Diaphragmatic hernia

The diaphragm is a dome-shaped muscular barrier between the chest and abdominal cavities. It separates your heart and lungs from your abdominal organs (stomach, intestines, spleen, and liver).
A diaphragmatic hernia occurs when one or more of your abdominal organs move upward into your chest through a defect (opening) in the diaphragm. This kind of defect can be present at birth or acquired later in life. It’s always a medical emergency and requires prompt surgery to correct.

1. Diaphragmatic
Hernia
NAME: MEMOONAARSHAD
GROUP 11 –6
TH
SEMESTER
UNIVERSITY: ISM –IUK
PRESENTED TO: SAPARBEKOVJ.S

2. What is
Diaphragmatic
Hernia?
Thediaphragmisadome-shaped
muscularbarrierbetweenthechestand
abdominalcavities.Itseparatesyourheart
andlungsfromyourabdominalorgans
(stomach,intestines,spleen,andliver).
Adiaphragmaticherniaoccurswhenone
ormoreofyourabdominalorgansmove
upwardintoyourchestthroughadefect
(opening)inthediaphragm.Thiskindof
defectcanbepresentatbirthoracquired
laterinlife.It’salwaysamedical
emergencyandrequirespromptsurgeryto
correct.

3. Explanation of Diaphragmatic Hernia with Visual
▪Thisisaphotoofaperitoneopericardial
diaphragmaticherniainacat.
▪Thephotowastakenduringnecropsyfrom
therightsideofthecat.
▪Totheleftistheabdomen,wherepartof
theliverandthegallbladdercanbeseen.
▪Thediaphragmisinthemiddle.Tothe
rightisthethorax.
▪Thelargestobjectseeninthethoraxisthe
restoftheliver.
▪Justtotherightofthatistheheart.
▪Theliverwasconnectedtoitselfthrougha
smallholeinthediaphragm(notseen).

4. What are the types of Diaphragmatic Hernia?
▪Congenitaldiaphragmatichernia
▪Congenitaldiaphragmatichernia(CDH)isabirthdefectofthediaphragm.
▪Morgagni'shernia
▪ThisrareanteriordefectofthediaphragmisvariablyreferredtoasaMorgagni,retrosternal,orparasternalhernia.
▪Accountingforapproximately2%ofallCDHcases,itischaracterizedbyherniationthroughtheforaminaofMorgagni
whicharelocatedimmediatelyadjacentandposteriortothexiphoidprocessofthesternum.
▪Bochdalekhernia
▪TheBochdalekhernia,alsoknownasapostero-lateraldiaphragmatichernia,isthemostcommonmanifestationof
CDH,accountingformorethan95%ofcases.
▪Hiatalhernia
▪Ahiatalherniaisatypeofherniainwhichabdominalorgans(typicallythestomach)slipthroughthediaphragmintothe
middlecompartmentofthechest.
▪Iatrogenicdiaphragmatichernia
▪Iatrogenicdiaphragmaticherniaisrarecomplicationsofthoracicorabdominalsurgery,havingbeendescribedfollowing
esophagectomy(1),gastrectomy(2),laparoscopiccholecystectomy(3),andnephrectomy(4).
▪Traumaticdiaphragmatichernia
▪Diaphragmaticrupture(alsocalleddiaphragmaticinjuryortear)isatearofthediaphragm,themuscleacrossthe
bottomoftheribcagethatplaysacrucialroleinbreathing.

5. What is the path physiology of Diaphragmatic
Hernia?
▪Thepathophysiologyofacquireddiaphragmaticherniasincludes
circulatoryandrespiratorydepressionsecondarytodecreased
functionofthediaphragm,intrathoracicabdominalcontents
leadingtocompressionofthelungs,shiftingofthemediastinum,
andcardiaccompromise.

