphalocele is seen immediately at birth.

Treatments

Treatment for infants with an omphalocele depends on a number of factors, including

the size of the omphalocele,
the presence of other birth defects or chromosomal abnormalities, and
the baby’s gestational age.

If the omphalocele is small (only some of the intestine is outside of the belly), it usually is treated with surgery soon after birth to put the intestine back into the belly and close the opening. If the omphalocele is large (many organs outside of the belly), the repair might be done in stages. The exposed organs might be covered with a special material, and slowly, over time, the organs will be moved back into the belly. When all the organs have been put back in the belly, the opening is closed.

Other Resources

The views of this organization are its own and do not reflect the official position of CDC.

Omphalocele.netexternal icon
Omphalocele.net provides support and encouragement to families who may be expecting a child with omphalocele, be connected with a child with omphalocele, and to people who were born with omphalocele.

References

Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ, Lupo PJ, Riehle‐Colarusso T, Cho SJ, Aggarwal D, Kirby RS. National population‐based estimates for major birth defects, 2010–2014. Birth Defects Research. 2019; 111(18): 1420-1435.
Stoll C, Alembik Y, Dott B, Roth MP. Omphalocele and gastroschisis and associated malformations. Am J Med Genet A. 2008 May 15;146A(10):1280-5.
Bird TM, Robbins JM, Druschel C, Cleves MA, Yang S, Hobbs CA, & the National Birth Defects Prevention Study . Demographic and environmental risk factors for gastroschisis and omphalocele in the National Birth Defects Prevention Study. J Pediatr Surg, 2009;44:1546-1551.
Alwan S, Reefhuis J, Rasmussen SA, Olney RS, Friedman JM, & the National Birth Defects Prevention Study. Use of Selective Serotonin-Reuptake Inhibitors in Pregnancy and the Risk of Birth Defects. N Engl J Med, 2007;356:2684-92.
Waller DK, Shaw GM, Rasmussen SA, Hobbs CA, Canfield MA, Siega-Riz AM, Gallaway MS, Correa A, & the National Birth Defects Prevention Study. Prepregnancy obesity as a risk factor for structural birth defects. Arch Pediatr Adolesc Med, 2007;161(8):745-50.

Gastroschisis

What is Gastroschisis?

Gastroschisis is an abdominal wall defect like omphalocele in which the anterior abdomen does not close properly allowing the intestines to protrude outside the fetus. The majority of fetuses with this problem are born to mothers in their late teens or early twenties. For some unknown reason, while the fetus is developing, the muscles of the abdominal wall do not form correctly. This allows some of the organs (stomach, intestine) to protrude outside the fetus’s body. The organs outside of the fetus’s body are floating in the amniotic fluid.

The amount of abdominal contents protruding outside of the fetus varies in each pregnancy. Some are very small (just a few loops of bowel), while others can be quite large and involve most of the intestine and stomach.

What is the outcome for a fetus with gastroschisis?

There is a range of severity for fetuses with gastroschisis that depends entirely on the condition of the intestine. Fortunately, most fetuses with gastroschisis do not have severe damage to the intestine before birth. The relatively normal intestine can be returned to the abdomen and the defect closed in one or two surgical operations shortly after birth. These babies will still be in the intensive care nursery for several weeks before the intestines work well enough to allow feeding and subsequent discharge home. However, the majority of these babies grow up normally .

Ten to twenty percent of fetuses with gastroschisis will have significant damage to the intestine that greatly complicates their postnatal course but rarely prevents survival. Babies born with damaged intestine can have a very difficult and prolonged stay in the intensive care nursery. These babies often require several surgical operations to return of the intestine to the abdomen using a plastic silo and eventual closure of the abdominal wall. The bowel can be so damaged that parts of it have to be removed. In the worst case, there may not be enough bowel left to absorb food. The most severely affected babies may not survive, and others may be left with a “short bowel syndrome.” At the very least, these babies may require nutritional support in the nursery for many months.

How serious is my fetus’s gastroschisis?

In order to determine the severity of your fetus’s condition it is important to gather information from a variety of tests and determine if there are any additional problems. These tests along with expert guidance are important for you to make the best decision about the proper treatment.

This includes:

The type of defect—distinguishing it from other similar appearing problems.
The severity of the defect—is your fetus’s defect mild or severe.
Associated defects—is there another problem or a cluster of problems (syndrome).

Amniocentesis and/or microarray may be necessary for chromosome testing. Sonography is the best imaging tool, but is dependent on the experience and expertise of the physician. Many problems are first detected during routine screening procedures performed in your doctor’s office (amniocentesis, maternal serum screening, routine sonography), but assessment and treatment of gastroschisis before and after birth will require the expertise of a specialized hospital with experience managing complex and rare fetal problems. We can work with your doctor to find a center convenient for you.

A sonogram will accurately diagnose gastroschisis and distinguish it from other similar conditions such as omphalocele. However, the test cannot always tell how severely the bowel damage is. Serial sonograms every few weeks may be necessary to see if the bowel outside the fetus’s body becomes dilated, develops a thick wall, or loses some blood flow.

Since 8 out of 10 fetuses with gastroschisis will not have damaged bowel and will do fine after birth, it is important to be able to identify those 2 fetuses out of the 10 who will have badly damaged bowel and may benefit from fetal intervention before birth. We follow all fetuses with a careful ultrasound examination every week or two to see if we can detect any change in the bowel.

It is very important to plan for delivery at a tertiary center with good neonatology and pediatric surgery for management and repair after birth. While it was originally thought that babies with the bowel on the outside of the body would have to be delivered by Cesarean section, this is not the case and most babies can be delivered vaginally. Good communication between perinatology (obstretricians) and neonatology (pediatricians) is crucial because many of the babies are born slightly premature.

What are my choices during this pregnancy?

It is important to carefully monitor throughout your pregnancy. Additional tests, other than ultrasounds, are not usually recommended, as this is a condition that is not associated with any other birth defect. Rarely, babies can also have bowel obstruction (blockage) as a consequence of the gastroschisis.

Babies with gastroschisis are watched carefully by ultrasound for intrauterine growth retardation (not growing enough while in the womb) and for damage to the intestines. Damage to the intestine can be caused from exposure to the amniotic fluid or by impairment of the blood flow to the exposed intestine.

Since most fetuses with gastroschisis will do well with serial ultrasound observation and preparation for delivery near term at an appropriate hospital, the most important decisions have to do with where the baby will deliver and what team of doctors will look after the baby before and after birth. Your perinatologist (specialized obstetrician) will discuss your delivery plans. It is not necessary to deliver your baby by Cesarean section. Delivering your baby vaginally will not be harmful to you or your baby.

The most important consideration is to be born at the center where the intestines can be immediately covered and kept warm and moist until surgical repair or silo placement. For reasons not immediately understood, mothers with a fetus with gastroschisis will have an increased incidence of preterm labor (delivery prior to 37 weeks). The biggest threat to the baby and to the condition of the intestine is to have to transport the baby to another medical center or in any way delay the repair. Therefore, delivery plans should be coordinated with your neonatologist (specialized pediatrician for newborns) and pediatric surgeon.

What will happen after birth?

