L1: Congenital Diaphragmatic Hernia Flashcards
Def of Congenital Diaphragmatic Hernia
Embryology of Congenital Diaphragmatic Hernia
Incidence of Congenital Diaphragmatic Hernia
One in 2500-5000 births
Most Common Congenital Diaphragmatic Hernia
Most common in its posterolateral part (foramen of Bochdalek)
Pathophysiology of Congenital Diaphragmatic Hernia
Types of Congenital Diaphragmatic Hernia
Cause of Bockdalek Hernia
- Failure of fusion of septum transversum postero-laterally with pleuroperitoneal membranes
Percentage of Bockdalek Hernia
Most common (95%)
Cause of Morgagni Hernia
Failure of fusion of septum transversum anteriorly with sternum & ribs
Sides in Bockdalek Hernia
- 13% in Right side
- 85% in Left side
- 2% in both sides
Percentage of Morgagni Hernia
Rare (< 5%)
Sides in Morgagni Hernia
- 90% in Right side
- 2% in Left side
- 8% in both sides
Rare Types of Congenital Diaphragmatic Hernia
Eventration of the diaphragm, Defects of the central tendon.
Why does Congenital Diaphragmatic Hernia occur in LT side?
Because the liver protects the right hemidiaphragm, diaphragmatic hernias most commonly occur on the left side!
Dx of Congenital Diaphragmatic Hernia
- Prenatal
- Postnatal
Prenatal Dx of Congenital Diaphragmatic Hernia
- Rad
Prenatal Dx of Congenital Diaphragmatic Hernia
- Rad
Postnatal Dx of Congenital Diaphragmatic Hernia
- Clinically & rad
Postnatal Dx of Congenital Diaphragmatic Hernia
- Clinically
Postnatal Dx of Congenital Diaphragmatic Hernia
- Rad
Postnatal Dx of CDH
- Symptoms
Postnatal Dx of CDH
- Scaphoid Abdomen
Because most of the abdominal viscera are at the chest
Postnatal Dx of CDH
- Physical Exam (Signs)
Postnatal Dx of CDH
- AP Diameter
Increased, Because it is distended by the abdominal viscera
Postnatal Dx of CDH
- Medistinal Shift
Signs of mediastinal shift to the opposite side (shifting of heart sounds).
Postnatal Dx of CDH
- Bowel Sounds
Audible bowel sounds within the chest
Postnatal Dx of CDH
- Breath Sounds
Absent breath sounds on the affected side.
Postnatal Dx of CDH
- Most Emportant INVx
ECHOOOOOO
Postnatal Dx of CDH
- ECHO
Postnatal Dx of CDH
- Rad
Postnatal Dx of CDH
- Plain X-Ray
Postnatal Dx of CDH
- Contrast
Confirm the presence of bowel inside the chest.
Postnatal Dx of CDH
- CT
Confirm diagnosis in doubtful cases.
TTT of CDH
- Pre-operative
- Operative
- Post-operative
TTT of CDH
- Preoperative
- cardiopulmonary system stabilizization
- Gastric Tube
- Ventilation
- Vascular Access
Preoperative TTT of CDH
- Cardiopulmonary System Stabilization
- cardiopulmonary system is stabilized and pulmonary hypertension should be controlled by medical treatment.
Preoperative TTT of CDH
- Gastric Tube
Gastric tube is inserted to decompress the stomach.
Preoperative TTT of CDH
- Ventilation
- 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.
Preoperative TTT of CDH
- Vascular Access
Secure
Operative TTT of CDH
Post-operative TTT of CDH
- controlled ventilation
- Pneumothorax
- Chylothorax
- Enteral feeding
Post-operative TTT of CDH
- Ventilation
- 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.
Post-operative TTT of CDH
- Pneumothorax
Post-operative TTT of CDH
- Chylothorax
- 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.
Post-operative TTT of CDH
- Enteral Feeding
- 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.
