The author - Chuklin Olga, general practitioner, internist. Work experience since 2003.
Aperture is a kind of wall between the chest and abdominal cavities. It is represented by the muscle fibers, and in the central part of the connective tissue.
Diaphragmatic hernia defects called as openings or protrusions in the diaphragm, through which the penetration of the abdominal organs into the chest cavity.
Kinds
It decided to allocate the following types of diaphragmatic hernia:
- traumatic hernia resulting from traumatic effects;
- congenital hernias - they occur in the presence of genetic malformations, occur only in the newborn;
- hiatal hernia (a natural orifice aperture);
- neuropathic hernia resulting from nervous disorders - an excessive relaxation of the muscles of the diaphragm;
- sliding hernia - they are characterized by the fact that the abdominal organs on their own come back into the abdominal cavity.
Causes
Among the reasons can be identified predisposing and precipitating.
Predisposing include the following:
- the weakness of the connective tissue;
- age over 50 years;
- dystrophic changes in muscle and ligaments;
- traumatic injury.
By provoking include the following:
- pregnancy;
- chronic constipation;
- regular overeating;
- weight lifting;
- frequent, intense cough;
- obesity;
- chronic diseases of the gastrointestinal tract.
When exposed to precipitating factors arises increased intra-abdominal pressure, with the result that there is a diaphragmatic hernia.
Symptoms of diaphragmatic hernia
Clinical manifestations of diaphragmatic hernia depends on its type.
So, traumatic hernias occur acutely.
In the presence of hiatal hernia clinical manifestations occur gradually, growing over time (depending on the size of hernia). For a long time with a minimum size of the hernia defect may be a complete absence of symptoms.
Marked clinical manifestations occur and if pinching occurs in organs hernial ring.
Symptoms of diaphragmatic hernia:
- burping air or gastric contents;
- heartburn, which increases with bending forward, horizontal position;
- bloating;
- rumbling sensation in the chest;
- dyspnea, tachycardia after a heavy meal;
- vomiting eaten food;
- difficulty in swallowing food passage (dysphagia).
characterized by such symptoms for infringement of diaphragmatic hernia:
- intense pain in the chest;
- nausea, vomiting;
- bloating.
Diagnostics
If you experience symptoms should consult a doctor-therapist.
The following diagnostic procedures are carried out to confirm the diagnosis:
- fibroezofagogastroduodenoskopiya (EGD) - by the sensor with the video camera on the end investigated inside the esophagus, stomach, duodenum 12. With EGD can detect localization of these organs to estimate the place of transition of the esophagus into the stomach.
- X-ray examination with the use of X-ray contrast agents, allows you to see the penetration of the abdominal organs into the chest cavity.
- pH monitoring to evaluate the level of acidity in the esophagus and the stomach, the esophagus if the acidity is increased, it is an indirect sign of hiatal hernia.
Treatment of diaphragmatic hernia
In most cases patients should be conservative treatment, surgical treatment is used for presence strangulated diaphragmatic hernia, traumatic hernias, with significant amounts diaphragmatic hernias.
Surgical treatment diaphragmatic hernia is ushivanii (plastic) hernial opening may be superimposed on synthetic mesh hernia defect site. Sometimes also used the fixation of the stomach to the abdominal wall, or suturing the fundus to the esophagus wall.
Conservative treatment is the application of the following recommendations:
- food in small portions;
- last meal no later than 3-4 hours before bedtime;
- sleep with a raised head of the bed, in a semi-sitting position;
- exception of fatty, smoked, fried, acidic foods;
- for antacids (omeprazole, ranitidine, almagel) reducing the acidity in the esophagus are used;
- for relieving pain spazmalitiki (Drotaverinum, no-spa, Duspatalin).
complications
Allocate following complications of diaphragmatic hernia:
- the most common are inflammatory diseases of the esophagus - reflux esophagitis, Esophageal ulcers;
- infringement of diaphragmatic hernia.
prevention
- exception strenuous exercise with weight lifting;
- maintaining the normal body weight;
- treatment of constipation;
- Treatment of diseases of the gastrointestinal tract;
- Avoid heavy meals.