Your baby should be born at a hospital with an Intensive Care Nursery (ICN) and a pediatric surgeon available. Soon after birth, your child will have surgery to close the opening in the abdominal wall and return the organs to the abdomen. The pediatric surgeon attempts to close the opening at the time of surgery, but sometimes this is not possible.

If the gastroschisis is too large, a silo is placed. A silo is a covering placed over the abdominal organs on the outside of the baby. Gradually, the organs are squeezed by hand through the silo into the opening and returned to the body. This method can take up to a week. Babies with gastroschisis can stay in the hospital from 2 weeks to 3-4 months. Because your baby’s intestine has been floating in amniotic fluid for months, it is swollen and does not function well. The return of the function of the gastrointestinal tract and the baby’s ability to tolerate feedings are two factors which determine the length of stay in the hospital. Babies are discharged from the hospital when they are taking all their feedings by mouth and gaining weight.

After discharge from the hospital, your baby has a small risk for developing bowel obstruction due to scar tissue or a kink in a loop of bowel. Symptoms of bowel obstruction include: 1) bilious (green) vomiting, 2) a bloated stomach, and 3) no interest in feeding. If any of these symptoms occur, you should contact your pediatrician immediatealy.

Support Groups & Other Resources

Mothers Of Omphaloceles (MOOs) — Omphalocele Support Group and Webring
Avery’s Angels Gastroschisis Foundation — Provides emotional and financial support to families who have babies born with gastroschisis
IBDIS — International Birth Defects Information Systems information on Gastroschisis and Omphalocele.
March of Dimes — Researchers, volunteers, educators, outreach workers and advocates working together to give all babies a fighting chance
Birth Defect Research for Children — a parent networking service that connects families who have children with the same birth defects
Kids Health — doctor-approved health information about children from before birth through adolescence
CDC – Birth Defects — Dept. of Health & Human Services, Centers for Disease Control and Prevention
NIH – Office of Rare Diseases — National Inst. of Health – Office of Rare Diseases
North American Fetal Therapy Network — NAFTNet (the North American Fetal Therapy Network) is a voluntary association of medical centers in the United States and Canada with established expertise in fetal surgery and other forms of multidisciplinary care for complex disorders of the fetus.

Gastroschisis in Babies | Causes, Diagnosis & Treatment

What Causes Gastroschisis?

The exact cause of gastroschisis is not known. It does not appear to be inherited. Having one baby with gastroschisis does not make it more likely that you would have another baby with the condition.

Severity of Gastroschisis

Gastroschisis is labeled as simple or complicated. This is based on how inflamed the bowel and/or organs are that have moved through the opening.

With simple gastroschisis

With complicated gastroschisis, one or more of the following occurs:

The bowel outside of the baby’s body is extremely damaged, e.g., a portion of the tissue has died (called necrosis), or the bowel has become twisted or tangled.
Intestinal atresia, which occurs when part of the baby’s bowel doesn’t form completely, or the intestine is blocked.
Other organs, such as the stomach or liver, protrude out of the opening as well.

Simple cases are more common than complicated ones.

Gastroschisis Evaluation and Diagnosis

It is possible for gastroschisis to be detected in the third month of pregnancy. However, we most often perform evaluations for it at 20-24 weeks, after it has shown up on an ultrasound. It is most commonly diagnosed by ultrasound around weeks 18-20 of pregnancy.

Some women are referred to us for gastroschisis late in pregnancy. We see them within two weeks of their referral. It is important to make a diagnosis and delivery plan as early as possible.

In babies with gastroschisis, the ultrasound will show loops of bowel floating freely. This often shows up when a woman goes in for a routine ultrasound with her obstetrician (OB). It is at this point that most of our patients affected by gastroschisis are referred to the Cincinnati Children’s Fetal Care Center. Here, we’ll work with you to assess how severe your case is and create a plan for the remainder of your pregnancy. We will also talk to you about what to expect after delivery.

An evaluation for gastroschisis consists:

An ultrasound (we can use an ultrasound performed within two weeks of your appointment with us, or one will be done on the day of your evaluation)
Possibly an MRI and/or a fetal echocardiogram to test your baby’s heart function
A meeting with a nurse, social worker and genetic counselor
A team meeting with a maternal-fetal medicine specialist (MFM), pediatric surgeon and neonatologist

An important part of the evaluation is determining whether the condition is gastroschisis or omphalocele. These conditions can sometimes look similar on an ultrasound. In omphalocele, a sac from the umbilical cord covers and protects the intestines that are outside of the baby’s body.

After your tests are complete, our team of experts meets with you to discuss the extent of the baby’s condition and its impact on the rest of the pregnancy. We’ll also cover medical treatments that might be needed right after the birth of your child, and long-term prognosis of babies with gastroschisis.

For patients who are local or plan to deliver locally, we also discuss:

We recommend frequent ultrasounds throughout the remainder of your pregnancy. These will help to monitor your baby’s health, the severity of the gastroschisis, and how it evolves.

Compassionate, Expert Care

The Cincinnati Fetal Care Center offers comprehensive diagnostic tests and the latest treatments for gastroschisis. Just as important, our team of specialists takes time to explain test results, answer questions and discuss treatment options. We understand that parents are facing unique challenges. We provide as much support as possible every step of the way. Extensive experience and expertise allow our team to treat the most complex cases of this condition.

Planning for Delivery

Normally we recommend our patients deliver at a level III hospital, which is one that can provide advanced trauma care. A children’s hospital should be nearby with a pediatric surgeon available to perform the surgery after your baby’s birth.

It is possible for a woman to have a vaginal delivery unless there are obstetric concerns. Your doctor may suggest a C-section at about 37 weeks of pregnancy if your baby’s lungs are mature enough.

For patients who deliver locally, your baby will be transferred to Cincinnati Children’s soon after delivery. Once you are stable, you will be given a pass from your delivery hospital to visit your baby until you are discharged. Your baby will stay in the NICU for a period of time after surgery.

Gastroschisis Treatment Options

There are no fetal interventions recommended for babies with gastroschisis. The condition cannot be corrected while you are pregnant. Rather, it must be treated right after your baby is born.

Any baby with gastroschisis must have surgery after birth. An infant cannot survive with his or her bowel outside of the body.

After your baby is born, doctors will assess how severe the gastroschisis is. The type of repair needed depends on how much bowel and/or organs are outside of your baby’s belly and any inflammation or damage to those tissues.

Primary Repair

With a simple gastroschisis, treatment often is what’s called a “primary repair.” This is a surgery where the bowel is placed back inside of the baby’s belly and the abdominal opening is closed. When possible, this surgery is done the day your baby is born.

This type of repair is performed when there’s relatively small amount of bowel outside of the belly, and the bowel is not overly swollen or damaged.

Staged Repair

A primary repair might not be possible if:

Your baby has a large amount of bowel outside the body
The bowel is very swollen
The baby’s belly doesn’t have enough room to hold all of the bowel

In these cases, several surgeries may be needed to slowly place the bowel / organs back into the belly. This is called a “staged repair.” This takes place over several days and can last up to two weeks.

