diaphragmatic hernia

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Related to diaphragmatic hernia: hiatus hernia


pertaining to a diaphragm.
diaphragmatic hernia protrusion of some of the contents of the abdomen through an opening in the diaphragm and into the chest cavity. The condition may be congenital or acquired.

Congenital diaphragmatic hernia in newborns is due to failure of the embryonic diaphragm to fuse. The opening in the diaphragm can be large enough to permit filling of the thoracic cavity with abdominal contents, thus interfering with normal expansion of the lungs. This produces respiratory distress, which is the outstanding feature of neonatal diaphragmatic hernia. hypoxia results from persistent fetal circulation that produces a right-to-left shunting via the foramen ovale and patent ductus arteriosus. The severity of symptoms and age of onset depend on the extent of hypoplasia of the lungs and the degree of interference with ventilation. The condition constitutes a surgical emergency. Without immediate and successful intervention the neonate is likely to succumb to rapid and progressive respiratory failure.

At the moment of birth the neonate with this condition will show some degree of respiratory distress. The abdomen may appear sunken and the anterior-posterior chest diameter enlarged. Because the position of the heart can be shifted by the herniating organs, heart sounds are often heard on the side opposite the hernia, and bowel sounds may be heard in the chest cavity. A simple x-ray of the chest and abdomen will demonstrate loops of bowel in the chest, with the mediastinum shifted toward the contralateral side.

Surgical repair of the hernia and restoration of internal organs to their rightful place should be done as soon as possible. Before surgery the neonate is stabilized without delay. Nasogastric decompression is begun; intubation and assisted ventilation with supplemental oxygen may be necessary.

Postoperatively, the infant may remain extremely critical; at times extracorporeal membrane oxygenation will be necessary until the persistent fetal circulation resolves. It has been found that the survival rate for these neonates is greatly improved if they are cared for in an environment that is quiet, soothing, and as nonstressful as possible considering the intensive monitoring and care they must have.

Diaphragmatic hernia in the adult usually is a sliding type of hiatal hernia; that is, a part of the stomach slides upward into the thoracic cavity, following the normal path of the esophagus through an enlarged hiatal opening in the diaphragm. Causes include congenital weakness of the structures, trauma, relaxation of ligaments and skeletal muscles, or increased upward pressure from the abdomen. It is most often found in persons of middle age or older.

Small sliding hiatal hernias are found in the majority of persons undergoing an upper gastrointestinal series. Most are asymptomatic and do not require treatment. Those causing symptoms do so because of inflammation of the esophageal lining resulting from gastroesophageal reflux. Typically, the symptoms occur after a full meal and include heartburn and indigestion. Large sliding hernias can cause intermittent abdominal and chest pain, difficult breathing, and cardiovascular symptoms. If the herniated portion of the stomach becomes incarcerated or is perforated, there is sudden sharp pain under the sternum and symptoms of obstruction. Although this rarely occurs, it is a surgical emergency.

The preferred treatment consists of small meals of bland, easily digested food, moderate exercise, and sleeping with the upper part of the body in a raised position. Surgical repair involves invasion of the abdominal and thoracic cavities and is reserved for severe cases that cannot be managed medically.


the abnormal protrusion of part of an organ or tissue through the structures normally containing it. adj., adj her´nial. A weak spot or other abnormal opening in a body wall permits part of the organ to bulge through. A hernia may develop in various parts of the body, most commonly in the region of the abdomen (abdominal hernia), and may be either acquired or congenital. An old popular term for hernia is rupture, but this term is misleading because it suggests tearing and nothing is torn in a hernia. Although various supports and trusses can be tried in an effort to contain the hernia, the best treatment for this condition is herniorrhaphy, surgical repair of the weakness in the muscle wall through which the hernia protrudes.
Bochdalek's hernia congenital posterolateral diaphragmatic hernia, with extrusion of bowel and other abdominal viscera into the thorax; due to failure of closure of the pleuroperitoneal hiatus.
cerebral hernia (hernia ce´rebri) protrusion of brain substance through a defect in the skull.
crural hernia femoral hernia.
diaphragmatic hernia see diaphragmatic hernia.
fat hernia hernial protrusion of peritoneal fat through the abdominal wall.
femoral hernia protrusion of a loop of intestine into the femoral canal, a tubular passageway that carries nerves and blood vessels to the thigh; this type occurs more often in women than in men. Called also crural hernia and femorocele.
hiatal hernia (hiatus hernia) protrusion of a structure, often a portion of the stomach, through the esophageal hiatus of the diaphragm; see diaphragmatic hernia.
Holthouse's hernia an inguinal hernia that has turned outward into the groin.
incarcerated hernia a hernia so occluded that it cannot be returned by manipulation; it may or may not become strangulated. Called also irreducible hernia.
incisional hernia hernia after operation at the site of the surgical incision, owing to improper healing or to excessive strain on the healing tissue; such strain may be caused by excessive muscular effort, such as that involved in lifting or severe coughing, or by obesity, which creates additional pressure on the weakened area.
inguinal hernia hernia occurring in the groin, or inguen, where the abdominal folds of flesh meet the thighs. It is often the result of increased pressure within the abdomen, whether due to lifting, coughing, straining, or accident. Inguinal hernia accounts for about 75 per cent of all hernias.

