Congenital Diaphragmatic Hernia

In: Science

Submitted By mintzas
Words 2636
Pages 11
The Diaphragm and Congenital Diaphragmatic Hernia

The diaphragm is a commonly misunderstood body part. Those who sing appreciate it purely due to their ability to control the diaphragm to enhance their singing. However, its real purpose in the human body is more important than that. The diaphragm plays such a crucial role in everyday life to the extent that one cannot survive without it. In this paper we will consider the role of the diaphragm through its anatomy and physiology. We will then review a congenital birth defect known as Congenital Diaphragmatic Hernia (CDH) and how it changes the anatomy and physiology of the body. We will also look at current research and prognosis of the disease in an effort to gain a better understanding of this often-fatal defect.

The diaphragm is located almost centrally in the body. It is a continuous sheet of muscle that spreads across the bottom of the rib cage creating a divide between the thoracic cavity and the abdominal cavity. As detailed in the text Gray’s Anatomy, the convex upper surface of the diaphragm faces the thorax and forms the bottom of the thoracic cavity. The concave inferior surface is pointed towards the abdomen and is mostly covered in peritoneum forming the superior part of the abdominal cavity. The right side of the diaphragm is superior to the right lobe of the liver, the right kidney, and the right adrenal gland. The left side of the diaphragm lays over the left lobe of the liver, the fundus of the stomach, the spleen, the left kidney, and the left adrenal gland (Gray, 2005).

The diaphragm has three parts, which are based on the regions of attachment of its outer surfaces. They are known as the sternal, the costal and the lumbar. Again, Gray’s Anatomy goes into great detail but in general, the sternal part is formed at the xiphoid process of the sternum. The costal part begins…...

Similar Documents

Anatomy

...the right atrium What does the spleen arise from? Dorsal mesentery, but is supplied by the artery of the foregut What does the thymus arise from? Epithelium of the 3rd branchial pouch What does the thyroid diverticulum arise from? The floor of the primitive pharynx What does the truncus arteriosus give rise to? The ascending aorta and pulmonary trunk What does the umbilical arteries give rise to? Medial umbilical ligaments What ear muscle does the 1st branchial arch form? Tensor tympani What effect does 13-cisretinoic acid have on the fetus? Extremely high risk for birth defects What effect does ACE inhibitors have on the fetus? Renal Damage What effect does iodide have on the fetus? Congenital goiter or hypothyroidism What effect does warfarin and x-rays have on the fetus? Multiple anomalies What effects does cocaine have on the fetus? Abnormal fetal development and fetal addiction What embryonic structure are the smooth parts of the left and right ventricle derived from? Bulbus cordis What embryonic structure does the coronary sinus come from? Left horn of the sinus venosus What embryonic structure does the median umbilical ligament come from? Allantois (urachus) What fetal landmark has developed within week 2 of fertilization? Bilaminar disk What fetal landmark has occurred within week 1 of fertilization? Implantation What fetal landmark has occurred within week 3 of......

Words: 11777 - Pages: 48

Electronic

...lumbar spondylolisthesis 122 Surgical treatment of scoliosis 126 Treatment of lumbar disc hernia: anterior approach 129 7 Upper limb surgery Sternoclavicular dislocation 134 Stabilisation of a shoulder prosthetic implant 136 Cleidectomy 137 Osteosynthesis of a fracture of the forearm 139 Anterior approach to the subacromial space 141 v Contents Anterior approach to the glenohumeral joint 143 Axillary approach to the glenohumeral joint 147 Subdeltoid approach to the proximal metaphysis of the humerus 150 Anterior approach to the proximal third of the radius 151 Allograft of patella and patellar ligament 173 Cross-section through the hip joint 176 Posterior approach to the acetabulum 177 Inguinal approach to the acetabulum 181 Extended iliofemoral approach to the acetabulum 186 Posteromedial approach to the ankle 190 Lateral approach to the subtalar and midtarsal joint 193 8 Lower limb surgery Anatomy of the posterior approach to the femoral shaft 154 Extended medial approach to the popliteal vessels 157 Anatomy of the knee 160 Anatomy of the lumbosacral plexus 162 Prosthesis of the patella 163 Repair of a rupture of the anterior cruciate ligament 167 Posterior approach to the posterior cruciate ligament 171 9 Miscellaneous Muscular studies 195 Surgery of the ear: neurosurgery 199 Surgery of the middle ear 202 Tympanic graft 204 Paediatrics: Pavlick’s harness 207 Congenital malformations 208 Detection of fetal anomalies 216 Dissection of the left heart 217......

