Diaphragm disorders By Dr seyed Mostafa Shiryazdi Associate

Diaphragm disorders By: Dr seyed Mostafa Shiryazdi Associate professor of surgery

Clinical Anatomy n -musculotendinous membrane n -central: tendinous n -peripheral: muscular

HIATUS n -Aorta: T 12 azygus vein-thoracic duct n -Esophagus: T 10 vagus nerves n -IVC: T 8

BLOOD SUPPLY n -abdominal aorta: RPA-LPA n -thoracic aorta: SPA n -internal mamary artery

VENOUS DRAINAGE n -left phrenic vein n -right phrenic vein n -Both drain to IVC

INNERVATION n -Right phrenic nerve: motor innervation n -Left phrenic vein: motor innervation n -Intercostal nerve: sensory innervation

Diaphragm develops between the 4 th and 8 th weeks of gestation

Failure closure of the pericardio peritoneal canal cause CDH(bochdalek hernia)

The crura develop from the mesentery of esophagus

Higher position of diaphragm LIVER in right HEART in left

Diaphragm develops Transverse septum Pleuroperitoneal membrane Dorsal and lateral body wall Mesentery of esophagus

CONGENITAL DIAPHRAGMATIC HERNIA n _BOCHDALEK HERNIA n -MORGAGNI HERNIA n -ESOPHAGEAL HIATAL HERNIA

BOCHDALEK HERNIA n Male: female 2/1 n Left sided 90% n Right sided 10%

Clinical Finding n Rsepiratory dystress n Absence of breath sounds n Bowel sound in chest n Scaphoid abdomen

Bochdalek hernia occurs in 1: 40005000 live birth n Morgagni hernia occurs <2% of all diaphragmatic hernia

Usually CDH discovered prenataly on routine ultrasound

After birth n CXR n BARIUM SWALLOW

Long term problems in CDH n Gastroesophageal reflux n Chronic lung disease n Hearing loss n Pectus excavatum n seizure

Contained sac in morgagni Omentum Colon Stomach Liver Small intestine

treatment n Nasogastric tube n Fluid and electrolyte n PEEP or ECMO n surgery

Right side: thoracotomy Left side: laparotomy

Mortality 30 -50% in 24 hours

MORGAGNI HERNIA n Larrey hernia or retrosternal n Rarely symptomatic n Symptomatic after 40 years

HIATAL HERNIA n Sliding n Paraesophageal n mixed

GER n Medical n Surgical n FTT-repeated recurrent respiratory infection-anemia-

Diaphragm tumors n Primary(rare): fibrosarcoma-hydatid TB n secondary cyst-

Eventration of diaphragm n Congenital(non paralysed) n Acquired(paralysed)

Trauma to diaphragm n 90% left sided n Early diagnosis: laparotomy n Late diagnosis: thoracotomy