6. What are the causes of a Diaphragmatic Hernia?
▪Acongenitaldiaphragmatichernia(CDH)isduetotheabnormaldevelopmentofthe
diaphragmwhilethefetusisforming.
▪Adefectinthediaphragmofthefetusallowsoneormoreoftheirabdominalorganstomove
intothechestandoccupythespacewheretheirlungsshouldbe.
▪Asaresult,thelungscan’tdevelopproperly.Inthemajorityofcases,thisaffectsonlyone
lung.
▪Anacquireddiaphragmatichernia(ADH)isusuallytheresultofabluntorpenetratinginjury.
▪Trafficaccidentsandfallscausethemajorityofbluntinjuries.
▪Penetratinginjuriesareusuallyduetostaborgunshotwounds.
▪Surgeryontheabdomenorchestmayalsocauseaccidentaldamagetoyourdiaphragm.
▪Rarely,thediaphragmaticherniamayoccurwithoutaknownreasonandgoundiagnosedfora
periodoftime,untilitbecomessevereenoughtocausesymptoms.

7. How Many Babies are Born with Diaphragmatic
Hernia?
▪Researchersestimatethatabout1inevery3,600babiesisborn
withdiaphragmaticherniaintheUnitedStates.
▪Abouthalfofallnewbornswhohavediaphragmaticherniaalso
haveotherconditions,includingbirthdefectsofthebrain,heart,
andintestines.

8. What are the risk factors for a Diaphragmatic
Hernia?
▪Mostcongenitaldiaphragmaticherniasareidiopathic;theircauseisunknown.
▪Itisbelievedacombinationofseveralfactorsleadtotheirdevelopment.
▪Chromosomalandgeneticabnormalities,environmentalexposuresand
nutritionalproblemsmayallhavearoleintheformationofthesehernias.
▪Itcanalsooccurwithotherorganproblemssuchasabnormaldevelopmentof
theheart,gastrointestinal,orgenitourinarysystems.
▪Thefollowingfactorsmayincreaseyourriskofanacquireddiaphragmatic
hernia:
▪bluntinjuriesduetoatrafficaccident
▪surgicalproceduresonthechestorabdomen
▪fallsthatimpactthediaphragmregion
▪stabwounds
▪gunshotwounds

9. What are the symptoms of a Diaphragmatic
Hernia?
▪Theseverityofsymptomswithadiaphragmaticherniacanvary
dependingonitssize,cause,andtheorgansinvolved.
▪DifficultyBreathing
▪Tachypnea(rapidbreathing)
▪Bluediscolorationoftheskin
▪Tachycardia(rapidheartrate)
▪Diminishedorabsentbreathsounds
▪Bowelsoundsinthechestarea
▪Lessfullabdomen

10. Difficult Breathing
▪Thisisusuallyverysevere.Ina
CDH,itresultsfromtheabnormal
developmentofthelungs.
▪InanADH,itoccurswhenthe
lungscan’tfunctionproperlydue
tocrowding.

11. Tachypnea (rapid breathing)
▪Yourlungsmaytryto
compensateforthelowlevelsof
oxygeninyourbodybyworkingat
afasterrate.

12. Blue discoloration of the skin
▪Whenyourbodydoesn’treceive
enoughoxygenfromyourlungs,
itcanmakeyourskinappear
blue(cyanosis).

13. Tachycardia (rapid heart rate)
▪Yourheartmaypumpmore
rapidlythannormaltotryto
supplyyourbodywithoxygenated
blood.

14. Diminished or absent breath sounds
▪Thissymptomiscommoninthe
caseofaCDHbecauseoneof
thebaby’slungsmaynothave
formedproperly.
▪Thebreathsoundsonthe
affectedsidewillbeabsentor
verydifficulttohear.

15. Bowel sounds in the chest area
▪Thisoccurswhenyourintestines
moveupintoyourchestcavity.

16. Less full abdomen
▪Yourabdomenmaybelessfull
thanitshoulduponpalpation(an
examinationofthebodyby
pressingoncertainareas).
▪Thisisduetoabdominalorgans
beingpushedupintothechest
cavity.

