Diaphrgmatic hernia

a risk factor for neonates

1. DIAPHRGMATIC HERNIA PRESENTED BY- JAISHREE MPT (PEDIATRIC)

2. The diaphragm developed at 8 weeks’ of gestation 1. Septum transversum 2.Pleuroperitoneal membrane 3.Dorsal mesentery of the esophagus 4.Body wall

3. DEFINTION Communication between the abdominal and thoracic wall with or without abdominal content in thorax, a defect, called as diaphragmatic hernia Hole is developed between chest and abdominal wall Predominance of hole is on left side which allows the abdominal content to pass into the chest cavity

4. Types ACCORDING TO ETIOLOGIC Congenital Traumatic

5. CONGENTIAL DIAPHRGMATIC HERNIA Congenital diaphragmatic hernia (CDH) is a birth defect of the diaphragm. The most common type of CDH are   Bochdalek hernia(posterolateral)  Morgagni hernia(retrosternal)  Diaphragm eventration   Central tendon defects of the diaphragm

6. Traumatic diaphragmatic hernia I njury may occur due to both penetrating and blunt traumas In 50-80% of blunt diaphragmatic rupture the left hemidiaphragm is injured T he right hemidiaphragm in injured in 12-40% of cases Common type are- Hiatal (oesophageal hiatus) Paraesophageal

7. PATHOPHYSIOGY Abdominal organ hernia Compression of thoracic viscera Pulmonary atelectasis Significance loss in functional capacity Compression of great veins Leads to deceased venous return Results in deceased cardiac output

8. CLINICAL PRESENATION Malformation of the diaphragm allows the abdominal organs to push into the chest cavity. Hindering proper lung formation

9. CAUSES  Pulmonary hypoplasia   Pulmonary hypertension Respiratory distress

10. SIGN AND SYMPTOMS Respiratory distress Cardinal sign present like (grunting, cyanosis) Use of accessory muscle Increased chest diameter Decreased or absent breath sound at site of hernia Shifting of apex beat on contralateral side of hernia

11. Delayed presentations Regurgitation Ischemia Sepsis Shock

12. INVESTIGATION Amniocentesis and maternal serum is advice in children with genetic history of CDH Sonography X-ray Magnetic resonance imaging MRI, CT scan SpO2 ABG analysis Pulmonary function test Cardiopulmonary exercise testing

13. INTERVENTION To prevent haemorrhage, hypovolaemic shock and cardiac arrythmia Ventilatory strategies is required in advance cases- Conventional mechanical ventilation HFOV Extracorporeal membrane oxygenation (ECMO)

14. Surgical intervention Median sternotomy, lateral thoracotomy, transthoracic surgeries Laparoscopic and thoracoscopic repair of hernial hole Liquid ventilation Tracheal occlusion

15. Complication Delayed growth in early years of life Neurocognitive defects Structural deformity like scoliosis and pectus excavatum Gastroesophageal reflux diseases Intestinal obstruction

16. PHYSIOTHERAPY INTERVENTION Breathing exercises- Deep breathing exercises with 3 sec hold Purse lip breathing Paper blowing or incentive spirometry Active cycle of breathing technique Thoracic expansion exercises Coughing and huffing technique Transcutaneous electrical nerve stimulation

17. THANK YOU