Diaphragm disease should not be underestimated. As scientists say, this organ is the second heart of the human body. If a person is he althy, for every minute he performs about 18 motor acts, moving up and down by 4 cm from the starting point. The diaphragm is the strongest human muscle that compresses the vascular system of the abdomen, the lymphatic vessels. Thanks to her, the veins are emptied, blood enters the chest.
General information
It is sometimes difficult to notice human diaphragm diseases, but some pathologies immediately manifest themselves as severe symptoms. All diseases of the body negatively affect its performance. Normally, a muscle contracts four times slower per minute than the heart. It provides a powerful blood pressure - much higher than guaranteed by cardiac muscle tissues. This is due to the large area of \u200b\u200bthe organ and the ability to strongly push blood.
With a certainperiodically, the diaphragm compresses the liver, which makes the bile flow easier and more accurate. At the same time, the muscle stimulates blood flow in the liver. The better the diaphragm works, the better the liver functionality, and this has a positive effect on the condition of a person suffering from various diseases. The reverse is also true: if the diaphragm does not work well, the functionality of all the vital organs of the body deteriorates.
Problems: Damage
For some diseases of the diaphragm, surgery is the most effective way to help someone in need. This is often the case in cases of organ damage. Closed damage is possible due to an injury at work or received on the road. A person can fall from a great height, get a concussion. The cause of damage can be a strong pressure on the abdomen. The rupture of the organ is usually explained by a sharp increase in pressure in the abdominal cavity. In most cases, damage is localized in the tendon center or nearby, as well as in the place where the tendons pass into muscle fibers.
Up to 95% occurs in cases of violation of the integrity of the left dome of the organ. Damage is accompanied by injuries of the pelvic bones, the integrity of the chest may be violated. Damage to the diaphragm often leads to a violation of the structure and integrity of organs located in the abdominal cavity. A wound, a rupture of a muscular organ due to negative pressure in the sternum, leads to a displacement of the stomach into the pleural area. The omentum shifts, parts of the intestine and liver move. May get hurtspleen.
Open option
Such a disease of the diaphragm is possible when receiving a wound. More often it is a cut, stab wound. The cause may be a thoracoabdominal wound obtained from a firearm. It is known from statistics that such damage is almost always accompanied by other violations of the integrity and structure of internal organs. The organs localized in the sternum and abdomen are predominantly affected.
Clinic and clarification
If damage is suspected, X-ray diagnosis of diaphragm disease is the main method for assessing the patient's condition. At the acute stage of development, manifestations of trauma are observed. The patient is in shock. Fixed weakness of the respiratory system, vascular, cardiac. Bleeding is usually fixed, bone fractures are possible. When the diaphragm is damaged, there is usually a hemopneumothorax, peritonitis.
When diagnosing, it is necessary to assess the compression, displacement of the mediastinal internal organs. Sometimes the structures that fall into the pleural zone are infringed. The task of the doctor is to discover this fact in time. To do this, resort to X-rays.
What to do?
Treatment of diaphragm disease against the background of a wound, rupture involves surgery. Urgent surgical intervention is indicated. Defects need to be repaired. The doctor puts separate seams, resorting to a material that is not able to dissolve. The abdominal organs are first returned to their place. The first stage of the operation is a thoracotomy or laparotomy. Selecting a particular optiondue to the characteristics of the patient's injury.
Hernia
This term refers to a pathological condition in which organs normally located in the abdominal cavity are displaced into the sternum. Defects that a person has from birth or subsequently acquired due to aggressive factors become the way of movement. All cases of hernia are classified into acquired, congenital, caused by trauma. False forms of the disease are known. This is the name of the condition in which there is no pathological sac in the peritoneum. Such pathologies are also available from birth, acquired. The first ones appear if certain areas characteristic of the embryo remain uncovered in the diaphragm. At this stage of human development in the muscle structure there are special ways of communicating cavities (sternum, abdominal). Normally, as a person develops, they overgrow. Cases of pathology are observed relatively rarely.