Words: 14256 - Pages: 58

Hernia

...Abstract There are many different types of hernias. The most common type is inguinal which occurs in the groin (Balentine, J.R, 2010). Other types of hernias are femoral, umbilical, incisional, hiatal, sports, and congenital diaphragmatic. Symptoms of a hernia may include pain or discomfort and localized swelling on the abdomen or in the groin area. If a hernia is found the usual treatment is surgery. Most common surgery is laparoscopic. What is a hernia? Why do we get them? What are symptoms caused by hernias? Who is more likely to get a hernia? How to help prevent from getting a one? These are all questions many people have. A hernia is any condition in which the viscera protrude through a weak point in the muscular wall of the abdominopelvic cavity (Saladin, 2010). This may cause a bulge or tear in the abdominal wall. This can be more noticeable when the muscles in the stomach are tightened causing pain. Lifting weights or heavy objects, running, or straining to have a bowel movement can put strain on the abdominal area and worsen the hernia. A hernia may be likened to a failure in the sidewall of a tire. The tire’s inner tube behaves like the organ and the side wall like the body cavity wall providing the restraint. A weakness in the sidewall allows a bulge to develop allowing the inner tube to protrude leading to the eventual failure of the tire. (Hernia Symptoms, 2007-2008) There are many different types of hernias that effect men, women, and......

Words: 1214 - Pages: 5

Hernia

...Hernia * is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it * The protruded parts are generally contained in a sac-like structure, formed by the membrane with which the cavity is naturally lined. * Inguinal hernia: Makes up 75% of all abdominal wall hernias and occurring up to 25 times more often in men than women. * Any condition that increases the pressure in the intra-abdominal cavity may cause the formation of a hernia, including the following: * Marked obesity * Heavy lifting * Coughing * Straining * Family history of hernias * Asymptomatic hernia * Presents as a swelling at the hernia site * No true pain or tenderness upon examination * Enlarges with increasing intra-abdominal pressure and/or standing * Incarcerated hernia * Painful enlargement of a previous hernia or defect * Cannot be manipulated (either spontaneously or manually) through the fascial defect * Nausea, vomiting, and symptoms of bowel obstruction (possible) * Strangulated hernia * Symptoms of an incarcerated hernia present combined with a toxic appearance * Systemic toxicity secondary to ischemic bowel is possible * Strangulation is probable if pain and tenderness of an incarcerated hernia persist after reduction * Direct Hernia * is most often an “acquired lesion”.  ......

Words: 796 - Pages: 4

Tram Pepar

...When the diaphragm relaxes, air is exhaled by elastic recoil of the lung and the tissues lining the thoracic cavity. Assisting this function with muscular effort (called forced exhalation) involves the internal intercostal muscles used in conjunction with the abdominal muscles, which act as an antagonist paired with the diaphragm's contraction.The diaphragm is also involved in non-respiratory functions, helping to expel vomit, feces, and urine from the body by increasing intra-abdominal pressure, and preventing acid reflux by exerting pressure on the esophagus as it passes through the esophageal hiatus.In some non-human animals, the diaphragm is not crucial for breathing; a cow, for instance, can survive fairly asymptomatically with diaphragmatic paralysis as long as no massive aerobic metabolic demands are made of it.AnatomyThe diaphragm is a dome-shaped musculofibrous septum that separates the thoracic from the abdominal cavity, its convex upper surface forming the floor of the former, and its concave under surface forming the roof of the latter. Its peripheral part consists of muscular fibers that take origin from the circumference of the inferior thoracic aperture and converge to be inserted into a central tendon.The muscular fibers may be grouped according to their origins into three parts: Part | Origin | sternal | two muscular slips from the back of the xiphoid process. | costal | the inner surfaces of the cartilages and adjacent portions of the lower six ribs on......

