Diaphragmatic bulge and paralysis
Introduction
Introduction to swell and paralysis "Eventration and Paralysis of the Diaphragm" refers to the completeness of the diaphragm, but an abnormal rise or high position of a part of the whole sputum or sputum, the former is caused by congenital diaphragmatic muscle dysplasia, the latter caused by sacral nerve injury, according to statistics 1/10000 of conventional adult chest. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: Neuritis Spinal tuberculosis
Cause
bulging and palsy
Congenital (swelling) is due to developmental defects in the embryo, impaired or completely undeveloped diaphragm muscle fibers, and lack of thick collagen fibers. When the intra-abdominal pressure is increased and the intrathoracic pressure is increased, the diaphragm is performed. Sexual bulging into the chest cavity, resulting in various complications of digestion, breathing, and circulatory system.
Acquired (rice) often causes diaphragmatic atrophy or muscle fiber degradation due to sacral neuropathic damage. The thinned part is composed of elastic fibrous tissue, which is common in trauma, surgery and injury, neck and chest inflammation, neuritis, tumor or spinal tuberculosis and other compression damage. The sacral nerve and the right sacral nerve branch are obvious, so the bulging sputum is more common on the right side, and both sides are rare.
Prevention
bulging and paralysis prevention
Pancreatic leakage prevention
When the pancreatic tail is close to the spleen, the ligament around the spleen is first released, and the spleen pedicle is exposed. The tail is bluntly dissociated, so that there is a gap between the spleen and the spleen. And tissue, ligation and severing blood vessels, pancreatic tail wounds covered with omentum or posterior peritoneum, can effectively prevent pancreatic leakage.
2. Prevent gastric leakage
In the case of the upper spleen, the spleen and stomach ligaments are too short to damage the stomach wall. The stomach wall should be inverted and serosalized whether or not it is damaged. If the defect is found to be large, it can be covered with a vascular omentum to re-size the membrane, which can avoid the cause. Gastric wall ischemia causes gastric leakage, and may also cause gastric leakage due to injury.
3. Reduce wound bleeding
The incidence of adhesions around the spleen of patients with spleen is high. Forcibly moving the spleen will inevitably cause extensive percolation of the peritoneum. When moving the spleen, gently move away from the spleen in a clockwise direction, fill the spleen with a large cotton pad, and treat it under direct vision. Spleen pedicle. After the spleen is removed, the peritoneal and spleen fossa are oozing the wound surface, and then the hemostatic glue is sprayed, and then the kidney is wrapped with the omentum, which can eliminate the residual cavity of the spleen and prevent intestinal obstruction, and can also spontaneously divert and absorb. The effusion, such as postoperative observation, the drainage volume gradually decreases, and the color changes from red to light, the body temperature is basically normal, the underarm drainage tube can be removed, generally 24 hours after surgery is appropriate, premature extubation is easy to be complicated by effusion infection.
Complication
Swelling and paralysis complications Complications Neuritis Spinal tuberculosis
Cervical and chest inflammation, neuritis, tumor or spinal tuberculosis, acute respiratory distress and heart, vascular dysfunction, etc.
Symptom
Symptoms of swell and paralysis Common symptoms Hernia, abdominal pain, bowel, gastrointestinal symptoms, shortness of breath, shortness of breath, difficulty swallowing, shortness of breath, paralysis, repeated pneumonia
In neonates, young children and children, complete sputum bulging is mainly dyspnea, shortness of breath, repeated pneumonia, and atypical symptoms of gastrointestinal tract. When the body is inhaled, several ribs are overextended (called Hoover sign). The tracheal heart is displaced to the opposite side, and the lower chest is percussed with dullness, and the bowel sounds are heard and the abdomen is flat.
In adults, the common symptoms of left swelling are difficulty in swallowing, upper abdominal pain, acid reflux, supine, gastrointestinal symptoms after head down or full food, due to gastrointestinal metastasis, left or right The lying position is relieved, and breathing difficulties, shortness of breath or pneumonia may occur, and the experience of living is similar to that of children.
Examine
bulging and paralysis
1. Chest X-ray examination is the main method of bulging sputum. The ascending diaphragm is like a smooth and complete curve. When the diaphragm is paralyzed, it can show the contralateral movement of the diaphragm.
2. Gastrointestinal angiography and barium enema examination can be found in elevated colon, inverted stomach or combined torsion.
Diagnosis
Diagnostic identification of swell and paralysis
diagnosis
Pneumoperitoneum can help diagnose the disease, and it can help with the diagnosis of difficult cases by scanning with high sputum.
Differential diagnosis
Congenital defects, sputum, etc.