A more common disease of the diaphragm is a false hernia due to trauma. It is more often explained by a wound of the internal organs, the muscles themselves. A previous isolated diaphragmatic rupture is possible, the size of which does not exceed three centimeters. This can appear not only in the muscle block of the organ, but also in the tendon zone.
True hernia
A distinctive feature of this pathological condition is the presence of a hernial sac. It covers organs that have shifted relative to the normal anatomical position. This disease of the diaphragm is usually observed against the background of growthpressure inside the abdominal cavity, which leads to displacement of the organs located in it. If they pass through the sternocostal area, a parasternal hernia is diagnosed. More often, pathological conditions are identified, named after researchers: Morgagni, Larrey. Passage of internal structures through poorly developed sites of a diaphragm of a breast is possible. In this case, a retrosternal hernia is diagnosed. If the internal organs move from an anatomically correct position through the lumbocostal areas, a Bochdalek hernia is detected.
And in the case of congenital pathology, and in a different variant of the disease, the hernial sac contains internal organs. These may include omentum, fiber. The latter is called parasternal lipoma. Atypically located true variants of diaphragmatic hernia in medicine are observed very rarely. They are somewhat similar to diaphragmatic relaxation. The key difference is the appearance of a hernia ring, which is accompanied by a potential risk of strangulation.
State Clinic
Symptoms indicating diaphragm disease vary greatly from case to case. Much is determined by the level of displacement of internal elements in the pleural block. The scale of the manifestation of pathology is determined by the volume of the moved parts, the level of fullness of the hollow structures. The fold, squeezing plays a role - this is usually observed near the gates of the pathological zone. The clinical picture is dictated by pulmonary collapse, mediastinal displacement. Much is determined by what the gate is, how big it is, what configuration it has. Known to be falsepathologies sometimes, in principle, are not characterized by severe symptoms. All manifestations are divided into general, associated with the respiratory, cardiac system and gastrointestinal tract.
Symptoms of diaphragm disease in humans include a feeling of heaviness in the pit of the stomach. The patient may notice pain in this area. Sensations extend to the chest, under the ribs. There is an increase, heaviness of the heartbeat, shortness of breath is recorded. Symptoms are especially pronounced if you eat tightly. Often, gurgling, rumbling are felt in the sternum. Symptoms are noticeable in the half where the hernia is located. If the patient lies down, the symptoms are activated. Following a meal, vomiting is possible with food that has barely entered the body. If gastric torsion is observed, the esophagus is bent, specific dysphagia is formed, large parts of the food move through the gastrointestinal tract much better than liquid.
Features of manifestations
Symptoms of diaphragm disease in humans include bouts of soreness. This is observed if the hernia is infringed. Sensations are localized in the area of the sternum where the infringement occurred. Pain in the epigastric zone is possible if there is an infringement in this place. There is a possibility of symptoms inherent in intestinal obstruction in acute form. If the hollow structure is infringed, the start of necrotic processes, perforation of the wall is possible. The result is pyopneumothorax.
You can assume the primary diagnosis if the patient has previously been injured. An important role in the formulation of the diagnosis is played by the patient's complaints and deteriorationmobility of the sternum, smoothing the gaps between the ribs from one half of the body. Doctors involved in the diagnosis, clinic, treatment of diaphragm disease note that in many patients with such a hernia, the stomach sinks. This is more characteristic of the case of the prolonged existence of pathology, large dimensions of the process. Over half of the sternum corresponding to the hernia, dullness, tympanitis are observed, the intensity is determined by the fullness of the gastrointestinal tract. The task of the doctor is to listen to intestinal peristalsis. Splashes, noises, weakness of respiratory noise, its disappearance are possible. Mediastinal dullness may move to unaffected areas.
