VIDYALAYA KALYAN SAMITIS presented by:Dr Madhu Teotia Addl Director(Education)
Diaphragm disorders By:Dr seyed Mostafa Shiryazdi Associate professor of surgery.
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Transcript of Diaphragm disorders By:Dr seyed Mostafa Shiryazdi Associate professor of surgery.
Diaphragm disordersDiaphragm disordersBy:Dr seyed Mostafa ShiryazdiBy:Dr seyed Mostafa Shiryazdi
Associate professor of surgeryAssociate professor of surgery
Clinical AnatomyClinical Anatomy
-musculotendinous membrane-musculotendinous membrane -central:tendinous-central:tendinous -peripheral:muscular-peripheral:muscular
HIATUSHIATUS
-Aorta:T12 azygus vein-thoracic -Aorta:T12 azygus vein-thoracic ductduct
-Esophagus:T10 vagus nerves-Esophagus:T10 vagus nerves -IVC:T8 -IVC:T8
BLOOD SUPPLYBLOOD SUPPLY
-abdominal aorta:RPA-LPA-abdominal aorta:RPA-LPA -thoracic aorta:SPA-thoracic aorta:SPA -internal mamary artery-internal mamary artery
VENOUS DRAINAGEVENOUS DRAINAGE
-left phrenic vein-left phrenic vein -right phrenic vein-right phrenic vein
-Both drain to IVC-Both drain to IVC
INNERVATIONINNERVATION
-Right phrenic nerve:motor -Right phrenic nerve:motor innervationinnervation
-Left phrenic vein:motor innervation-Left phrenic vein:motor innervation
-Intercostal nerve:sensory -Intercostal nerve:sensory innervationinnervation
Diaphragm develops between the 4Diaphragm develops between the 4thth and 8and 8thth weeks of gestation weeks of gestation
Failure closure of the pericardio Failure closure of the pericardio peritoneal canal cause CDH(bochdalek peritoneal canal cause CDH(bochdalek
hernia)hernia)
The crura develop from The crura develop from the mesentery of the mesentery of
esophagusesophagus
Higher position of Higher position of diaphragmdiaphragm
LIVER in rightLIVER in right
HEART in leftHEART in left
Diaphragm developsDiaphragm developsTransverse septumTransverse septum
Pleuroperitoneal membranePleuroperitoneal membraneDorsal and lateral body wallDorsal and lateral body wall
Mesentery of esophagusMesentery of esophagus
CONGENITAL DIAPHRAGMATIC CONGENITAL DIAPHRAGMATIC HERNIAHERNIA
_BOCHDALEK HERNIA_BOCHDALEK HERNIA -MORGAGNI HERNIA-MORGAGNI HERNIA -ESOPHAGEAL HIATAL HERNIA-ESOPHAGEAL HIATAL HERNIA
BOCHDALEK HERNIABOCHDALEK HERNIA
Male:female 2/1Male:female 2/1 Left sided 90%Left sided 90% Right sided 10%Right sided 10%
Clinical FindingClinical Finding
Rsepiratory dystressRsepiratory dystress Absence of breath soundsAbsence of breath sounds Bowel sound in chestBowel sound in chest Scaphoid abdomenScaphoid abdomen
Bochdalek hernia occurs in Bochdalek hernia occurs in 1:4000-5000 live birth1:4000-5000 live birth
Morgagni hernia occurs <2% of all Morgagni hernia occurs <2% of all diaphragmatic herniadiaphragmatic hernia
Usually CDH discovered Usually CDH discovered prenataly on routine prenataly on routine
ultrasoundultrasound
After birthAfter birth
CXRCXR BARIUM SWALLOWBARIUM SWALLOW
Long term problems in CDHLong term problems in CDH
Gastroesophageal refluxGastroesophageal reflux Chronic lung diseaseChronic lung disease Hearing lossHearing loss Pectus excavatumPectus excavatum seizureseizure
Contained sac in Contained sac in morgagnimorgagni
OmentumOmentumColonColon
StomachStomachLiverLiver
Small intestineSmall intestine
treatmenttreatment
Nasogastric tubeNasogastric tube Fluid and electrolyteFluid and electrolyte PEEP or ECMOPEEP or ECMO surgerysurgery
Right Right side:thoracotomyside:thoracotomy
Left side:laparotomyLeft side:laparotomy
Mortality 30-50% in Mortality 30-50% in 24 hours24 hours
MORGAGNI HERNIAMORGAGNI HERNIA
Larrey hernia or retrosternalLarrey hernia or retrosternal Rarely symptomaticRarely symptomatic Symptomatic after 40 yearsSymptomatic after 40 years
HIATAL HERNIAHIATAL HERNIA
SlidingSliding ParaesophagealParaesophageal mixedmixed
GERGER
MedicalMedical SurgicalSurgical
FTT-repeated respiratory infection-FTT-repeated respiratory infection-anemia-recurrentanemia-recurrent
Diaphragm tumorsDiaphragm tumors
Primary(rare):fibrosarcoma-hydatid Primary(rare):fibrosarcoma-hydatid cyst-TBcyst-TB
secondarysecondary
Eventration of diaphragmEventration of diaphragm
Congenital(non paralysed)Congenital(non paralysed)
Acquired(paralysed)Acquired(paralysed)
Trauma to diaphragmTrauma to diaphragm
90% left sided90% left sided
Early diagnosis:laparotomyEarly diagnosis:laparotomy
Late diagnosis:thoracotomyLate diagnosis:thoracotomy