17. How is a Diaphragmatic Hernia diagnosed?
▪Doctorscanusuallydiagnoseacongenitaldiaphragmaticherniabeforethe
babyisborn.
▪Abouthalfthecasesarerevealedduringanultrasoundexaminationofthe
fetus.
▪Theremayalsobeanincreasedamountofamnioticfluid(thefluidthat
surroundsandprotectsthefetus)withintheuterus.
▪Afterbirth,thefollowingabnormalitiesmayappearduringaphysical
examination:
▪abnormalchestmovements
▪difficultybreathing
▪bluediscolorationtotheskin(cyanosis)
▪absentbreathsoundsononesideofthechest
▪bowelsoundsinchest
▪a“half-empty”feelingabdomen

18. How is a Diaphragmatic Hernia diagnosed?
(Contd..)
▪ThefollowingtestsareusuallysufficienttodiagnoseeitheraCDH
oranADH:
▪X-ray
▪ultrasoundscan(usessoundwavestoproduceimagesofthethoracic
andabdominalcavitiesandtheircontents)
▪CTscan(allowsfordirectviewingoftheabdominalorgans)
▪arterialbloodgastest(takesblooddirectlyfromanarteryandtestsfor
levelsofoxygen,carbondioxide,andacidity,orpHlevel)
▪MRI(formorefocusedevaluationoforgansespeciallyinafetus)

19. How is a Diaphragmatic Hernia treated?
▪Bothcongenitalandacquired
diaphragmaticherniastypically
requireurgentsurgery.
▪Surgerymustbeperformedto
removetheabdominalorgans
fromthechestandplacethem
backintotheabdomen.
▪Thesurgeonwillthenrepairthe
diaphragm.

20. How is a Diaphragmatic Hernia treated? (Contd..)
▪WithaCDH,surgeonsmayperformsurgeryasearlyas48to72hoursafterthe
babyisdelivered.
▪Surgerymayoccurearlierinemergencysituationsoritmaybedelayed.
▪Everycaseisdifferent.
▪Thefirststepistostabilizethebabyandincreaseitsoxygenlevels.
▪Avarietyofmedicationsandtechniquesareusedtohelpstabilizetheinfantand
assistwithbreathing.
▪ThesebabiesarebestcaredforatacenterwithahighlyspecializedNeonatal
IntensiveCareUnit(NICU).
▪Oncethebabystabilizes,thensurgerycanoccur.
▪WithanADH,thepatienttypicallyneedstobestabilizedbeforesurgery.
▪BecausemostcasesofADHareduetoinjury,theremightbeother
complicationssuchasinternalbleeding.
▪Therefore,thesurgeryshouldhappenassoonaspossible.

21. Visual representation of Normal & Herniated baby

22. How can a Diaphragmatic Hernia be prevented?
▪Currently,thereisnoknownwaytopreventaCDH.
▪Earlyandregularprenatalcareduringpregnancyisimportanttohelp
detecttheproblembeforebirth.
▪Thisallowsforproperplanningandcarebefore,during,andafter
delivery.
▪SomebasicpreventivemeasuresthatcanhelpyouavoidanADH
include:
▪Drivingsafelyandalwayswearingaseatbelt.
▪Avoidingactivitiesthatmakeyoupronetosignificantbluntinjuriestothe
chestorabdomen,suchasextremesports.
▪Limitingalcoholandavoidingdrugusewhichcanmakeyoumoreproneto
accidents.
▪Exercisingcautionaroundsharpobjects,suchasknivesandscissors.

23. What is the long-term outlook for Diaphragmatic
Hernia?
▪TheoutlookforaCDHdependsonhowdamagedthelungsare,as
wellastheseverityofinvolvementofotherorgans.
▪Accordingtocurrentresearch,theoverallsurvivalratefor
congenitaldiaphragmaticherniasis70-90percent.
▪ThesurvivalrateforanADHcorrelatesdirectlywiththetypeof
injury,age,andoverallhealthoftheindividual,aswellasthe
severityoftheherniabasedonthesizeandotherorgansinvolved.

24. References
▪Diaphragmatic Hernia: Causes, Symptoms & Diagnosis
(healthline.com)
▪Facts about Diaphragmatic Hernia | CDC

25. Thank You 