Instrumental examination
Before formulating a conclusion, it is necessary to make an X-ray diagnosis of the diaphragm disease. Additionally, CT is sometimes required. If the gastric cavity has shifted into the sternum, there is a high horizontal liquid level on the left side. With prolapse of the small intestine, the study of the field of the lungs shows areas of shadow, light. The displacement of the liver, spleen on x-ray is reflected by a darkened area of the lung field. In some patients, the diaphragmatic dome is clearly visible, the abdominal organs that have come out above it.
Sometimes a contrast x-ray examination of the gastrointestinal tract is recommended. This may show parenchymal internal organs have fallen out or are hollow. In the study, the exact position of the hernia gate, their dimensions are determined. They start from the information about the squeezing of the displaced areas. Sometimes pneumoperitoneum is needed to make an accurate diagnosis. If a herniafalse, air moves into the pleural zone. On X-ray, the result will be consistent with pneumothorax.
Therapy
With the above symptoms, the treatment of diaphragm disease is practiced surgically (the risk of infringement is high). If the pathology is localized in the right half of the body, the operation is transthoracic. The parasternal scenario requires an upper laparotomy. If the pathology is localized on the left, transthoracic access is required. First, the adhesions are separated, then the edges of the defective area are released, the zones that have risen from there are brought down to the peritoneal region, then the damaged block of the diaphragm is sutured. Nose sutures are required. These should be separate. The task of the surgeon is to make a duplication. Sometimes the defect is very large. This requires the use of synthetic products to block it. Use made of lavsan or teflon.
If a hernia is retrosternal, Larrey, the organs that have shifted from the blocks placed are transferred lower, then the bag is turned out and cut off. The next stage is the formation of seams in the form of the letter "P" with subsequent tying. This is how the defective edges are treated, then the posterior vaginal sheet of the abdominal muscles. The next stage of the surgeon's work is the processing of the ribs, the sternal periosteum.
Nuances and cases
If, with the above symptoms of the disease, diaphragm treatment is necessary against the background of a pathology localized in the lumbocostal region, separate sutures are made to sew up the diaphragm defect. The task of the doctor is to formduplication.
If the hernia is strangulated, a transthoracic approach is required. The restraining ring is cut. The next step in the doctor's work will be to study the filling of the hernial sac. If the prolapsed organs are still viable, they should be repositioned into the peritoneal region. If the changes are irreversible, it is required to remove the affected areas. The final step is suturing the defect of the muscular organ.
Hiatal hernia
Such a disease of the diaphragm can be acquired during life or inherited from birth. All cases are divided into paraesophageal, axial. The latter are also called sliding. In fact, such a pathology is a protrusion of the gastric cavity through the opening of the esophagus, anatomically provided in the diaphragm. The majority of cases of this disease do not have severe symptoms. If the acid reflux worsens over time, the symptoms of gastroesophageal reflux disease (GERD) are observed. To make a diagnosis, an X-ray examination is indicated. The patient must first take one sip of barium sulfate. The therapeutic course is chosen based on the symptoms of the case. Treatment is needed if typical manifestations of GERD are observed.
The etiology of the pathology is still unclear. It is believed that a hernia appears as a result of stretching of the ligaments of the fascia of the diaphragmatic fissure, the esophagus. Most often there is a sliding form of the disease. The gastroesophageal transition in patients with this disease is above the diaphragmatic level, a certain percentage of the stomach is also located above. If astudies show a paraesophageal hernia, the transition is anatomically correct, a certain percentage of the stomach is adjacent to the esophagus inside the opening.
Features of the case
A hernia is an abnormal protrusion. Such a disease of the diaphragm according to a sliding scenario is recorded in approximately 40% of the persons who came for a preventive study. The phenomenon is one of the relatively widespread. More often it is detected quite by accident, when the patient is sent for an X-ray examination due to some other reasons. In this disease of the diaphragm, clinical recommendations are difficult to formulate due to problems in determining the relationship between symptoms and the fact of the presence of the disease. Statistical studies show that the main percentage of GERD sufferers have such a hernia. But among those who found such a hernia, GERD was detected in less than half.