With a staged repair, a plastic pouch or “silo” is placed around the bowel and attached to the belly. Every day the silo is tightened and some of the bowel is gently pushed inside. When all the bowel is inside, the silo is removed, and the belly is closed. Some babies may need the help of a breathing machine for a few days after the surgery or surgeries.

Of the gastroschisis repairs performed by the surgeons we partner with at Cincinnati Children’s, about 50 percent are primary, and the other 50 percent are staged reductions.

About 10 percent of babies born with gastroschisis also have a part of the bowel that does not develop correctly. In these cases, some babies may experience:

Bowel resection – a surgery on the bowel needed when part of the bowel is extremely damaged
Colostomy – an opening to allow to allow stool to pass out of the body and into a bag
Short bowel syndrome – when a large portion of the intestine does not work normally
Intestinal transplantation – when a new intestine is needed (rare)

Post-Surgery Follow-Up Care

Your baby’s bowel has developed outside of the belly. It needs to heal and adjust to functioning normally. Because of that, babies with gastroschisis commonly have feeding challenges the first few weeks of life.

During this time, your baby will receive IV nutrition. Babies with gastroschisis often need other treatments as well, including:

Medications for comfort
Antibiotics to prevent infection
Careful attention to control body temperature

Once your baby’s bowel is functioning — usually after about two to three weeks — breast milk or special formula will begin.

Your baby will be discharged once he or she is doing well with feedings and the bowel appears to be functioning normally. Hospital stays can range anywhere from 30-50 days or more.

A follow-up appointment will be scheduled with your neonatologist and / or pediatric surgeon. The doctor will assess your baby’s feeding, development and surgery site, and rule out any obstruction in the belly.

Gastroschisis Prognosis

Babies with gastroschisis are usually smaller than average. After birth, it can take some time for them to catch up developmentally. Long-term problems mostly occur in the very complicated cases. These can be related to feeding, bowel or infection issues.

Babies with gastroschisis can have very different experiences based on how severe each case is. They first must recover from their initial surgical repairs, become successful at feeding, and their bowel must heal. After that, most babies who had gastroschisis can go on to live a normal, healthy life without complications related to the condition.

St John guide to first aid for adbominal injuries

The abdominal cavity lies below the ribcage and above the pelvic cavity. Unlike the chest and pelvic cavities, there are no bones to protect the abdomen and any injury may cause serious damage to some of the abdominal organs, including the liver, spleen or stomach. In some cases, the injury may involve both the abdominal and pelvic contents. If this occurs, the injured patient may bleed to death internally unless urgent hospital treatment is provided.

Symptoms and signs – Not all may be present

history of injury to the abdominal area

bleeding wound or other obvious injury, possibly with visible intestines

severe pain and possible muscle spasm across the abdominal wall

nausea or vomiting

bruising of the skin

patient unable to stand and holding the injured area for pain relief

patient shows other indications of internal bleeding

How you can help

1. Place patient at total rest and assess the injury

Assist the patient to lie down in a position of greatest comfort, usually on the back or on the uninjured side, with both knees drawn up for relief of pain and spasm.

Loosen any tight clothing, especially at waist and neck. Support the patient with pillows and blankets for comfort, as needed. Give frequent reassurance.

Call 111 for an ambulance.

2. Control bleeding and cover any wound

If necessary, hold the wound edges together to control bleeding. Sometimes the patient can change position slightly to help the wound to close.

If the intestines are visible, DO NOT touch or try to replace them.

Cover a gaping wound with sterile dressings soaked in warm water to avoid damage to organs.

DO NOT allow the patient to eat, drink or smoke.

3. Observe the patient

While waiting for the ambulance to arrive, observe the patient closely for any changes in condition.

Have the information on hand when you need it the most.
Buy the First Aid Handbook >>

Learn the practical skills to help save a life.
Book a first aid course >>

Battling a Bulging Hernia | NIH News in Health

December 2017

Print this issue

Don’t Ignore Your Groin Pain

Usually, the wall of the abdomen is strong. The muscles keep your intestine in place. But if there’s a weak spot, the intestine can push through and form a hernia. A person may be born with a weakness there, or the weakness may develop over time later in life.

“It’s like when you look at an old tire on a car and you see kind of a bulge on the sidewall of the tire. That’s because there’s a weakness in the wall of the tire. And the air is pushing the wall of the tire outward to create that bulge,” says Dr. Dana K. Andersen, an NIH hernia expert.

A hernia developing in the abdomen is extremely common. Babies, children, and adults get them. Most of the time, hernias are found in men over 40. Can lifting heavy objects give you a hernia? Maybe if you already have a weakness in the wall of your abdomen.

“The majority—three-quarters—of abdominal wall hernias are in the groin,” Andersen says. The groin region is the lower abdomen.

The first sign of a hernia is a small bulge from the lower abdomen. You may notice it only when you stand up, cough, jump, or strain. That’s because those activities increase the pressure within your abdomen. That increased pressure can make a part of your intestine pop out of an area of weakness. When you lie down, the bulge may go away.

If you think you may have a hernia, ask your doctor. A doctor can usually detect a hernia during a physical exam. Your doctor can rule out other conditions that cause bulges or lumps.

If the bulge is very soft, your doctor may be able to massage the intestine back into the abdomen. A small, soft hernia that does not cause pain may not need treatment right away. The doctor may suggest watching and waiting for changes, like pain, to develop. If a hernia is painful or large, your doctor may suggest you see a surgeon for advice. You may need surgery to repair the hernia.

If your doctor can’t massage the intestine back into the abdomen, that means it’s trapped. A trapped intestine is dangerous because its blood supply can be cut off or strangulated.“The rim of the defect is forming a sort of a noose around the abdominal contents,” Andersen explains. “If that noose is tight enough so that the loop of intestine can’t be eased back through the defect, then the concern is that the intestine itself could be injured by strangulation.”

A strangulated hernia can be very serious and even life threatening. Symptoms include severe pain that doesn’t go away, nausea, and vomiting.

Surgery is usually needed if the intestine is trapped—and emergency surgery if it’s strangulated. A hernia is one of the most common reasons for surgery in the United States. “It’s a successful and low-risk procedure done about 800,000 times a year in the United States,” Andersen says.

If you think you may have a hernia, talk with your doctor. And check out the tips in Wise Choices for how to keep a hernia from getting worse. Keep in mind that anyone with sudden pain in the groin should immediately seek medical help.

Small Bowel Obstruction | MUSC Health

What is Small Bowel Obstruction?

From the moment you swallow food until you release the remains of your meal in a bowel movement, the entire digestive tract performs an amazing feat of moving the food through the organs by way of a special set of muscles that contract and expand. In fact, the sound you hear when your stomach growls is a result of the contractions that are going on as you digest food.

Small bowel obstruction is a potentially dangerous condition. There are a number of conditions in which the contractions of the bowel muscles make the process of moving the food very slow. These can be annoying and impact the quality of life.

There are two types of small bowel obstruction:

functional — there is no physical blockage, however, the bowels are not moving food through the digestive tract
mechanical — there is a blockage preventing the movement of food.

Funtional causes may include:

Muscle or nerve damage that may be the result of abdominal surgery, or disorders such as Parkinson’s disease
Infections
Certain medications that paralyze the contractions. Strong narcotics have this effect.

