DIAPHRAGMATIC HERNIA.pptx

DIAPHRAGMATIC HERNIA

1. DIAPHRAGMATIC HERNIA PRESENTED BY: M.C.KNIRANDA ASSISTANT PROFESSOR SSNSR, SU.

2. DEFINITION Diaphragmatic hernia is a defect or hole in the diaphragm that allows the abdominal contents to move into the chest cavity. Protrusion of abdominal organs through an opening in the diaphragm.

3. INCIDENCE CDH is a life-threatening condition affecting one in every 2,500-4,000 births. The most serious complication of CDH is inadequate lung development.

4. TYPES OF CONGENITAL DIAPHRAGMATIC HERNIA There are two types of congenital diaphragmatic hernia (CDH ) – Bochdalek hernia. Morgagni hernia.

5. BOCHDALEK HERNIA A Bochdalek hernia is a hole in the diaphragm that can occur on the right or left side. It is caused by either a malformation of the diaphragm or the intestines’ movement into the chest cavity as the diaphragm forms. Left-sided Bochdalek hernias are most common, accounting for 80% of cases . Bochdalek hernias that occur on the right side are far less common ( 10% of cases ), but can lead to worse outcomes due to the liver’s movement into the diaphragm.

6. MORGAGNI HERNIA A Morgagni hernia is a hole in the middle of the diaphragm near the chest. It happens when the tendon (fibrous connective tissue that attaches muscle to bone) in the middle of the diaphragm develops abnormally . Morgagni hernias are much less common than all  Bochdalek  hernias. 

7. There is no known cause for the development of congenital diaphragmatic hernias. There is nothing someone can do to cause or prevent their baby from developing a congenital diaphragmatic hernia.  CAUSES OF CONGENITAL DIAPHRAGMATIC HERNIA

8. CLINICAL MANIFESTATIONS When CDH is not diagnosed prenatally , the symptoms of a congenital diaphragmatic hernia are observable soon after birth . While they vary between each child, the most common symptoms of CDH include : Breathing difficulty Rapid breathing (hyperventilating) Rapid heart rate (tachycardia)

9. Blue skin color (cyanosis) One side of the chest is larger (Abnormal Chest Development) Belly looks caved-in (concave/scaphoid) The specific symptoms of CDH are dependent on the type of hernia , Bochdalek vs. Morgagni hernias. Babies with Morgagni hernias sometimes show no symptoms. CLINICAL MANIFESTATIONS

10. DIAGNOSTIC EVALUATION Fetal ultrasound : Diaphragmatic hernia can be diagnosed using fetal ultrasound in the second and third trimesters of pregnancy. At the 20-week ultrasound, and is often first detected on a routine pre-natal ultrasound. A fetal echocardiogram: (ultrasound of the heart) may be done to check for heart abnormalities before birth. X-ray Pulmonary Function Test ABG analysis

11. TREATMENT Babies with a congenital diaphragmatic hernia (CDH) can have different treatment plans depending on the severity of the case. Most times, a baby is diagnosed with CDH in utero, and during the pregnancy, a treatment plan is developed prior to giving birth .

12. Resuscitation with ventilatory support is of prime importance in patients born with a CDH . ECMO has been shown to decrease the mortality of CDH. ECMO –( extracorporeal membrane oxygenation ) MEDICAL TREATMENT

13. ECMO is a therapy used to treat people with life-threatening heart and lung failure. ECMO involves the use a machine to replace some of the functions of a patient's lungs or heart, or both simultaneously . While ECMO therapy can be life-saving, it is not itself a treatment. The decision to utilize ECMO is made early in the disease process, usually within 24 hours of birth . An ECMO machine circulates blood through a machine to remove carbon dioxide and add oxygen . MEDICAL TREATMENT

14. ECMO machine

15. Maternal antenatal corticosteroid (e.g . Betamethasone and dexamethasone) administration has also been employed in an effort to improve fetal lung growth and maturity, but the available evidence is insufficient to support its routine use.   Prostaglandin E1 (PGE1) has been used to treat severe pulmonary hypertension in patients with CDH. MEDICAL TREATMENT

16. Median sternotomy, Lateral thoracotomy Congenital diaphragmatic hernia repair Fetoscopic Endoluminal Tracheal Occlusion (FETO ) SURGICAL TREATMENT

17. Median sternotomy Median sternotomy is a type of surgical procedure in which a vertical inline incision is made along the sternum , after which the sternum itself is divided using a sternal saw ( bone cutter). This procedure provides access to the heart and lungs for surgical procedures such as heart transplant, lung transplant.

18. Thoracotomy A thoracotomy is a surgical procedure in which a cut is made between the ribs to see and reach the lungs or other organs in the chest or thorax. A thoracotomy is performed for diagnosis or treatment of a disease and allows doctors to visualize, biopsy or remove tissue as needed.

19. CONGENITAL DIAPHRAGMATIC HERNIA REPAIR Congenital diaphragmatic hernia (CDH) repair is a surgery to close an opening or space in a baby's diaphragm.

20. The surgery is done under general anesthesia. The surgeon usually makes a cut (incision) in the belly under the lower ribs. This allows the organs in the area to be reached. The surgeon gently pulls these organs down into place through the opening in the diaphragm and into the abdominal cavity . CONGENITAL DIAPHRAGMATIC HERNIA REPAIR

21. In less severe cases, the surgery can be done using smaller incisions in the chest. A small video camera called a thoracoscope is placed through one of the incisions. This allows the surgeon to view inside the chest. If the hole is small , it may be repaired with stitches . Otherwise, an artificial patch is used to cover the hole. CONGENITAL DIAPHRAGMATIC HERNIA REPAIR

22. Fetoscopic Endoluminal Tracheal Occlusion (FETO) Fetoscopic endoluminal tracheal occlusion, or FETO, is a surgical procedure to treat the most severe cases of congenital diaphragmatic hernia (CDH) that are diagnosed in utero.

23. Fetoscopic Endoluminal Tracheal Occlusion (FETO)

24. NURSING MANAGEMENT PRE-OPERATIVE CARE – Reduce stimulation Resuscitation, if respiratory distress occurs Maintain oxygen saturation IV fluids are given Keep the infant in semi-fowler’s position For pain relief ,after surgery administer analgesics Provide rest and comfort to the baby.