Congenital diaphragmatic hernia and oesophageal atresia

Question 1

What is a congenital diaphragmatic hernia

Answer 1

A birth defect with abnormal diaphragmatic development which allows herniation of abdominal viscera through a diaphragmatic defect

Question 2

Explain the different congenital hernias

Answer 2

Bochdalek: Postero-lateral
Morgagni:
Hiatal hernia:

Question 3

Explain the associations with Bochdalek hernias

Answer 3

Malrotation is always present

Postnatal physiology:
- Lung hypoplasia
- Pulmonary hypertension
- Persistent foetal circulation

Question 4

How are hernias in children diagnosed

Answer 4

Decreased chest movement on the affected side
Shift of cardiac impulse
Presence of bowel sounds in chest
Scaphoid abdomen
Cyanosis/respiratory distress
X-ray findings

Question 5

What is the treatment of diaphragmatic hernias

Answer 5

NG tube on free drainage
O2
Drip - 5% Dextrose IV
Refer to paediatric surgeon ASAP
Delayed surgical repair:
- Only after pulmonary hypertension is corrected
- Lung hypoplasia is not changed by surgery

Question 6

What are the long term complications in diaphragmatic hernias

Answer 6

10% mental retardation
50% Pulmonary function abnormal
30-50% Growth failure
50% GORD
20% Intestinal obstruction due to adhesions

Question 7

How does Morgagni hernias present

Answer 7

Asymptomatic or recurrent respiratory symptoms

Leads to development of colonic obstruction and gangrene possible anytime

Closure of hernia always necessary even in asymptomatic patients

Question 8

What is the definition of oesophageal atresia

Answer 8

Congenital absence of a segment of the oesophagus

Question 9

How is oesophageal atresia diagnosis

Answer 9

During first feed
- Immediate regurgitation of milk through mouth and nose
- Cannot swallow saliva
- Choking, Coughing, Cyanosis,

Question 10

What are the investigations for oesophageal atresia

Answer 10

Check oesophageal permeability with feeding tube
Check X-ray (full babygram): check feeding tube

No contrast necessary

8French NG tube

Question 11

What is the treatment for oesophageal atresia

Answer 11

Give O2
Treat as bowel obstruction:
- NG tube
- IV line with appropriate fluids

Examine for life threatening abnormalities (VACTERL)
Prepare for transport (TWO SIDES) to tertiary hospital