There are also serious conditions which may require immediate intervention:

Hernias — probably the most common condition in children and adults, in which a small part of the intestine protrudes through another part of the body. Adhesions may also be a cause. Scar tissue can form that blocks the intestinal canal.
Inflammatory Bowel Disease — a condition in which the walls of the intestine become inflamed
Tumors in the intestine that impede the flow
A volvulus, or a twisting of the intestine
Intussusception, a condition in which a segment of the intestine collapses into itself

Symptoms of Small Bowel Obstruction

intermittent pain due to perstalsis
distension of the stomach depending on where the obstruction is located
vomiting
constipation
fever and a racing heart

Why you need to see a physician if you suspect you have a small bowel obstruction?

If a part of the intestine becomes twisted, blood flow to that portion may be reduced, and the blocked part may die. This is a very serious condition. Another serious condition can occur in which the intestine ruptures, leaking contents into the bowel cavity. This causes an infection known as peritonitis.

Your doctor may ask you these questions about your condition:

How long have you been experiencing this problem
Have you had this condition before? Did it clear up?
Did the pain arise quickly?
Is the pain constant?
Have you ever had surgery in the abdominal area?

Diagnosis of Small Bowel Obstruction

Usually all that is required to diagnos an obstruction of the small bowel is an x-ray of the abdomen.

Luminal contrast studies
computed tomography (CT scan)
ultrasonography (US)

Once the diagnosis of bowel obstruction is entertained, location, severity and etiology are to be determined. Most importantly is the differentiation between simple and complicated obstruction.

Treatment of Small Bowel Obstruction

Antiemetics are medications that keep you from throwing up
Analgesics are mild pain relievers
Antibiotics will attack any infection you may have
Bowel decompression is a procedure in which a tube is guided into the impacted area in an attempt to reduce the pressure and address adhesions.
Surgery

Complications of Small Bowel Obstruction

Abdominal abscesses are pockets of infected pus in the abdominal cavity
Sepsis, a condition in which the blood becomes infected
Short Bowel Syndrome is a condition that results in malabsorption of nutrients

Quick intervention is the best medicine for small bowel obstructions. Complications arise quickly, and require complex surgery. Early intervention results in favorable outcomes with few complications. See your doctor if you think you may be having a problem.

90,000 ᐈ Removal of polyps in the intestine in St. Petersburg

Intestinal polyps are one of the most commonly diagnosed pathologies. Most often, they do not cause discomfort and become an accidental finding when examining the lower gastrointestinal tract.

Previously, when detecting such benign neoplasms, they adhered to expectant tactics. But the modern approach involves removing the polyp, which is considered a factor at increased risk of bowel cancer.In this case, preference is given to sparing surgical techniques; if possible, endoscopic techniques are used.

What is intestinal polyp

Intestinal polyps are soft-tissue benign lesions on the pedicle that protrude above the surface of the mucous membrane, originating from the epithelium or stroma of the intestinal wall

They are of several types:

By quantity: single and multiple. With the abundant appearance of polyps, they speak of intestinal polyposis.
Shape: drop-shaped, cauliflower-like, villous.
By tissue structure (histology): glandular (adenomatous), fibrous (connective tissue) and villous.

Small, solitary intestinal polyps rarely cause any symptoms. If they are damaged, an admixture of blood may appear in the feces, but the matter still does not reach profuse bleeding. Large and multiple polyps can disrupt the functioning of the intestinal wall, which will be accompanied by unstable stools with alternating constipation and diarrhea, polyhypovitaminosis, discomfort and even pain in the abdomen.And the formations located in the rectum can lead to deformation of the excreted feces, impurities of mucus in it.

What contributes to the appearance of polyps

Any conditions that lead to repeated trauma to the intestinal wall or contribute to its inflammation predispose to polypous growth. This could be:

Chronic constipation with frequent use of enemas and irritating laxatives further increases the likelihood of polyps.Removal of such formations is recommended to be combined with the selection of therapy to normalize the stool.
Unbalanced diet with a large amount of easily digestible refined food, fried and canned foods, low fiber in the diet, excess protein and animal fats.
Chronic diseases of the large intestine: colitis of any etiology, Crohn’s disease, ulcerative colitis.
Chronic paraproctitis, chronic rectal fissures and hemorrhoids, in which rectal polyps often have to be removed.
Frequent episodes of diarrhea of any etiology.
Hereditary burden.
Hypodynamics. Insufficient physical activity and a sedentary lifestyle contribute to intestinal dyskinesia, provoke venous congestion in the small pelvis, and negatively affect the work of all organs of the abdominal cavity.
Chronic intoxication, including bad habits (smoking, alcoholism).
Age. As the body ages, the likelihood of tumor growth increases.In most cases, surgery to remove intestinal polyps is performed on persons over 50 years of age.

The immediate causative factor in patients with a diagnosed polyp of the colon or rectum usually cannot be identified, usually they have a complex of predisposing conditions.

Why do polyps still prefer to be removed

For a long time it was believed that intestinal polyps are characterized by a low percentage of malignancy (malignancy).Therefore, the preference was given to wait and see tactics. Basically, removal of polyps in the intestine was recommended if they were large, multiple, with a wide base. Patients were also referred for surgery if follow-up showed a tendency for growth or ulceration of these tumors.

But studies have shown that up to 30% of colon polyps become malignant within 7-8 years. Therefore, at present, such formations are referred to as precancerous conditions.Moreover, neither the size nor the location of their location makes it possible to reliably assess the likelihood of degeneration into intestinal cancer.

Important! Removing polyps is the only effective way to treat them. No conservative and folk methods are able to lead to the resorption of these neoplasms and prevent their degeneration into a cancerous tumor.

When is it recommended to remove a polyp in the intestine

Indications for removing a polyp include:

Identification of bleeding, ulceration, uneven growth and or suppuration of the polyp during intestinal endoscopy.
Increase in polyp size according to dynamic observation.
Recurrent diarrhea in a patient that is not amenable to adequate medical correction and is not explained by other reasons.

Polyposis against the background of a chronic inflammatory process in the intestine, the symptoms of which cannot be stopped conservatively. Alarming signs include abdominal pain, stool instability, discomfort during bowel movements, and mucus in the stool.

In most cases, removal of intestinal polyps occurs routinely. The initial detection of such neoplasms rarely becomes a reason for emergency intervention, unless signs of their neoplastic (malignant) growth are found.

If the polyp does not cause discomfort, wait and see tactics are acceptable. But this is possible only on condition that the patient annually undergoes an endoscopic examination of the intestine to monitor the state of the detected neoplasm and adjacent sections of the intestine.Moreover, any changes in the gastrointestinal tract should be the reason for an unscheduled visit to a doctor and additional diagnostics.

Preparation for operation

Surgery to remove a polyp is called a polypectomy. When using the endoscopic technique, it does not require long-term hospitalization of the patient and refers to the so-called “one-day surgery”.

