Congenital diaphragmatic hernias

Question 1

What anatomical site defect results in a Bochdalek hernia?

Answer 1

Pleuroperitoneal membrane

Question 2

What anatomical site defect results in a Morgagni hernia?

Answer 2

Septum transversum

Question 3

Give the characteristics of a Bochdalek hernia

Answer 3

Posterolateral portion of diaphragm
1/5000
50% associated congenital anomalies
Malrotation always present

Question 4

Which side do the majority of Bochdalek hernias occur on?

Answer 4

90% left

Question 5

Explain why the child with a Bochdalek hernia experiences hypoxemia

Answer 5

Abdominal herniation into pleural cavity -> lung hypoplasia -> thickened lung arterial walls and decreased tissue -> pulmonary arterial hypertension

Question 6

Name features of a Bochdalek hernia on clinical examination

Answer 6

Decr chest movement affected side
Cardiac impulse shift to opposite side
Bowel sounds in chest
Scaphoid abdomen
Respiratory distress
Cyanosis

Question 7

Discuss the treatment of a Bochdalek hernia

Answer 7

NG tube
IV line
Immediate intubation with low pressure ventilation
Nitric oxide therapy
CVS support
Surgical repair

Question 8

Name complications of a Bochdalek hernia

Answer 8

Early mortality
Mental retardation
Poor pulmonary function
Growth failure
GER
Intestinal obstruction

Question 9

What are the characteristics of a Morgagni hernia?

Answer 9

Gap in restrosternal portion of diaphragm

No impediment of lung development

Question 10

Discuss treatment of Morgagni hernia

Answer 10

Surgical closure