A congenital condition in which abdominal content protrudes through the defect in the abdominal wall and is not covered with sac is?

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Explanation

Gastroschisis is a congenital defect of the anterior abdominal wall, resulting in the protrusion of abdominal contents.
The key feature is the absence of a protective sac or membrane covering the exposed organs, which are typically the intestines.
The defect is usually located to the right of an intact umbilical cord.
Because the bowel is exposed to amniotic fluid in utero and air after birth, it often appears thickened, matted, and edematous.

Option A: Omphalocele is incorrect because in this condition, the herniated abdominal contents are covered by a protective sac composed of peritoneum and amnion. The defect is at the midline, directly involving the umbilical cord insertion.
Option B: An umbilical hernia is a smaller defect at the umbilical ring, but the protruding contents are covered by skin and subcutaneous tissue, not exposed.
Option C: An incisional hernia is an acquired condition that develops at the site of a previous surgical incision due to weakness in the abdominal wall. It is not a congenital defect present at birth.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Congenital abdominal wall defects as background academic context rather than a clinical decision trigger.
Immediate nursing care for a newborn with gastroschisis is life-saving and focuses on preventing hypothermia, fluid loss, and infection of the exposed bowel.
The exposed viscera must be immediately covered with sterile, warm, saline-soaked dressings and then placed in a sterile bowel bag or covered with plastic wrap to minimize heat and water loss.
These infants require urgent surgical consultation and are typically transferred to a neonatal intensive care unit (NICU) with pediatric surgery capabilities.

How to Approach the Question

First, identify the key terms in the question: 'congenital,' 'abdominal content protrudes,' and the most crucial differentiator, 'not covered with sac.'
Analyze the options based on your knowledge of congenital abdominal wall defects.
Recall the primary distinction between Gastroschisis and Omphalocele: the presence of a sac (Omphalocele) versus the absence of a sac (Gastroschisis).
The phrase 'not covered with sac' directly points to Gastroschisis as the correct answer.
Eliminate the other options based on their definitions. Umbilical hernia is covered by skin, and incisional hernia is an acquired condition, not congenital.

Concept Tested & Keywords

Concept Tested: Congenital abdominal wall defects
Stem keywords: congenital condition, abdominal content protrudes, defect in abdominal wall, not covered with sac
Lead-in keywords: is
Negative lead-in flag: false

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1142-1144

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 755-757

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