Nevertheless, even such a gentle intervention option requires some preliminary preparation, which is carried out in accordance with the doctor’s recommendations at home.It includes:

Compliance with certain dietary restrictions to prevent flatulence and constipation, natural bowel cleansing. Avoiding legumes, cabbage, fried and canned foods is recommended. With poor tolerance to dairy products, they are also limited. This diet is maintained for several days before the planned removal of the polyp. During the day before the operation, only easily digestible, liquid or semi-liquid meals should be taken.
Last meal and water intake – no later than 10-12 hours before the visit to the clinic.If this recommendation is violated, the anesthesiologist must be informed about it. These limitations are explained by the need to use general anesthesia (anesthesia) to remove the polyp.
Laxatives and a cleansing enema on the eve of the operation are performed as prescribed by the doctor.

Important! The doctor should be informed about the use of any drugs that affect blood clotting – primarily about aspirin (acetylsalicylic acid) -based drugs.

How is the removal of a colon polyp

Removal of a polyp of the rectum and large intestine is performed using a colonoscope under general anesthesia in a specially equipped room. The patient is positioned on his side. After immersion in anesthesia, the doctor carefully inserts a colonoscope into the rectum, which is an atraumatic flexible tube with manipulators, a camera and a lighting system. The doctor monitors the progress of the apparatus and the condition of the intestinal wall using a high-resolution screen.

After examining the mucous membrane and evaluating the polyp, they begin to remove it. The neoplasm is gently captured with a loop, lifted and carefully cut off from the base, while coagulating the tissue to prevent bleeding. At the same time, they try to capture a part of the surrounding healthy tissues, which serves as the prevention of recurrent growth of the polyp. The removed tissue is carefully removed and sent for histological and cytological analysis. The operation ends here.

Removal of the intestinal polyp by the endoscopic method is a gentle and, at the same time, a reliable option for surgical treatment.The use of a colonoscope allows not only to perform all manipulations with high accuracy, but also to monitor the state of the intestinal mucosa. The absence of sutures and the short duration of the operation make the recovery period as short as possible, which is also an important advantage over other methods.

Endoscopic polyp removal in ICLINIC is performed by experienced highly qualified doctors, using only modern equipment and the possibility of histological examination of the removed material.

We recommend:

FKS

FCC with the advice of a leading specialist

Endoscopic polyp removal

Appointment of a gastroenterologist

Test for the likelihood of stomach cancer

Are you over 45 years old?

Not really

Have your relatives had cancer?

Not really

Do you have chronic diseases of the gastrointestinal tract:

– chronic gastritis,
– peptic ulcer,
– chronic colitis and other inflammatory bowel diseases,
– Crohn’s disease,
– ulcerative colitis,
– previously identified polyps of the stomach and intestines,
– identified submucous epithelial formations of the gastrointestinal tract?

Not really

Have you had stomach and intestinal surgeries?

Not really

Do you have cicatricial adhesive changes in the gastrointestinal tract?

Not really

Do you smoke (more than 1 cigarette per day)?

Not really

Do you allow for errors in your diet (low consumption of fruits and vegetables, high consumption of meat and animal fats)?

Not really

You have at least one of the following symptoms:

– overweight,
– difficulty swallowing,
– irritability,
– pallor of the skin,
– chest pain,
– unmotivated weakness,
– sleep disturbance,
– loss of appetite,
– bad breath,
– belching,
– nausea and / or vomiting,
– a feeling of heaviness in the abdomen,
– changes in stool (constipation and / or diarrhea),
– traces of blood in the stool,
– abdominal pain.

Not really

Make an appointment

What are the advantages of ICLINIC?

The highest level of specialists: among them are doctors of medical sciences and members of the world’s medical communities, and the average length of service of the clinic’s doctors is 16 years of impeccable work.
Modern expert equipment: diagnostic devices of the medical center were released in 2017 by the world’s leading manufacturers (Pentax and others of the same level).
Impeccable endoscopic diagnostic accuracy thanks to high image resolution of 1.25 million pixels.
Unique technologies for early diagnosis of cancer, including i-scan – virtual chromoendoscopy. With the help of this technology, even the smallest, initial tumor changes can be recognized.
Everything for the patient’s comfort: effective pain relief, including general anesthesia; thin endoscopes less than 10mm in diameter; fast and accurate handling.
Safety: automated disinfection of equipment with quality control, monitoring of vital functions of the patient during research.
Narrow specialization: the medical center deals with diseases of the digestive system, constantly improving in its particular field. Our specialists are constantly undergoing advanced training, participate in international conferences, trainings and seminars in Russia and Europe.
Convenient location: Petrogradskiy district of St. Petersburg is located not far from the center.It is convenient to get here both by car and by public transport. Chkalovskaya metro station is located very close to the clinic, and also not far from the medical center of St. Petersburg Sportivnaya, Petrogradskaya and Gorkovskaya stations.

Our professionalism is always on guard for your health.

90,000 Colon polyps, diagnosis and treatment “In good hands”

Polyps are formations that protrude into the lumen of an organ and are benign in nature.

Colon polyps are a common pathology in people of different ages. Visually distinguish polyps on a “leg” or on a wide base. They come in a variety of sizes and shapes.

By morphological structure, polyps are divided into:

Adenomatous (prone to degeneration and transformation into cancer, according to the literature in 75% of cases)
Hyperplastic (from the intestinal mucosa, benign)
Juvenile (hamartoma – consists of the same tissues as the organ, but with an abnormal structure and degree of tissue differentiation, usually benign)

The larger the size of the adenomatous polyp, the more options for its transformation into a malignant process, especially in polyps with a broad base.

Adenomatous polyps during histological examination are divided into: glandular, villous and mixed. Timely diagnosis and detection of polyps with their subsequent removal and histological examination is the key to the prevention and early diagnosis of colorectal cancer. In people with a hereditary predisposition to polyposis or with oncological alertness, it is recommended to undergo a colonoscopy once every 1-2 years.

The most informative diagnostic method and at the same time the ability to remove a colon polyp in any of its parts is colonoscopy.It is possible to carry it out under anesthesia (“in a dream”) and without it.

The factors that predispose to the appearance of polyps are:

Hereditary predisposition, family history
Inflammatory bowel disease
Functional diseases of the gastrointestinal tract (problems with motility of the colon: constipation and / or diarrhea)
Sedentary lifestyle and insufficient water intake
Stress factors
Unhealthy diet: high levels of animal fat in food, insufficient fiber intake
Dysbacteriosis of various etiology
Colon anomalies, etc.

Clinical manifestations of the presence of polyps in the colon are usually absent. Possible complaints include: sometimes blood in the stool, flatulence, bloating in the abdomen, chronic constipation and / or diarrhea.

When complaints appear, with an existing family predisposition, it is necessary to consult a proctologist. At the consultation, the doctor will carefully collect complaints, anamnesis, conduct an examination and prescribe appropriate examinations (for example, feces for occult blood, sigmoidoscopy or colonoscopy, etc.).

In our medical center you can get advice from proctologists: A.A. Kryachko, as well as A.N. Igolkina. on all planning and urgent issues (emergency).

90,000 Crooked teeth – a solution to the problem from the clinic of aesthetic dentistry Prosmile.Ru

Crooked teeth, at first glance, are a purely aesthetic problem. It would seem that it’s terrible that one
or have a few teeth grown a little off where they should be? Curvature of the teeth can spoil the smile or give it
a certain emotional coloring (for example, protruding front incisors in most people are associated with excessive
simplicity of character, and the lower ones that go inward give the smile a predatory expression).But the biggest problem with curves
teeth in their negative impact on health.

