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Hiatal and Diaphragmatic Hernia

Hiatal and Diaphragmatic Hernia

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Published by Kath
hiatal hernia, diaphragmatic hernia, nursing management, signs and symptoms, diagnostic test, and etc.

hiatal hernia, diaphragmatic hernia, nursing management, signs and symptoms, diagnostic test, and etc.


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Published by: Kath on Jan 28, 2010
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HIATAL HERNIA TYPE OF HERNIA DIAPHRAGMATIC HERNIAOVERVIEWCongenital diaphragmatic hernia (CDH) is a congenital
Hiatal hernia is a condition in which the upper portion of thestomach protrudes into the chest cavity through an opening of thediaphragm called the esophageal hiatus. This opening usually islarge enough to accommodate the esophagus alone. Withweakening and enlargement however, the opening (or herniation)can allow upward passage or even entrapment of the upper stomach above the diaphragm.Hiatal hernia is a common condition. By age 60, up to60% of people have it to some degree.There are 2 types of hiatal hernia.
The most common (95%), The sliding type, asits name implies, occurs when the junction between thestomach and esophagus slides up through the esophagealhiatus during moments of increased pressure inthe abdominal cavity. When the pressure is relieved, thestomach falls back down with gravity to its normal position.
The fixed type (or paraesophageal) implies thatthere is no sliding up and down. A portion of the stomachremains stuck in the chest cavity.malformation (birth defect) of the diaphragm. The most commontype of CDH is aBochdalek hernia; other types include Morgagni'shernia, diaphragm eventration and central tendon defects of thediaphragm. Malformation of the diaphragm allowsthe abdominal organs to push into the chest thereby impedingproper lung formation.CDH is a life-threatening pathology in infants, and a major causeof death due to two complications: pulmonaryhypoplasia and pulmonary hypertension.
Experts disagree on therelative importance of these two conditions, with some focusing onhypoplasia, others on hypertension.
Newborns with CDH oftenhave severe respiratory distress which can be life-threateningunless treated appropriately.Types of congenital diaphragmatic herniaBochdalek herniaThe Bochdalek hernia, also known as a postero-lateraldiaphragmatic hernia, is the most common manifestation of CDH,accounting for more than 95% of cases. In this instance thediaphragm abnormality is characterized by a hole in the postero-lateral corner of the diaphragm which allows passage of theabdominal viscera into the chest cavity. The majority of Bochdalekhernias (80-85%) occur on the left side of the diaphragm, a largeproportion of the remaining cases occur on the right side, and asmall fraction are bilateral i.e., left and right sided defects.
 Morgagni's herniaThis rare anterior defect of the diaphragm is variably referred to as
Morgagni¶s, retrosternal, or parasternal hernia. Accounting for approximately 2% of all CDH cases, it is characterised byherniation through the foramina of Morgagni which are locatedimmediately adjacent to the xiphoid process of the sternum.
Themajority of hernias occur on the right side of the body and aregenerally asymptomatic; However newborns may present withrespiratory distress at birth similar to Bochdalek hernia. Additionally, recurrent chest infections and gastrointestinalsymptoms have been reported in those with previouslyundiagnosed Morgagni's hernia
In asymptomatic individualslaparoscopic surgical repair is still recommended as they are atrisk of a strangulated intestine.Diaphragm eventrationThe diagnosis of congenital diaphragmatic eventration is usedwhen there is abnormal displacement (i.e. elevation) of part or allof an otherwise intact diaphragm into the chest cavity. This raretype of CDH occurs because in the region of eventration thediaphragm is thinner, allowing the abdominal viscera to protrudeupwards. This thinning is thought to occur because of incompletemuscularisation of the diaphragm, and can be found unilaterally or bilaterally.
Minor forms of diaphragm eventration areasymptomatic, however in severe cases infants will present withrespiratory distress similar to Bochdalek herniaHiatal Hernia

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