Under diaphragmatic hernia understand the movement of the abdominal organs into the chest through a natural or abnormal opening in the diaphragm. A muscular diaphragm plate which is disposed between the abdominal and thoracic cavities of the body. Function of the diaphragm on the one hand is the delimitation of these cavities, on the other – is the respiratory diaphragm muscle, which plays an active role in the process of breathing.
Diaphragmatic hernia is a whole group of diseases. Its different types differ from each other by birth, clinical manifestations, course and prognosis.
Diaphragmatic hernia chop up to traumatic and nontraumatic. Traumatic hernia associated with damage to the diaphragm, which may occur as a result of injury, a fall or compression of the abdomen in road and other injuries. In most cases, traumatic hernia combined with multi-organ damage. Only operative treatment is carried out on urgent indications.
Among the non-traumatic hernias are the following varieties:
– Hernia orifices aperture, ie, openings which normally from one cavity to another penetrates esophagus, the aorta, and other blood vessels and nerves
– False congenital hernia (malformations, cleft at which the existing posts in the embryonic period between the chest and abdominal cavities, such hernias are found usually in infancy and require surgical intervention)
– True hernia weak zones diaphragm (the place of origin of these hernias are the so-called “weak area” aperture, ie, places in which the diaphragm is thinner and less durable).
The most common of all of these diseases are a hiatal hernia. They account for over 90% of all diaphragmatic hernias, and in the structure of digestive diseases occupy third place in frequency after the ulcer and cholelithiasis. A hiatal hernia occurs when a hiatal (opening through which the esophagus from the thoracic cavity penetrates the abdominal) abdominal part of the esophagus, stomach or part of the abdominal part of the esophagus with a portion of the stomach is displaced into the chest cavity. Sometimes a hiatal in the chest cavity can be displaced and other organs located in the abdomen.
Causes of the disease
The factors that lead to the development of diaphragmatic hernias can be divided into predisposing and produce.
Predisposing factors include: congenital or acquired weakness of the connective tissue, traumatic injuries diaphragm, the muscular dystrophic changes and ligaments, etc.
The clinical symptoms of diaphragmatic hernia caused by moving into the chest of the abdominal cavity, they bend in the hernial ring, and the compression of the lung and mediastinal shift in a healthy way. Symptoms depend on which organs are involved in the pathological process.
When a hiatal hernia patients complain of heartburn, belching, pain in the upper abdomen, chest and upper quadrant, shortness of breath and palpitations after eating, especially abundant. Fasting usually these phenomena are observed. In some patients there is vomiting after eating, bringing relief. The characteristic symptoms are felt by the sick sounds of “gurgling and rumbling” in the chest.
Be suspected if the patient has a diaphragmatic hernia may physician on the basis of questioning and examination. For the diagnosis of conduct radiopaque study (pre-study patient is instructed to drink harmless to the body contrast agent barium suspension) and esophagogastroduodenoscopy (EGD).
Sliding hiatal hernia is most often complicated by reflux esophagitis and inflammatory diseases of the esophagus (esophagitis, esophageal ulcer), linked to the constant influence on his mucous membrane acidic contents of the stomach.
The most dangerous complication of diaphragmatic hernia is an infringement. The reason for its development may be a factor in any associated with increased intra-abdominal pressure (physical activity, coughing, overeating). If the infringement of a sudden there is pain in the upper abdomen and the left side of the chest may be vomiting, delayed stool, etc. If the infringement of a diaphragmatic hernia surgery is urgent.
Sliding hiatal hernia is not subject to infringement, and in most cases require surgical intervention. Appointed by mechanically and chemically light diet with fractional power in small portions, drugs to reduce gastric acid secretion and reduce the aggressiveness of gastric contents. Patients with hiatal hernia counter heavy physical work, wearing tight belts, tires, increase intra-abdominal pressure.