This is because crooked teeth are difficult to clean properly. In places where due to wrong
bite there is no access to a toothbrush, bacteria accumulate, tartar forms, which leads to caries and periodontitis.
In addition, uneven teeth shift the jaw, which can cause problems when chewing and swallowing food, and therefore
and diseases of the stomach and intestines. A crooked tooth, shifting the lower jaw to the side, has a negative effect on the mandibular
joint, which can cause headaches.

In general, malocclusion is a matter of not only aesthetic but also practical importance. Hence,
the problem must be solved before it causes more problems. So, consider what the varieties are
uneven teeth and how to fix it.

Uneven dentition. The teeth seem to fit over each other.

Solution: You can fix the situation by installing
braces.
It is possible to use plastic, metal,
ceramic or sapphire systems.Today, sapphire braces are the most widely used.
Due to their light transmission, they are barely visible on the teeth. By establishing the so-called
“Smart braces”, you can avoid many problems, as they themselves correct the position of the teeth
in the right directions. Braces are installed for patients of different ages, including people
mature. Treatment with braces before prosthetics is very effective, as it allows you to achieve
better results than without braces.There are modern systems
inconspicuous
braces that adhere to the inner (invisible) side of the teeth, incognito braces are especially effective.
Before placing braces, the oral cavity must be sanitized. The time of wearing braces – from
six months to two years, in severe cases, treatment may last longer. During the period of their wearing
a regular visit to an orthodontist and a hygienist doctor is mandatory for professional
oral hygiene.

Uneven dentition with slight curvature of the teeth.

Solution: It is possible to use removable
kappa – one of
the latest techniques in orthodontics. These mouthguards are made of transparent material using modern technology. As
To align the teeth, a new aligner is required until the desired evenness of the dentition is achieved.
This method is especially effective for adolescents, since their teeth are quite mobile and can be easily corrected.

Single curve or protruding tooth

Solution: As a rule, if a person notices only one crooked tooth, and believes that
the whole trouble is only in him, then, most likely, he is mistaken.The ugliest tooth always catches the eye, and it is worth it
fix how the other begins to annoy. Unfortunately, there is an opinion that braces or aligners are needed for extensive
pathology. The protruding tooth must be inscribed in the dentition, and there is not always a place for it. There are correction techniques
with a filling or veneer, but they have many drawbacks and cannot always return the patient to the desired functionality
tooth. In most cases, the upper canines are protruding, since they erupt later and they do not always have enough space,
therefore, it is orthodontic treatment that is the benchmark in correcting crooked and protruding teeth.

Surface irregularities

Solution: Application of direct or indirect veneers.
Veneers –
thin restorations or onlays on the anterior tooth surface. In the process of installing them, the dentist removes
a thin layer of tooth enamel and with the help of special durable glue attaches a thin plate – veneer. This technique
allows you to get the perfect shape and color of your teeth.

Our dentists will find an individual solution for your smile!
ProSmile Clinic.ru – generator of healthy and happy smiles!

90,000 2.4.2.1. Endoscopic methods / ConsultantPlus

2.4.2.1. Endoscopic methods.

– Colonoscopy is recommended for all patients, and in the absence of changes in the colon – double-balloon enteroscopy in order to diagnose and determine the source of bleeding [3, 4, 31].

Strength of recommendation C (evidence level 4)

Commentary.On endoscopic examination, acquired angiodysplasia may look like a rounded, bright red or cherry-colored mucous membrane that does not protrude into the lumen of the intestinal wall. Moderately dilated convoluted vessels radiate from it over a length of 7-10 mm. The size of these pathological formations is from 0.3 to 0.7 cm. The formations are easily injured, with the appearance of blood droplets. The small size of the vascular pathological formation can also be attributed to the characteristic signs of acquired angiodysplasia.According to the largest study in our country, in most patients, angiodysplasias are localized in the right sections of the colon and terminal section of the ileum, which is another characteristic feature of this disease [3, 4]. Two-balloon enteroscopy with examination of the entire small intestine is also quite informative research [10, 32, 33]. So in a meta-analysis by Brito H. et al. (2018), who combined the results of 17 studies and included 1477 cases, speaks of the high diagnostic value of double balloon enteroscopy in identifying the source of bleeding.The sensitivity of the method was 84%, and the specificity was 92%. The authors note that performing double balloon enteroscopy after video capsule small bowel endoscopy increases the chances of identifying the source of bleeding by 7% [31].

– Patients who have not been diagnosed with colonoscopy and double-balloon enteroscopy, if it is technically possible to examine the small intestine, video capsule endoscopy is recommended [34]

Strength of recommendation A (level of evidence – 1)

Commentary.Video capsule endoscopy is used to identify the source of latent bleeding. Both methods can be used when all other methods of detecting the source of bleeding have already been exhausted. The diagnostic value of small bowel video capsule endoscopy and two-balloon enteroscopy in identifying the source of small bowel bleeding is 38–83% [35, 36] and 58% [37], respectively. The results of the latest meta-analysis confirm the findings [34]. In two independent studies, it was suggested that video capsule endoscopy and double balloon enteroscopy are complementary methods and should be used together to find the source of small bowel bleeding [33, 38].

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Kefir, cabbage and kvass in the service of immunity

Strong immunity – reliable protection of a person from any misfortunes, created and improved in the course of evolution. The human body has several lines of defense: frontline attacks are repelled by the conglomerate of bacteria that inhabit our skin. The most insidious enemies who have managed to break through this line are dealt with by the “elite special forces” of cellular immunity.But Antonina Sarangova, Candidate of Biological Sciences, Associate Professor of the Department of Biophysics of the Siberian Federal University, tells about the intestinal-based immunity support group.

– The topic of “smart gut” is now very popular with science journalists and bloggers. Where does such an interest in the digestion process come from, and what does our immunity have to do with it?

– The word immunity comes from the Latin immunitas – liberation (from foreign, harmful), immunity. Scientists have been thinking about the role of microbes in the world around them since the time of Louis Pasteur.Gradually, knowledge about these creatures, their influence on other organisms increased. An epochal event was the realization that the microbiota of the body is an integral part of it. Moreover, this microbiota forms, develops and “learns” together with the body and, perhaps, even significantly affects it.

It is generally accepted that the number of microbial “population” in the gastrointestinal tract increases “from top to bottom”: the stomach is the least populated, where mainly lacto- and bifidobacteria, micro- and streptococci, resistant to an acidic environment, and the “population density” is only 10 ³ CFU / ml.In the small intestine, the number of “residents” and their diversity increases to 400 species (10 ³ –10 ⁵ CFU / ml), and the large intestine is most populated by various bacteria, containing up to 500 species of bacteria, the number of which is 10 ¹² CFU / ml – 8 orders of magnitude higher. Perhaps this can be compared with the number of inhabitants of various cities and countries: 10 ³ – like a village with a thousand inhabitants, 10 ⁵ – a city slightly smaller than the city of Abakan in the Krasnoyarsk Territory, and 10 ¹² – this is already a hundred countries, each of which is as densely populated as China… What does this mean? Exactly that the mucous membrane of the large intestine is incredibly densely colonized by microbes that form a complex relationship with our body.

