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Y4R4 - Surgery II 👨‍⚕️ > L1: Congenital Diaphragmatic Hernia > Flashcards

L1: Congenital Diaphragmatic Hernia Flashcards

1
Q

Def of Congenital Diaphragmatic Hernia

A
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2
Q

Embryology of Congenital Diaphragmatic Hernia

A
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3
Q

Incidence of Congenital Diaphragmatic Hernia

A

One in 2500-5000 births

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4
Q

Most Common Congenital Diaphragmatic Hernia

A

Most common in its posterolateral part (foramen of Bochdalek)

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5
Q

Pathophysiology of Congenital Diaphragmatic Hernia

A
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6
Q

Types of Congenital Diaphragmatic Hernia

A
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7
Q

Cause of Bockdalek Hernia

A
  • Failure of fusion of septum transversum postero-laterally with pleuroperitoneal membranes
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8
Q

Percentage of Bockdalek Hernia

A

Most common (95%)

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9
Q

Cause of Morgagni Hernia

A

Failure of fusion of septum transversum anteriorly with sternum & ribs

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9
Q

Sides in Bockdalek Hernia

A
  • 13% in Right side
  • 85% in Left side
  • 2% in both sides
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10
Q

Percentage of Morgagni Hernia

A

Rare (< 5%)

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11
Q

Sides in Morgagni Hernia

A
  • 90% in Right side
  • 2% in Left side
  • 8% in both sides
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12
Q

Rare Types of Congenital Diaphragmatic Hernia

A

Eventration of the diaphragm, Defects of the central tendon.

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13
Q

Why does Congenital Diaphragmatic Hernia occur in LT side?

A

Because the liver protects the right hemidiaphragm, diaphragmatic hernias most commonly occur on the left side!

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14
Q

Dx of Congenital Diaphragmatic Hernia

A
  • Prenatal
  • Postnatal
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15
Q

Prenatal Dx of Congenital Diaphragmatic Hernia

A
  • Rad
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16
Q

Prenatal Dx of Congenital Diaphragmatic Hernia

  • Rad
A
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17
Q

Postnatal Dx of Congenital Diaphragmatic Hernia

A
  • Clinically & rad
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18
Q

Postnatal Dx of Congenital Diaphragmatic Hernia

  • Clinically
A
19
Q

Postnatal Dx of Congenital Diaphragmatic Hernia

  • Rad
A
20
Q

Postnatal Dx of CDH

  • Symptoms
A
21
Q

Postnatal Dx of CDH

  • Scaphoid Abdomen
A

Because most of the abdominal viscera are at the chest

21
Q

Postnatal Dx of CDH

  • Physical Exam (Signs)
A
22
Q

Postnatal Dx of CDH

  • AP Diameter
A

Increased, Because it is distended by the abdominal viscera

23
Q

Postnatal Dx of CDH

  • Medistinal Shift
A

Signs of mediastinal shift to the opposite side (shifting of heart sounds).

24
Q

Postnatal Dx of CDH

  • Bowel Sounds
A

Audible bowel sounds within the chest

25
Q

Postnatal Dx of CDH

  • Breath Sounds
A

Absent breath sounds on the affected side.

26
Q

Postnatal Dx of CDH

  • Most Emportant INVx
A

ECHOOOOOO

27
Q

Postnatal Dx of CDH

  • ECHO
A
28
Q

Postnatal Dx of CDH

  • Rad
A
29
Q

Postnatal Dx of CDH

  • Plain X-Ray
A
30
Q

Postnatal Dx of CDH

  • Contrast
A

Confirm the presence of bowel inside the chest.

31
Q

Postnatal Dx of CDH

  • CT
A

Confirm diagnosis in doubtful cases.

32
Q

TTT of CDH

A
  • Pre-operative
  • Operative
  • Post-operative
33
Q

TTT of CDH

  • Preoperative
A
  • cardiopulmonary system stabilizization
  • Gastric Tube
  • Ventilation
  • Vascular Access
34
Q

Preoperative TTT of CDH

  • Cardiopulmonary System Stabilization
A
  • cardiopulmonary system is stabilized and pulmonary hypertension should be controlled by medical treatment.
35
Q

Preoperative TTT of CDH

  • Gastric Tube
A

Gastric tube is inserted to decompress the stomach.

36
Q

Preoperative TTT of CDH

  • Ventilation
A
  • Ventilation by mask or Ambu bag is contraindicated
  • Mechanical ventilation techniques which avoid barotrauma to the hypoplastic lung.
  • Insert endotracheal tube if respiratory support is needed.
37
Q

Preoperative TTT of CDH

  • Vascular Access
A

Secure

38
Q

Operative TTT of CDH

A
39
Q

Post-operative TTT of CDH

A
  • controlled ventilation
  • Pneumothorax
  • Chylothorax
  • Enteral feeding
40
Q

Post-operative TTT of CDH

  • Ventilation
A
  • The newborn will require controlled ventilation while still under the effects of anaesthesia and neuromuscular blockade.

Note: If a chest tube has been placed at the time of surgery, it is placed to water seal or to a very low level of suction to drain air or fluid under pressure.

41
Q

Post-operative TTT of CDH

  • Pneumothorax
A
42
Q

Post-operative TTT of CDH

  • Chylothorax
A
  • Chylothorax occurs in up to 20% of newborns following repair of a diaphragmatic hernia and may be an indication for chest tube if one was not placed intraoperatively.
43
Q

Post-operative TTT of CDH

  • Enteral Feeding
A
  • Enteral feedings are delayed until bowel function has clearly been established, as evidenced by minimal nasogastric drainage, presence of bowel sounds, and passage of stool.

Y4R4 - Surgery II 👨‍⚕️ (21 decks)

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