Words: 4757 - Pages: 20

Pediatrics

...1. Congenital rubella: a) Has an incubation period of 7-10 days. b) May be complicated by polyarthralgia. c) Rarely causes deafness. d) Is an indication for termination if it occurs in the first two months of pregnancy. e) May cause prolonged jaundice. 2. Recognised causes of delayed bone age include: a) Hypopiturtarism b) Primary hypothyroidism c) Congenital adrenal hypoplasia d) Prolonged corticosteroid therapy e) Tuberculosis 3. Kwashiorkor: a) Hypothermia is a recognized complication T b) Edema is mainly due to protein losing enteropathy. T c) Measles is a recognized precipitant F d) The incidence is highest in the first two month of life F e) The birth of a second child to the mother may be a contributory factor F 4. At the age of eight months a baby can be expected to: a) Roll over from front to back T b) Sit up with a straight back T c) Pick a small bead between thumb and finger T d) Say up to five word clearly F e) Feed himself with a spoon F 5. if a child in the ward's develops measles, the following action are appropriate a) Close the wards to all admissions for one week F b) Actively immunized all the other patients against measles T c) Give gamma globulin to all patients who have not been immunized or had measles T d) Forbid visiting by the parents until the rash has gone F e) Give prophylactic antibiotics to all contacts at home T 6. Convulsion in the first week of life is characteristic of a) Hypocalcaemia T b) Post......

Words: 12009 - Pages: 49

Requiring Newborn Screening of Critical Congenital Heart Disease

...Requiring Newborn Screening of Critical Congenital Heart Disease Date With the numerous technological advances that have occurred in today’s health care system, one would think newborn screening would be required in Maryland for the most common birth defect in the United States, critical congenital heart disease (CCHD), but only just this year has the state considered the requirement (Department of Legislative Services, Office of Information Systems [DLSOIS], 2011). Critical congenital heart disease, a disorder in which an infant’s heart or blood vessels near the heart develop abnormally before birth, affects approximately 8 out of every 1,000 infants each year in the US, amounting to around 36,000 infants (DLSOIS, 2011). CCHD is the leading cause of death among infants within the first year of life, amounting to nearly 40% of deaths, often due to the fact that a large number of infants with this disease go undetected (Martin, Bradshaw, & Wright, n.d.). Although some babies are diagnosed with congenital heart disease shortly before or after birth, many diagnoses are not made until days, weeks, or months later; sometimes not at all. Many benefits are associated with implementing CCHD screening, many treatment options are available for those diagnosed with CCHD, and a bill is being proposed to the State of Maryland’s General Assembly about including this screening in the Department of Health and Mental Hygiene’s Newborn Screening Program (DLSOIS, 2011). The......

Words: 1743 - Pages: 7

Birth Defects

...related health problems, tenth revision (ICD-10), includes birth defects in Chapter XVII: Congenital malformations, deformations and chromosomal abnormalities. Birth defects like inborn errors of metabolism and blood disorders of prenatal origin appear in other chapters. Birth defects can be defined as structural or functional abnormalities, including metabolic disorders, which are present from birth. The term congenital disorder is considered to have the same definition; the two terms are used interchangeably.2 The eleventh revision of the classification provides an opportunity for a review of the current entry. 3. Irrespective of definition, birth defects can cause spontaneous abortions and stillbirths and are a significant but underrecognized cause of mortality and disability among infants and children under five years of age. They can be life-threatening, result in long-term disability, and negatively affect individuals, families, health-care systems and societies. BIRTH DEFECTS AND GLOBAL NEWBORN AND CHILD MORTALITY 4. Congenital disorders are a common condition. WHO estimates that some 260 000 deaths worldwide (about 7% of all neonatal deaths) were caused by congenital anomalies in 2004.3 They are most prominent as a cause of death in settings where overall mortality rates are lower, for example in the European Region, where as many as 25% of neonatal deaths are due to congenital anomalies. 1 2 See document EB126/2010/REC/2, summary record of the seventh......