The settlement of the “megacities” of the gastrointestinal tract begins in infancy and proceeds in accordance with the cultural traditions of the family and the individual characteristics of the child. Through complementary foods, we gradually tune the children’s intestines to digest various nutrients and create conditions for populating it with various microbes that will specialize in breaking down nutrient substrates.Simply put, we form a normal microflora for our children, and by a certain age, microbial associations “start up” in their intestines, helping to fully assimilate foods that will have to be eaten throughout their lives.
Once in your stomach, your meal (and with it bacteria) is relentlessly attacked by gastric juices. But part of the bacteria, nevertheless, passes the acid barrier, partly bypasses the small intestine and is retained in the large intestine. This is where everything interesting happens.

– Who lives there?

– Firstly, the large intestine is abundantly populated with bifidobacteria, which perform an important function: they secrete a number of metabolites, for example, acidic products or lysozyme, which act as antagonists for pathogenic microflora.Secondly, by lactobacilli. They contribute to the production of immunoglobulins – this is a very ancient form of immunity, inherited from our most distant ancestors. Immunoglobulins are blood plasma proteins that react with antigens in a specific, only inherent way, neutralizing the latter. Bacteria, by attaching to the intestinal mucosa, cause the body to produce these proteins, thereby forming the body’s defense system against infections. In addition, the entire intestinal microflora produces vitamins and minerals vital to humans.

And also bifidobacteria and lactobacilli, like other representatives of microflora, participate in colonization resistance, that is, they provide a stable colonization of the intestinal mucosa, preventing the pathogenic flora from settling “in the neighborhood”. This process is hourly and continuous. The microflora of the gastrointestinal system is constantly “updated”, just like the software on a smartphone.

– As far as I understand, bifidobacteria and lactobacilli lead us to the topic of pre- and probiotics.What is the connection between them and why do we need these pre and pro?

Prebiotics – preparations of non-microbial content, often low-molecular, fast-digesting carbohydrates. They are needed to stimulate the growth of intestinal microflora and act as growth factors for microbes.

Probiotics are real living bacteria, the very bifidobacteria and lactobacilli. They are designed to have a beneficial effect on physiological, biochemical and immune responses. Probiotics are available in drugstore form.They are prescribed by a doctor in case of proven disorders of the gastrointestinal tract.

Not long ago it seemed that only prebiotics could be used. Scientists believed that by using growth factors, a person sufficiently stimulates the growth of the “correct” gastrointestinal flora. Moreover, the production of prebiotics is technologically simpler, they are stored for a relatively long time and do not require a special temperature regime. However, it quickly became clear that it is still necessary to populate living cells into the “inner world” of a person.At the household level, we replenish our body with probiotics by using fermented milk products.

– How can you not remember the beautiful bottles of yoghurt and related advertising promising to increase immunity in the season of colds.

– In fact, yoghurts, no matter how banal, are different. Some are really not worth waiting for. If the packaging indicates a long shelf life (six months to a year), the composition includes sugar and dyes – this is not a product for which the microflora will thank you.The shorter the shelf life and the simpler the type of yogurt (there are no intricate additives in the composition, the color is close to the natural shade of milk), the better.

As we have already found out, in yoghurts, as in all fermented milk products, there are probiotics – living bacteria that can be naturally transported into the body and populate the intestines. It would seem – what is the problem? We buy kefir or yogurt marked 1 * 10 ⁷ CFU / g. (this means that one gram of the product contains at least 10 million living bacteria) and we live in peace.But it’s not that simple.

On the way from production to the consumer, dairy products undergo a constant change in temperature – they are either in the refrigerator or warm, and so that over time the product is not acidified by metabolites, acidity stabilizers or preservatives are added to it. Not all bacteria can survive this. But with those few survivors who have reached, in spite of everything, the intestines, we will get the results of the metabolism of bacteria – the useful substances and vitamins produced by them.And only a few living cells from yoghurt “thrown” into our body will be able to reach the small intestine.

– Does this mean that yoghurts, kefirs and other fermented milk products are useless?

– Not at all! You get milk protein, fat, carbohydrates and essential metabolic products of beneficial lactobacilli and bifidobacteria, why not? You just don’t have to believe in the philistine picture that you drank yogurt – and a huge landing of the necessary bacteria landed in the intestines.Of the 10 million cells per gram, only a few will remain, which will almost transit through the small intestine, which, as we remember, is sparsely populated both numerically and in terms of species diversity. But in the large intestine, these cells will linger and begin to develop, form a rich microbial association. Therefore, our large intestine is inhabited by almost five hundred types of bacteria!

All naturally fermented products are very useful: for our compatriots they are sauerkraut, kefir, yogurt, sour cream, cheese, kvass.Note that you should not add moldy cheeses to this list, unless you are a hereditary French. The intestines are trained, and from the very birth of a child it learns to work on a certain “fuel”. The French do an excellent job with special food mold, the Balkan peoples adore “Bulgarian” yoghurt, pickled turnips and apples, the people of the Caucasus make delicious yogurt yogurt and dishes based on it. “Where I was born – there it came in handy”, each culture has its own ethnic strain of bacteria, most compatible with the microbiome of local residents.

– I can’t help but ask about the effect on the immunity of ginger – due to the spread of coronavirus infection, prices for this popular spice have increased significantly …

– It is necessary to recall the main task of spices and herbs, to which it is customary to refer to the root of ginger. The pungent taste of some spices irritates cellular receptors and intensifies the exchange of fluids (in particular, blood). Metabolic processes are accelerated, cells receive useful substances faster. There are no specific components that magically scare off viruses in ginger.I think the hype around this product is more likely related to the desire of people to do something during the epidemic, somehow quickly protect themselves with the help of a well-known and affordable product. The same story is with lemons, which we usually use for colds. By the way, why do we want sour drinks and do not want sweets? Sour creates conditions for the reproduction of the aforementioned bifidobacteria. Sweet is the substrate for yeast to multiply.

In addition, immunity cannot be bought either with the help of ginger or for a lemon (especially since lemon is inferior in vitamin C content to black currants and rose hips, and it is sour due to citric acid).Immunity is formed, trained, educated, and it takes time. And also a certain lifestyle.

– What else would you advise during the period of self-isolation, besides the reasonable consumption of fermented foods that are useful for “intestinal” immunity?

– More physical activity! Otherwise, even the most healthy foods will not work as they should, and the consumption of calories without their intensive consumption will affect health and weight.

– Not all people tolerate dairy products well.What is the reason for this, and what should those who cannot tolerate whole cow’s milk do?

– The intestines know how to exercise, as we have already said. If a person has been drinking milk all his life and feels fine, then that’s great. If, with age, a person has a decrease in the amount of an enzyme that processes milk, and he began to perceive this product worse, it is better to switch to fermented milk products. If you can’t look at milk from childhood, you don’t need to torture yourself. You can find fermented milk products that suit you personally.For example, ferment milk with “narine” sourdough.

