Re: Diaphramatic hernia
From: James S Smeltzer MD (gaperina@mindspring.com)
Sat Oct 12 09:33:08 2002
Hi,
This is a beautiful review.
Prompt recognition in the delivery room is essential for successful
management, if sonography has failed to identify it. Positive pressure
ventilation with mask fills the stomach and bowel with air and this may
impede repair later. Intubation and positive pressure ventilation are
essential for resuscitation.
Respiratory efforts and appearance of the chest and abdomen are quite
distinctive and help to distinguish between the three principle causes of
acute respiratory emergencies at a term birth:
1. Diaphragmatic hernea: Paradoxical abdominal movement. Normally when we
breathe in, the abdomen appears to enlarge as the contents pulled down by
the diaphragm are displaced and move outward. With this problem, the
contents move into the chest, and the abdomen appears to get thinner with
inspiration. Chest size is normal or small. No retractions are seen. Does
not transilluminate. Relieved by intubation and bagging.
2. Airway obstruction: Variable sized chest. Retractions are seen with
inspiration. May be stridor. Treated by intubation, bagging if needed.
3. Pneumothorax: Large chest with bulging intercostal spaces. Absent
breath sounds. Transilluminates. Relieved by aspiration, then chest tube.
Jim S
At 01:28 PM 10/11/2002 -0500, you wrote:
>Congenital Diaphragmatic Hernia (CDH)
>
>The diaphragm separates the chest from the abdominal cavity. This
>separation
>occurs in utero through the merging of two membranes that normally close
>off the
>open area between the chest and abdomen. If this area fails to close
>completely,
>the result is a diaphragmatic hernia. Furthermore, abdominal organs
>such as the
>small and large intestines, liver, and spleen can move into the chest
>cavity
>through the abnormal opening. CDH is usually an isolated congenital
>abnormality,
>but other abnormalities associated with the heart, kidneys, and brain
>may also occur. Events leading to CDH begin at 8-10 weeks gestation.
>CDH can usually be diagnosed by sonography around 20-25 weeks gestation.
>
>The two most common types of CDHs are Bochdalek hernias and Morgagni
>hernias.
>Agenesis of the diaphragm is a less common type of a Bochdalek hernia.
>Other
>diaphragmatic anomalies that are less commonly seen include
>paraesophageal
>hernias, diaphragmatic eventration, and acquired traumatic hernias.
>
>Bochdalek hernias make up approximately 90% of all cases of CDHs. The
>incidence
>is 1:2200-5000 live births. They are slightly more common in boys than
>girls.
>With this type of hernia, the stomach and intestines usually move up
>into the
>chest cavity. Babies with this type of hernia are also more likely to
>have
>another birth defect such as a chromosomal abnormality (5-16%) or a
>congenital
>heart defect (20%).
>
>Morgagni hernias make up only 2% of all CDH cases and are more common in
>girls.
>With this type of hernia, the bowel penetrates through the diaphragm and
>up next
>to the heart.
>
>In cases where CHD is the only health problem in a baby, there is only a
>2%
>chance that it will reoccur in a future pregnancy.
>
>Symptoms of CHD include: difficulty breathing, rapid heart rate,
>cyanosis (blue
>color of the skin), one side of chest larger than the other, concave
>abdomen
>
>Reference:
>
>http://www.cincinnatichildrens.org/Health_Topics/Your_Childs_Health/chest_a
nd_lungs/Conditions_and_Diagnoses/diaphragmatic-hernias.htm
>
>At Thu, 10 Oct 2002, Terry J DuBose wrote:
>>
>>Victoria, one of my students is currently searching the literature on
>>this subject... she submitted a good, brief discussion on the genesis of
>>CDH this week. I would like to ask her to respond to your question.
>>
>>Peace, Terry J DuBose, M.S., RDMS
>>Univ. Arkansas for Medical Sciences
>>Little Rock, AR USA
>>
>>On Wed, 9 Oct 2002 21:10:26 -0500 "Victoria Hospodar Valentine"
>><vvalentine4@attbi.com> writes:
>>> Does a diaphragmatic heria always present at an early fetal age, or
>>> can it
>>> develop late in the pregnancy? I have been trying to find articles
>>> which
>>> explain the the process, but most I have found have been case
>>> studies. Can
>>> anyone point me to some helpful articles?
>>>
>>> Victoria Valentine, RDMS
>>>
>