A sac formed from the peritoneum and containing a portion of the intestine or omentum, or both, pushes either directly outward through the weakest point in the abdominal wall (direct hernia) or downward at an angle into the inguinal canal (indirect hernia). Indirect inguinal hernia (the common form) occurs more often in males because it follows the tract that develops when the testes descend into the scrotum before birth, and the hernia itself may descend into the scrotum. In the female, the hernia follows the course of the round ligament of the uterus.

Inguinal hernia begins usually as a small breakthrough. It may be hardly noticeable, appearing as a soft lump under the skin, no larger than a marble, and there may be little pain. As time passes, the pressure of the contents of the abdomen against the weak abdominal wall may increase the size of the opening and, accordingly, the size of the lump formed by the hernia. In the early stages, an inguinal hernia is usually reducible—it can be pushed gently back into its normal place. Inguinal hernia usually requires herniorrhaphy.
intra-abdominal hernia (intraperitoneal hernia) a congenital anomaly of intestinal positioning, occurring within the abdomen, in which a portion of bowel protrudes through a defect in the peritoneum or, as a result of abnormal rotation of the intestine during embryonic development, becomes trapped in a sac of peritoneum.
irreducible hernia incarcerated hernia.
mesocolic hernia an intra-abdominal hernia in which the small intestine rotates incompletely during development and becomes trapped within the mesentery of the colon.
Morgagni's hernia congenital retrosternal diaphragmatic hernia, with extrusion of tissue into the thorax through the foramen of Morgagni.
paraesophageal hernia hiatal hernia in which part or almost all of the stomach protrudes through the hiatus into the thorax to the left of the esophagus, with the gastroesophageal junction remaining in place.
Paraesophageal hernia. From Dorland's, 2000.
posterior vaginal hernia downward protrusion of the pouch of Douglas, with its intestinal contents, between the posterior vaginal wall and the rectum; called also enterocele. See illustration.
Posterior vaginal hernia. From McKinney et al., 2000.
reducible hernia one that can be returned by manipulation.
Richter's hernia incarcerated or strangulated hernia in which only a portion of the circumference of the bowel wall is involved.
rolling hernia paraesophageal hernia.
scrotal hernia an inguinal hernia that has passed into the scrotum.
sliding hernia hernia of the cecum (on the right) or the sigmoid colon (on the left) in which the wall of the viscus forms a portion of the hernial sac, the remainder of the sac being formed by the parietal peritoneum.
sliding hiatal hernia the most common type of diaphragmatic hernia; a hiatal hernia in which the upper stomach and the cardioesophageal junction protrude upward into the posterior mediastinum. The protrusion, which may be fixed or intermittent, is partially covered by a peritoneal sac.
Sliding hiatal hernia. From Dorland's, 2000.
slip hernia (slipped hernia) sliding hernia.
strangulated hernia one that is tightly constricted. As any hernia progresses and bulges out through the weak point in its containing wall, the opening in the wall tends to close behind it, forming a narrow neck. If the neck becomes pinched tight enough to cut off the blood supply, the hernia will quickly swell and become strangulated. This is a very dangerous condition that can appear suddenly and requires immediate surgical attention. Unless the blood supply is restored promptly, gangrene can set in and may cause death. If a hernia suddenly grows larger, becomes tense, and will not go back into place, and there is pain and nausea, it is strangulated. Occasionally, especially in the elderly, hernia strangulation may occur without pain or tenderness.
umbilical hernia see umbilical hernia.
vaginal hernia hernia into the vagina; called also colpocele.

di·a·phrag·mat·ic her·ni·a

protrusion of abdominal contents into the chest through a weakness in the respiratory diaphragm; a common type is the hiatal hernia.