Worm remedy proved effective against COVID-19

https://ria.ru/20210808/koronavirus-1744923512.html

Worm remedy proved effective against COVID-19

Worm remedy proved effective against COVID-19 – RIA Novosti, 08.08.2021

A remedy for worms proved to be effective against COVID-19

A remedy for parasites may become a successful medicine in the fight against the spread of coronavirus, experts from the Scripps Institute (USA) said.Results … RIA Novosti, 08.08.2021

2021-08-08T13: 38

2021-08-08T15: 31

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MOSCOW, August 8 – RIA Novosti. A remedy for parasites can become a successful medicine in the fight against the spread of coronavirus, experts from the Scripps Institute (USA) said. The results of the study, published in the scientific journal ACS Infectious Disease, have been shown to be effective against certain infections in salicylanides – drugs for parasites – that have been proven ten to fifteen years ago. However, according to the authors of the new work, the area of action of such drugs is usually limited to the intestines, and sometimes they can be toxic to the body.When the world faced a pandemic last year, scientists decided to test the effect of salicylanides on COVID-19, taking into account all the antiviral properties of the substance. One of the compounds (No. 11) was distinguished by the ability to pass through the intestine and be absorbed into the bloodstream without causing toxicity. The study showed that it also prevents cell infection. “The compound blocks the release of viral material, and it simply disintegrates. This process prevents SARS-CoV-2 from replicating,” said one of the authors of the work, Kim Janda.In experiments on mice, salicylanide # 11 reduced levels of inflammation, as well as interleukin-6, a protein that is a key factor in inflammation and, as a result, cytokine storm. Scientists now plan to confirm their findings in complex animal tests, and then conduct clinical studies. In their opinion, in the face of the emergence of more aggressive strains of SARS-CoV-2, the agent will be able to protect people, especially those who are unable to vaccinate.

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in the world, society, science, usa, health – society, coronavirus covid-19
13:38 08.08.2021 (updated: 15:31 08.08.2021)
Worm remedy proved to be effective against COVID-19
MOSCOW, 8 Aug – RIA Novosti. A parasite remedy could be a successful drug in the fight against the spread of coronavirus, said experts from the Scripps Institute (USA).The research results are published in the scientific journal ACS Infectious Disease.
The substances contained in salicylanides – drugs for parasites – are effective against certain infections, which was proven ten to fifteen years ago. However, according to the authors of the new work, the area of action of such drugs is usually limited to the intestines, and sometimes they can be toxic to the body.
April 20, 02:07 Spread of coronavirus Immunologist named a remedy for coronavirus with weakened immunity
When the world faced a pandemic last year, scientists decided to test the effect of salicylanides on COVID-19, taking into account all the antiviral properties of the substance.One of the compounds (No. 11) was distinguished by the ability to pass through the intestine and be absorbed into the bloodstream without causing toxicity.
Research has shown that it also prevents cell infection. “The compound blocks the release of viral material, and it simply disintegrates. This process prevents SARS-CoV-2 from replicating,” said one of the authors of the work, Kim Janda.
In experiments on mice, salicylanide # 11 reduced the levels of inflammation, as well as interleukin-6, a protein that is a key factor in inflammation and, as a result, cytokine storm.
Scientists now plan to validate their findings in sophisticated animal tests and then conduct clinical studies. In their opinion, in the face of the emergence of more aggressive strains of SARS-CoV-2, the agent will be able to protect people, especially those who are unable to vaccinate.
July 30, 11:10 Spread of coronavirus Scientists announced the creation of the most effective antibodies to coronavirus 90,000 Polyps in the intestine and stomach. Biopsy of a polyp of the stomach.
Polyps are any benign formations on the mucous membrane that protrude into the lumen of a hollow organ.Despite their benign nature, polyps are not at all harmless, since they can contribute to the development of various complications in those organs where they are localized. So, for example, often the cause of stomach cancer is not timely cured polyps. Also, polyposis can lead to bleeding, perforation, bowel obstruction.
There are polyps of various sizes and shapes, on a pedicle and on a broad base, with a smooth, villous, lobed or ulcerated surface. Finally, they can be single and multiple, or they can cover almost the entire mucous membrane (for example, the stomach).
1
Colon polyp on a long stem
2
Colon polyp
3
Hemispherical colon polyp
In terms of the frequency of localization in different parts of the gastrointestinal tract, polyps in the stomach are “in the lead”. Often polyps are also localized in the rectum and colon, less often in the esophagus, duodenum and small intestine.
Polyps in the stomach and intestines may not show any symptoms for many years, while gradually degenerating into cancer – adenocarcinoma.Signs such as pain and fever, obstruction, exhaustion, anemia, etc. appear at a late stage of the disease.
Reasons for the formation of polyps
Scientists have not yet come to a consensus about the etiology of polyps. The most common are the inflammatory theory and the theory of embryonic ectopia (displacement – congenital or acquired – of tissue in an unusual place for it), etc.
Polyps of the stomach and intestines are often found in patients with various gastroenterological pathologies (eg., gastritis, the presence of pathogenic Helicobacter pylori infection).
Polyps, as a rule, develop against the background of pre-existing gastroenterological diseases. Therefore, it is so important for patients with identified pathology to be monitored by a gastroenterologist and regularly undergo endoscopic examinations. The final diagnosis is made by biopsy of polyps of the stomach and intestines.
Risk factors for the development of polyps in the stomach and intestines are also age over 40, heredity, long-term use of certain medications, etc.
Symptoms of polyps in the stomach
Polyps in the stomach in 80% of cases develop in the antrum, but there is also another localization. Among polyps of various shapes and sizes, a polyp on a broad base that has grown to a significant size is especially dangerous from the point of view of malignancy.
Unfortunately, timely detection of polyps in the stomach is difficult, since they develop asymptomatically for a long time. In a similar situation, they become an accidental finding during gastroscopy or fluoroscopy.
Pain in stomach polyps occurs with a pronounced inflammatory process and is localized under the spoon (more often as a reaction to food intake).
If the polyposis overgrowth blocks the outlet from the stomach, vomiting occurs. Typical signs are nausea, belching, bitter taste in the mouth. With ulceration of the polyp, gastric bleeding occurs (in this case, blood appears in the vomit and feces, and there are also signs of anemia). Acute cramping pains in the epigastric region indicate a possible infringement of a polyp on a long leg when it flows into the duodenum.
With malignancy of the polyp, general weakness, weight loss, and lack of appetite are noted. Unfortunately, the process of the transition of a polyp to a cancerous formation cannot be traced. Therefore, when detecting polyps of the stomach, the patient should be under the dispensary supervision of a gastroenterologist.
Symptoms of polyps in the intestine
In most cases, polyps in the intestine do not bother the patient, do not affect the functioning of the organ. With a significant growth of the polyp, constipation may occur, and with its ulceration, bleeding from the rectum.Abundant mucous discharge from the rectum is possible (with villous polyps, which are the most dangerous due to possible degeneration into cancer).
Diagnostics and treatment of polyps of the stomach and intestines
The most effective type of diagnosis in the study of polyps of the stomach and intestines is the endoscopic method, which allows you to establish the size, shape, localization of the formation, perform targeted biopsy and determine the tactics of treatment.

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