Words: 2582 - Pages: 11

Signs of Shock in Animals

...A blood clotting test may also be run. If the ingestion occurred recently the doctor may choose to induce emesis immediately upon arrival to the clinic. If it is unknown when the patient may have been poisoned with mouse bait it is important to remember they may not show signs for several days after eating the poison. Signs may include: lethargy, pale gums, trouble breathing, vomiting blood or a bloody nose. A medication to improve clotting ability (Vitamin K1), hospitalization and blood transfusions may be needed depending on the patient’s signs. A common trauma seen is a patient being hit by a car causing chest trauma. Chest trauma is of great concern when a hit by car arrives at the clinic. There can be fractured ribs, diaphragmatic hernia (tear in the diaphragm), Pneumothorax (buildup of air in the pleural space) and hemothorax (blood in the pleural space) present with a chest trauma. These patients will likely present with signs of shock and respiratory distress. Difficulty breathing, rapid heart rate, abnormal lung sounds, pale or blue mucous membranes and in a state of panic (nervousness) due to difficulty in breathing. Of course a hit by car patient could have many other traumas as well as thorax related concerns. Fractured legs, head injuries, lacerations or even degloving wounds (the skin has been peeled away from the underlying connective tissue)....

Words: 564 - Pages: 3

Anatomu

...veins in the limbs tend to occur as two or more smaller vessels tightly surrounding their accompanying artery. This feature is especially true of the deep vessels, where the veins are denoted as accompanying veins (venae comitantes). This arrangement works as a physiological countercurrent heat exchange mechanism, in which outflowing warmer arterial blood warms the inflowing cooler venous blood. Choice A (The direction of blood flow in veins is away from the heart) is incorrect. Regardless of any anatomical or physiological characteristics, veins always carry blood toward the heart. Conversely, arteries always carry blood away from the heart. This simple rule helps in interpreting issues with fetal-adult circulatory patterns and with many congenital anomalies. Choice C (Veins are less abundant than arteries) is incorrect. Veins are more abundant and more variable than arteries, thus often making them more challenging subjects. Furthermore, the venous system normally contains a significantly greater volume of systemic blood because of its greater surface area, typically greater wall diameters, and ability to expand. Choice D (The walls of veins are thicker than those of their companion arteries) is incorrect. Largely due to the lower blood pressure in the venous system, the walls of veins (especially the medium-sized veins) are thinner than their matching arteries. This characteristic is notable in the tunica media (the middle, mostly smooth muscle layer). Choice E (Veins tend to......

Words: 201595 - Pages: 807

Congenital Hyperplasia

...Congenital Adrenal Hyperplasia Definition Congenital adrenal hyperplasia (CAH) is a genetic disorder of the adrenal glands which involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both. Frequency About 1 in 10,000 to 18,000 children are born with congenital adrenal hyperplasia. Review of Related Anatomy and Physiology The adrenal glands are two bean-shaped glands curved over the top of the kidneys. It has a glandular (cortex) and neural tissue (medulla) parts. The central medulla region is enclosed by the adrenal cortex, which contains three separate layers. The adrenal cortex is responsible for producing three major groups of steroid hormones known as the corticosteroids. The hormones are the following: 1. Mineralocorticoids (aldosterone) – important in regulating the mineral or salt content in the blood, particularly the sodium and the potassium ions. The target organ of this hormone is the kidney tubules which is the one responsible for reabsorbing the minerals selectively or allowing them to be excreted out from the body. Increase aldosterone results to increase sodium retention by the kidney tubules and excretion of the potassium. When sodium increases the water also increases or follows. Thus, mineralocorticoids help in the regulation of water and electrolyte levels (equilibrium) in the body. 2. Glucocorticoids (cortisone and cortisol) – promotes the normal cell metabolism which helps the body to counteract the stressors...

