congenital diaphragmatic hernia
Introduction
Introduction to congenital sputum Congenital warts are a type of non-traumatic warts. The most common are esophageal hiatus hernia, thoracoabdominal hernia, parasternal spasm, and hernia. The severity of sputum varies depending on the volume of abdominal organs, the degree of organ dysfunction, and the increase in intrathoracic pressure on the degree of respiratory dysfunction. basic knowledge The proportion of sickness: 0.2% Susceptible people: no special people Mode of infection: non-infectious Complications: atelectasis pulmonary hypertension
Cause
Congenital delirium
In addition to defects and weak points in the congenital diaphragmatic fusion, the formation of sputum is also related to the following factors:
1 The difference in pressure between the chest and the abdomen and the activity of the abdominal organs; various factors that cause increased intra-abdominal pressure such as bending, difficulty in defecation and pregnancy can cause the abdominal organs to enter the chest through the diaphragm defect and the weak part.
2 With age, the diaphragmatic muscle tone is reduced and the esophageal ligament is relaxed, so that the esophageal hiatus is enlarged, and the sacral station or corpus can be inserted into the posterior mediastinum through the enlarged esophageal hiatus.
3 chest trauma, especially chest and abdomen combined injury caused by diaphragmatic rupture, sputum classification is different, according to the presence or absence of sacral sac points true sputum and false sputum, but generally according to the history of trauma or not, sputum is divided into traumatic sputum and non-traumatic sputum, The latter can be divided into two categories: congenital and acquired.
Prevention
Congenital spasm prevention
There are no effective preventive measures for this disease, so the prevention is mainly focused on preventing postoperative complications. The main points are as follows:
1. Take a semi-recumbent position after waking to relieve the pressure of the abdominal organs on the diaphragm, which is beneficial to the healing of the diaphragmatic wound.
2. Continued gastric decompression after operation to prevent abdominal distension from compressing the diaphragm.
3. Before the recovery of bowel movement, intravenous infusion, appropriate amount of potassium, after the anus is exhausted, the stomach decompression tube is removed, and the airflow is inflated.
4. Encourage patients to cough, ultrasonic atomization and inhalation to prevent respiratory complications.
5. Keep the chest drainage tube open to prevent the healing of the diaphragm repair due to pleural effusion.
6. Regular application of antibiotics to prevent infection.
Complication
Congenital diaphragmatic complications Complications atelectasis pulmonary hypertension
Congenital diaphragmatic hernia usually occurs in the posterolateral part of the diaphragm (Bochdalek), with 90% on the left side. The intestinal segment and even most of the abdominal cavity contents can protrude into the affected side of the chest. If the left side is very large, the lungs on the affected side are dysplastic. After birth, the newborn inflate the intestines due to inhalation of gas, forcing the heart and mediastinum to move right to oppress the normal lung on the right side, resulting in more severe acute respiratory distress. Severe cases of respiratory distress, scaphoid abdomen, the affected chest can be heard in the bowel. In the milder cases, mild dyspnea occurs after hours or days as the contents of the abdominal cavity gradually protrude into the chest through a small defect in the diaphragm.
Part of pulmonary dysplasia with atelectasis, decreased pulmonary blood flow, increased pulmonary vascular resistance resulting in persistent pulmonary hypertension, right to left shunt at the level of the foramen ovale or arterial catheter and severe hypoxia.
Recently, children with congenital diaphragmatic hernia have been found to have pulmonary dysplasia and abnormal thickening of bilateral pulmonary artery wall. High resistance to severe pulmonary blood flow leads to obstruction of normal oxygenation. The decrease in pulmonary blood flow results in the child being still in anoxic state during ventilator support. Persistent pulmonary hypertension is an important cause of death in congenital diaphragmatic hernia.
Symptom
Congenital symptoms of sputum Common symptoms Indigestion Loss of appetite, abdominal pain, bloating, upper abdominal pain, neonatal hypothermia, constipation, severe pain, dyspnea, abdominal muscle tension
It varies mainly according to the position and size of the sputum, the contents of the sputum, and the changes in the function of the internal organs. The parasternal hiatus is less likely to have symptoms after adulthood, mainly due to upper abdominal pain, fullness discomfort, loss of appetite, indigestion, intermittent constipation and bloating. These symptoms are easily overlooked and misdiagnosed as digestive tract. Disease, occasional X-ray examination, can be found in the presence of gastric vesicles and intestinal curvature behind the sternum and was diagnosed. If invagination occurs in the small intestine or colon, it can produce clinical symptoms of acute intestinal obstruction or intestinal stenosis.
Examine
Congenital examination
The diagnosis of this disease is not possible, so no more special examinations are needed. For some cases that are difficult to judge, X-ray examination can be performed:
1. Chest film:
The mediastinum is displaced to the healthy side, and the inflated intestine can be seen in the thoracic cavity. Sometimes the liver and spleen are seen, and the affected lung is obviously stressed.
2. Gastrointestinal iodine oil imaging examination:
A clearer understanding of the intestines in the chest.
Diagnosis
Congenital diaphragmatic diagnosis
Generally speaking, the diagnosis is not too difficult. According to the position of the chest and abdomen, the position and direction of the bullet or knife stab into the body, the condition of the ballistic entrance and exit can roughly determine the anatomical path that the body passes through, and thus it is estimated that the diaphragm has no damage. X-ray examination of the chest and abdomen of traumatic hernia is easy to identify the intestines in the chest cavity. The presence of free gas under the armpits indicates the perforation of the abdominal organs. However, due to the accumulation of effusion and gas in the chest, it is sometimes difficult to show the diaphragm. The presence of rupture and intrusion into the gastrointestinal tract.
Combined with auxiliary examination, the diagnosis can be confirmed. If it is a parasternal hernia, because of the small hole, the symptoms usually appear in adulthood, mainly manifested as upper abdominal pain, fullness discomfort, loss of appetite, indigestion, intermittent constipation and bloating. The above symptoms are easily neglected and misdiagnosed as digestive tract diseases. Occasionally, X-ray examination reveals that there are gastric vesicles and intestinal shadows behind the sternum and is diagnosed. Therefore, X-ray examination should be performed for patients with suspected paralysis.
