L1: Congenital Diaphragmatic Hernia

Question 1

Def of Congenital Diaphragmatic Hernia

Answer 1

Question 2

Embryology of Congenital Diaphragmatic Hernia

Answer 2

Question 3

Incidence of Congenital Diaphragmatic Hernia

Answer 3

One in 2500-5000 births

Question 4

Most Common Congenital Diaphragmatic Hernia

Answer 4

Most common in its posterolateral part (foramen of Bochdalek)

Question 5

Pathophysiology of Congenital Diaphragmatic Hernia

Answer 5

Question 6

Types of Congenital Diaphragmatic Hernia

Answer 6

Question 7

Cause of Bockdalek Hernia

Answer 7

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

Question 8

Percentage of Bockdalek Hernia

Answer 8

Most common (95%)

Question 9

Cause of Morgagni Hernia

Answer 9

Failure of fusion of septum transversum anteriorly with sternum & ribs

Question 9

Sides in Bockdalek Hernia

Answer 9

• 13% in Right side
• 85% in Left side
• 2% in both sides

Question 10

Percentage of Morgagni Hernia

Answer 10

Rare (< 5%)

Question 11

Sides in Morgagni Hernia

Answer 11

• 90% in Right side
• 2% in Left side
• 8% in both sides

Question 12

Rare Types of Congenital Diaphragmatic Hernia

Answer 12

Eventration of the diaphragm, Defects of the central tendon.

Question 13

Why does Congenital Diaphragmatic Hernia occur in LT side?

Answer 13

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

Question 14

Dx of Congenital Diaphragmatic Hernia

Answer 14

• Prenatal
• Postnatal

Question 15

Prenatal Dx of Congenital Diaphragmatic Hernia

Answer 15

• Rad

Question 16

Prenatal Dx of Congenital Diaphragmatic Hernia

• Rad

Answer 16

Question 17

Postnatal Dx of Congenital Diaphragmatic Hernia

Answer 17

• Clinically & rad

Question 18

Postnatal Dx of Congenital Diaphragmatic Hernia

• Clinically

Answer 18

Question 19

Postnatal Dx of Congenital Diaphragmatic Hernia

• Rad

Answer 19

Question 20

Postnatal Dx of CDH

• Symptoms

Answer 20

Question 21

Postnatal Dx of CDH

• Scaphoid Abdomen

Answer 21

Because most of the abdominal viscera are at the chest

Question 21

Postnatal Dx of CDH

• Physical Exam (Signs)

Answer 21

Question 22

Postnatal Dx of CDH

• AP Diameter

Answer 22

Increased, Because it is distended by the abdominal viscera

Question 23

Postnatal Dx of **CDH** - Medistinal Shift

Answer 23

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

Question 24

Postnatal Dx of **CDH** - Bowel Sounds

Answer 24

Audible bowel sounds within the chest

Question 25

Postnatal Dx of **CDH** - Breath Sounds

Answer 25

Absent breath sounds on the affected side.

Question 26

Postnatal Dx of **CDH** - Most Emportant INVx

Answer 26

ECHOOOOOO

Question 27

Postnatal Dx of **CDH** - ECHO

Answer 27

Question 28

Postnatal Dx of **CDH** - Rad

Answer 28

Question 29

Postnatal Dx of **CDH** - Plain X-Ray

Answer 29

Question 30

Postnatal Dx of **CDH** - Contrast

Answer 30

Confirm the presence of bowel inside the chest.

Question 31

Postnatal Dx of **CDH** - CT

Answer 31

Confirm diagnosis in doubtful cases.

Question 32

TTT of **CDH**

Answer 32

- Pre-operative - Operative - Post-operative

Question 33

TTT of **CDH** - Preoperative

Answer 33

- cardiopulmonary system stabilizization - Gastric Tube - Ventilation - Vascular Access

Question 34

Preoperative TTT of **CDH** - Cardiopulmonary System Stabilization

Answer 34

- cardiopulmonary system is stabilized and pulmonary hypertension should be controlled by medical treatment.

Question 35

Preoperative TTT of **CDH** - Gastric Tube

Answer 35

Gastric tube is inserted to decompress the stomach.

Question 36

Preoperative TTT of **CDH** - Ventilation

Answer 36

- 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.

Question 37

Preoperative TTT of **CDH** - Vascular Access

Answer 37

Secure

Question 38

Operative TTT of **CDH**

Answer 38

Question 39

Post-operative TTT of **CDH**

Answer 39

- controlled ventilation - Pneumothorax - Chylothorax - Enteral feeding

Question 40

Post-operative TTT of **CDH** - Ventilation

Answer 40

- 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.

Question 41

Post-operative TTT of **CDH** - Pneumothorax

Answer 41

Question 42

Post-operative TTT of **CDH** - Chylothorax

Answer 42

- 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**.

Question 43

Post-operative TTT of **CDH** - Enteral Feeding

Answer 43

- 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.