diaphragmatic hernia

Etymology: Gk, diaphragma, partition; L, rupture
the protrusion of part of the stomach through an opening in the diaphragm, most commonly an abnormally enlarged esophageal hiatus. In some cases the intestines may also herniate into the chest. The enlargement of the normal opening for the esophagus may be caused by trauma, congenital weakness, increased abdominal pressure, or relaxation of ligaments of skeletal muscles, and it permits part of the stomach to slide into the thorax. A sliding hiatal hernia, one of the most common pathological conditions of the upper GI tract, may occur at any age but is most prevalent in elderly and middle-aged people. A kind of diaphragmatic hernia is hiatal hernia.
observations Symptoms of diaphragmatic hernia vary but usually include heartburn after meals, when the patient is in a supine position, and on exertion, especially when bending forward. Regurgitation of food, dysphagia, abdominal distention after eating, belching, intestinal rumbling, rapid breathing, and a dull epigastric pain radiating to the shoulder may occur. The similarity of some of the symptoms to those of myocardial infarction may make the patient fearful and anxious. Continued reflux of gastric juice into the esophagus may lead to ulceration with bleeding and the formation of fibrous tissue. Gastric contents regurgitated during sleep may be aspirated into the lungs.
interventions The patient is placed in bed in a semi-Fowler's position and raised to a high Fowler's position during and after small, frequent meals of a bland diet. The individual is encouraged to chew slowly and thoroughly, to drink one or two glasses of water with a meal (unless contraindicated), and to avoid smoking. The blood pressure, pulse, respirations, and temperature are monitored. Medication for pain, an antacid such as aluminum hydroxide gel, and diagnostic endoscopy and x-ray films may be ordered. To facilitate visualization of the hernia, the patient may be placed in a Trendelenburg position during studies of barium swallowing. If symptoms are severe, persistent, and unrelieved by conservative measures, the hernia may be repaired surgically.
nursing considerations The patient is instructed, before discharge, to eat frequent, small bland meals; not to recline after eating; to lose weight (if indicated); not to smoke; and to avoid constipation. The patient may need to sleep with the head of the bed raised on blocks. Recurrence of symptoms may usually be prevented by observing these instructions.

diaphragmatic hernia

A common–1:2000 live births congenital defect in which a loop of bowel passes through the diaphragm, due to a defective closure of the pleuroperitoneal membrane–through the foramen of Bochdalek, resulting in a common cavity, with the abdominal organs–usually left-sided prolapsing into the chest cavity, which compromises respiration; permutations of DH may be discovered later in life–eg, parasternal hernias or membranous defects; less common sites of DH–through esophageal hiatus or Morgagni's foramen Treatment Surgical repair, ventilatory support and bicarbonates Mortality 40%

di·a·phrag·mat·ic her·ni·a

(dī'ă-frag-mat'ik hĕr'nē-ă)
Protrusion of abdominal contents into the chest through a weakness in the respiratory diaphragm; a common type is the hiatal hernia.

diaphragmatic hernia

Protrusion of any abdominal organ or part or an organ through the DIAPHRAGM into the chest (thoracic) cavity.


pertaining to the diaphragm.

diaphragmatic abscess
in the cow produces a syndrome of humped back, pain on percussion over the xiphoid area, fever and leukocytosis.
diaphragmatic hernia
in cattle, cases resulting from traumatic reticulitis show chronic ruminal tympany, distention, emaciation, anterior displacement of the heart with systolic murmur. Congenital cases in calves and those in cows due to trauma show dyspnea, displacement of the heart, and gut sounds audible in the chest. Horse cases are usually traumatic in origin and result in an acute onset of severe colic with no good distinguishing signs. In dogs and cats, uncommonly congenital but a common sequela to trauma with signs of dyspnea and pleural effusion. See also peritoneopericardial hernia.
diaphragmatic rupture
see diaphragmatic hernia (above).
diaphragmatic septal defects
include pleuroperitoneal and pericardioperitoneal defects.
synchronous diaphragmatic flutter
violent, unilateral hiccoughs occur with each heartbeat, sometimes with muscle tetany reminiscent of lactation tetany; some cases of that disease also have flutter. Acid-base imbalance is present in most cases. Recovery is spontaneous and following treatment with calcium solutions.
diaphragmatic tendon
the heart-shaped tendinous center of the diaphragm.
References in periodicals archive ?
The right lateral position for laparoscopic diaphragmatic hernia repair in pregnancy: technique and review of the literature.
Congenital diaphragmatic hernias (CDH) are potentially life-threatening lesions that result from an anatomical defect in the diaphragm that permits abdominal contents to herniate into the thoracic cavity.
Dual-hit hypothesis explains pulmonary hypoplasia in the nitrofen model of the congenital diaphragmatic hernia.
On clinical examination, the patient had some epigastric tenderness and CT demonstrated a large anterior diaphragmatic hernia (Fig.
Joanne Harvey, from Middlesbrough, went through the heartbreak of seeing two of her children die from diaphragmatic hernias.
Vitamin A Missing or underdeveloped eyes; hydrocephalus; cardiovascular anomalies; urogenital anomalies; diaphragmatic hernia Vitamin D Skeletal abnormalities Vitamin D Skeletal abnormalities Vitamin E Anencephaly; umbilical hernia; club feet; cleft lip Vitamin K Brain hemorrhages; hypoprothrombinemia
CHERUBS (The Association of Congenital Diaphragmatic Hernia Research, Awareness, and Support), a non-profit agency headquartered in North Carolina that provides support for the medical condition known as CDH, which occurs when the diaphragm of a baby fails to fully form, thus preventing growth of the lungs.
12, 2015 /PRNewswire/ -- On October 24th at TPC Wakefield Plantation in North Raleigh, the Wake Forest based international charity, CHERUBS, is holding an event to raise funds to assist families of babies born with Congenital Diaphragmatic Hernia (CDH).
Bedlington's Bradley Tweedy was born with a tracheoesophageal fistula and atresia, and a rightsided diaphragmatic hernia, forcing him to spend the first year of life in hospital fighting for his life.

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