Diaphragmatic hernia : symptoms and treatment
Disease / / August 12, 2017
- reasons diaphragmatic hernia
- Types diaphragmatic hernias
- Symptoms diaphragmatic hernia
- diagnosis of diaphragmatic hernia
- Treatment of diaphragm hernia
- Features course and treatment of certain types of diaphragmatic hernia
Aperture - this anatomical partition separating the abdominal cavity from the chest cavity.Along the periphery it consists of striated muscle, and connective tissue of the heart.In addition, the diaphragm while reducing participates in breathing, by increasing the volume of the thoracic cavity and straightening the lungs.
Diaphragmatic hernia is a defect (a hole or protrusion) in the diaphragm through which the authorities can penetrate from the abdominal cavity into the chest cavity and vice versa.This condition occurs quite often.So in 7-8% of patients complaining of chest pain and heartburn X-ray examination revealed diaphragmatic hernia.
reasons diaphragmatic hernia
Causes of diaphragmatic hernia are diverse and may vary depending on the type and
- in newborns is genetic abnormalities of the diaphragm;
- adult status is prolonged increase in intra-abdominal pressure (cough, chronic bronchitis, heavy lifting, prolonged labor in women, heavy exercise, chronic constipation, obesity, pregnancy);
- injury (penetrating wounds of the abdomen or chest cavity, blunt trauma, stroke);
- age - people over 50 years of hernias occur more often, it is due to age-related changes of tone of the diaphragm;
- violation of the innervation of the diaphragm area, which leads to relaxation and its protrusion to form a hernia sac;
- chronic diseases of the gastrointestinal tract (stomach ulcer and 12 duodenal ulcer, chronic esophagitis, cholecystitis, pancreatitis).
Types diaphragmatic hernias
There are several basic types of diaphragmatic hernia:
- congenital hernia;
- acquired traumatic hernia of the diaphragm may be true (with the presence of hernia sac) and false (hernia sac is not, there is a hole in the diaphragm);
- neuropathic hernia due to relaxation (relaxation) of the diaphragm portion;
- hernia orifices aperture (the hole where the esophagus passes through the diaphragm - esophageal hernia or hiatal hernia).
Symptoms diaphragmatic hernia
All hernias are typical symptoms associated with dysfunction of the upper gastrointestinal tract:
- Heartburn - burning sensation appears in the upper abdomen Hotels (epigastrium), which increases with body slopes.Heartburn with diaphragmatic hernia is associated with a decrease in the tone of the cardiac sphincter (the valve that separates the esophagus and the stomach).
- constant burping air - is the result of air into the stomach.
- Bloating - the reason is the same as that of belching.
- Chest pain occurs because of compression and infringement of organs in a hernial bag aperture (often the cardiac section of the stomach and esophagus);
- Sometimes there is anemia associated with prolonged slight bleeding from the esophagus, which is located in the hernial sac.
At small sizes hernia its manifestations may be absent.
Diagnostics diaphragmatic hernia
In the absence of specific symptoms, always conducted instrumental diagnosis of diaphragmatic hernia:
- X-ray examination of the chest with contrast medium (barium mixture).Once the patient drinks a barium mixture, it fills the stomach and the esophagus, so the X-rays clearly visible protrusion of an organ through a diaphragmatic hernia.
- Fiboroezofagogastroduodenoskopiya (FEGDS) - with the help of a telescopic tube explores the state of the esophageal mucosa and the stomach, which penetrate through the hernial opening in the chest cavity.
- pH-meters - investigated the level of acidity in the esophagus and stomach, increased acidity in the esophagus is reason to suspect diaphragmatic hernia.
Treatment of hernia of the diaphragm
choice of method of treatment diaphragmatic hernia depends on its severity and location:
- Conservative therapy - used in small hernia or contraindications to surgery.Use diet, eliminating sharp, acidic foods, smoked.Eating small meals should be carried out 5-6 times a day.Of the medicines used to eliminate heartburn antacids (Aluminium phosphate gel, Almagel, ranitidine, omez) and antispasmodics for pain relief (no-spa, Drotaverinum).
- Surgical treatment - used in larger sizes hernia infringement in its esophagus or stomach.It consists in excision of the hernia sac, followed by plastics (anatomical restoration) hernia opening.Plastic by direct suturing hernia opening.The variant using an overlay "patch" on the hernial orifice made of synthetic materials.
Features course and treatment of certain types of diaphragmatic hernia
- congenital hernia.Such a diaphragmatic hernia in the fetus is still developing during the fetal development.Is a genetic defect of the diaphragm development, can be combined with malformations of other organs.Treatment consists of surgical intervention with the plastic of hernia, is carried out after the baby is born.
- Traumatic true acquired hernia - occurs after a prolonged increase in intra-abdominal pressure or blunt abdominal trauma.It is characterized by the presence of hernia sac (protrusion of the diaphragm), which is part of the stomach or esophagus.When small amounts of possible conservative therapy.For radical treatment is used with plastic surgery hernia.
- Traumatic false acquired hernia - is the result of penetrating trauma (usually a knife) into the abdominal or thoracic cavity with damage to the diaphragm.As a result - without opening the hernial sac into which penetrate organs (esophagus, stomach, or a part of the small intestine) from the abdominal cavity into the chest cavity.Treatment with surgery alone to stop the bleeding, reposition (movement) of the bodies back into the abdominal cavity and closure of the hernia opening.
- Neuropathic hernia of the diaphragm - the result of violation of the innervation of the diaphragm portion, thereby reducing muscle tone in this place and forms a protrusion and hernial sac.Medical and surgical treatment, depending on the size of the herniation.
- esophageal hernia - appears in place of the passage of the esophagus through the diaphragm due to the weakening of the ligaments.In this part of the stomach (or the bottom of the cardiac department) protrudes into the chest cavity.There are 2 types of esophageal hernia: sliding (part of the stomach yourself back into the abdominal cavity) and static (part of the stomach is located in the chest cavity permanently).This hernia of the diaphragm is almost always accompanied by heartburn and regurgitation, swallowing disorders are a pain in the chest cavity.Treatment initially conservative with the use of diet, antacids, and antispasmodics.In the case of infringement of the stomach into the hernial sac surgery is performed with plastic diaphragm.
is important to remember that children diaphragm weaker than adults.The risk of diaphragmatic hernia with an increase in intra-abdominal pressure above.Therefore we can not allow a significant and prolonged stress abdominal muscles in a child (cough, constipation, heavy lifting).
12 Aug, 2017
12 Aug, 2017