Diaphragmatic hernia

Respiratory muscles and diaphragm is the main second most important muscle in the body by the heart. Because the body relies so much on the diaphragm for respiratory function understanding of pathological processes that alter its functionality is very important.
With diminishing diaphragmatic function and dysfunction of respiratory appears. The body shows multiple mechanisms to compensate for loss of function in the diaphragm. However, no compensatory mechanism can not prevent the alterations in respiratory compromise diaphragmatic excursions.
Diaphragmatic hernias can be divided into two major categories: congenital and gained. Congenital diaphragmatic hernias occur through defects of the diaphragm demonstrating the embryological early in life. However, a subset of adults shows a small diaphragmatic hernia is not detected in childhood.
Congenital diaphragmatic hernias occur in 1 in 3,000 births.Mortality and morbidity due to pulmonary hypoplasia, so this response to artificial ventilation therapy resistant pulmonary hypertension. The survival rate is 65%.
If diaphragmatic lesion is discovered during the acute phase of trauma surgical approach is technically less thoracotomy or laparotomy. To be managed depends traumatic hernia diagnosis.In the acute phase of trauma an abdominal approach is preferred because 89% of patients have associated abdominal injuries. In the late phase of trauma thoracic approach is necessary because these patients have adhesions intrathoracic organs.
Correcting the defect depends on its size. It can suture the defect is small enough or if you apply a synthetic hairpiece. Laparoscopic abdominal exploration became popular to determine diaphragmatic integrity. In the absence of lesions associated diaphragm is repaired by laparoscopic techniques.
After correction of a diaphragmatic defect is important in lung function and radiographic assessment. After traumatic hernia recurrence is possible. In association with injuries to other injuries prognosticuld epinde. Persons with isolated diaphragmatic injuries tend to recover without disabilities for a long time.
Anatomy:The diaphragm is a modified dome musculofibros tissue that separates the thorax from the abdomen. Four components make up embryological diaphragm: septum transversum, folds pleuroperitoneale, miotoamele cervical and dorsal mesentery.Development begins in the third week of gestation and is complete in the eighth week. Failure folds pleuroperitoneale development and cause birth defects muscle migration.The origin of the diaphragm muscle is situated at the coast in June inferior xiphoid process and lower external and internal arched ligaments. A total of three structures crossing the diaphragm: holes allowing passage of the aorta in the abdomen, esophagus, and vena cava.
Pathogenesis:Diaphragmatic hernia occurs when the diaphragm muscle anatomical entities do not develop normally in the chest allowing abdominal Displacement components.
Bochdalek hernia of diaphragm:These include most cases of hernia diaphragmatic hernia. The main problem in these hernias are represented by the posterolateral diaphragm defects that cause abnormal development or lack pleuroperitoneale creases diaphragmatic muscle migration. Over 90% of patients with these hernias is a doctor in the first year of life. These cases carries a mortality of 45-50%%. Mortality due to pulmonary hypoplasia and pulmonary hypertension of the affected side.
Morgagni hernias:These hernias are less common and occur only in 15% of cases.Morgagni foramen is situated on the front line of the diaphragm sternocostal scored on hiatus. In 90% of cases appears to the right.
Hernias winnings:Most common cause of these hernias is represented by penetrating trauma. Road accidents are the leading cause of diaphragmatic injuries. Other rare causes are labor in women with a history of diaphragmatic hernia and Nissen fundoplication in patients with barotrauma.
These theories have been proposed to explain the mechanisms gained hernias;Diaphragm tensioned membrane-sfisierea-Diaphragmatic avulsion of the attachment pointsSudden-transmission of forces through the viscera.
Ruptured left is more common than the right, liver protection and hardness due to diaphragm law. Diaphragmatic hernia pathophysiology gained include circulatory and respiratory depression secondary decrease in diaphragm function, intrathoracic compression of abdominal contents on the lungs, the pressure on the mediastinum, cardiac compromise. Small diaphragmatic hernias are not found only in a few months or years when patients with digestive symptoms strangulation shows internal organs, shortness of breath.