Sliding hernia is a disease of the diaphragm, the majority of which have no symptoms at all. Less commonly, patients report pain in the sternum. There may be other sensations that indicate reflux. If the pathology is formed paraesophageally, it does not manifest itself by any sensations. If we compare the course of the case with a sliding form, we should note the likelihood of infringement of the esophageal opening. Therefore, there is a risk of complications in the form of strangulation. Any type of hernia can provoke massive bleeding in the gastrointestinal tract, causing a hidden focus of bleeding.
Clarification and treatment
If based on the symptoms of the diseasediaphragm or without any at all, the doctor believes that it is necessary to check the patient for the presence of a hernia of the esophageal diaphragmatic opening, prescribe an X-ray examination. Use barium sulfate for ascertaining. If the pathology is very large, it is more likely to detect it by chance when the patient is sent for an X-ray examination of the sternum. If the pathological process is small, the only reliable modern method of detection is fluoroscopy with a preliminary intake of barium sulfate.
If a sliding hernia is detected, there are no symptoms of the disease, and specialized treatment is usually not prescribed. If symptoms characteristic of GERD are observed, therapy is chosen based on this diagnosis. In case of diaphragmatic disease, hospital surgery is indicated only in the case of the paraesophageal type due to the likelihood of infringement. In the case of a sliding type of hernia, sometimes surgery is required if an internal focus of bleeding has formed. There is a possibility of complications in the form of peptic esophageal stricture, which also requires surgical measures. If GERD does not respond to conservative treatment for a long time, surgery may be recommended.
Paraesophageal hernias: features
Such diseases of the diaphragm are divided into two categories: antral, fundic. Through the opening of the diaphragm near the esophagus, gastric and intestinal tissues can move into the mediastinum. The fundic type of flow is more often detected. The clinical picture is determined by the characteristics of the content of the hernia sac, as well as the level of movement of organs from the outside. Notthe functionality of the closure of the sphincter of the esophagus is disturbed. Possible manifestations of violations of the gastrointestinal tract. Sometimes the disease is detected when neuromuscular diseases diagnosed through ultrasound of the diaphragm are suspected. A hernia can manifest itself as a malfunction of the respiratory system or a violation of the functionality of the cardiovascular system. More often, a displacement of the stomach into the sternum cavity is detected.
Sternal fluoroscopy reveals the shadow of the heart with a rounded light block. Sometimes the liquid level is reflected. If the stomach contains a contrast agent, it is possible to determine where and how the fallen block is located, how it is located relative to the cardia, the esophagus. If the symptoms suggest a polyp, there is a suspicion of a peptic ulcer or gastric oncology, an esophagogastroscopy is necessary.
Diaphragm relaxation
This term refers to a pathological condition in which the diaphragm becomes thinner and shifts upward along with the nearby organs, while the attachment line often remains original. Congenital cases of such a disease are possible due to underdevelopment or absolute muscle aplasia. Perhaps an acquired disease, in most cases due to damage to the nervous system that feeds the diaphragm. There is a possibility of an absolute course of the process, in which the dome is completely affected and moves. This is most often seen on the left. An alternative option is a limited pathological process in which one of the sections of the diaphragm becomes thinner. More often this is observed on the right in the anteromedial zone.
In case of relaxation, the lung is compressed from the affected area, the mediastinum is displaced in the opposite direction, gastric volvulus or a similar pathology of the intestinal tract in the bend near the spleen is possible.
Relaxation on the right in a limited area does not show symptoms. If the process proceeds on the left, the symptoms are similar to a hernia, but there is no risk of infringement, since there is no hernial ring. To make a diagnosis, the displacement of internal organs is studied, the condition of the lungs and mediastinal structures is assessed. Instrumental diagnostic methods - CT, X-ray examination.