Words: 891 - Pages: 4

Asdominallo

...Abstract There are many different types of hernias. The most common type is inguinal which occurs in the groin (Balentine, J.R, 2010). Other types of hernias are femoral, umbilical, incisional, hiatal, sports, and congenital diaphragmatic. Symptoms of a hernia may include pain or discomfort and localized swelling on the abdomen or in the groin area. If a hernia is found the usual treatment is surgery. Most common surgery is laparoscopic. What is a hernia? Why do we get them? What are symptoms caused by hernias? Who is more likely to get a hernia? How to help prevent from getting a one? These are all questions many people have. A hernia is any condition in which the viscera protrude through a weak point in the muscular wall of the abdominopelvic cavity (Saladin, 2010). This may cause a bulge or tear in the abdominal wall. This can be more noticeable when the muscles in the stomach are tightened causing pain. Lifting weights or heavy objects, running, or straining to have a bowel movement can put strain on the abdominal area and worsen the hernia. A hernia may be likened to a failure in the sidewall of a tire. The tire’s inner tube behaves like the organ and the side wall like the body cavity wall providing the restraint. A weakness in the sidewall allows a bulge to develop allowing the inner tube to protrude leading to the eventual failure of the tire. (Hernia Symptoms, 2007-2008) There are many different types of hernias that effect men, women, and......

Words: 333 - Pages: 2

Anencephaly

...Anencephaly is a congenital embryological neurological disorder of the neural tube which causes portions of the brain and the skull not to develop properly (Saheb). Because the neural tube does not close adequately these children will not have a forebrain or a midbrain (Kurtoglu), rather they will develop “Fibro vascular tissue with scattered islands of neural elements” (Behrman). This malformation of the brain and the cranial vault causes many of these children to be still born (Elwood & Lemire). According to the Centers for Disease Control, “3 pregnancies in every 10,000 in the United States will have anencephaly. This means about 1,206 pregnancies are affected by these conditions each year in the United States”(CDC). The unfortunate infants who live momentarily experience sepsis, pneumonia, or atelectasis(Behrman). Its pathology is unclear, however, researchers believe genetics and nutrition are contributing factors (CDC). Children with Anencephaly experience abnormalities of, “Congenital talipus, equinovarus or valgus, spina bifida, cystic kidneys, cystic liver, high palate with cleft, diaphragmatic hernia, immature lungs, thymic hyperplasia, megaoesophagus, hypertrophy of bladder and hypoplasia of epididymis, hypoplatic lungs, syndactyly, cyclopia, club foot, cleft palate, imperforate anus, renal defects, cardiac defects, large thymus, absence of thumb and radius, large thymus, and reduced size of adrenal gland (Jones). Those full term infants who live for few days...

Words: 897 - Pages: 4

Genetics Review

...28 KNOW about Spina Bifida KNOW neural crest **really important concept** there is a NON-NEURAL PART that becomes THYMUS and THYROID KNOW Embryonic folding digestive tract yolk sac opens to midgut **READ SLIDE** Which system becomes functional first CARDIOVASCULAR KNOW HEMATOPOIESIS Blood cells for developing embryo yolk sac, thymus, liver, bone marrow, spleen…. Provide development of blood system (5 different structures to know here) Lecture 29 Pharyngeal arches which structures are developed from which arch! (very similar to cell lines) “if thymus did not develop.. which arch is most likely affected?” KNOW Pharyngeal arches 1-6 **no need to know “pouches” ** there will be THREE questions on this Congenital diaphragmatic HERNIA respiratory problems when born when folding takes places, the peritoneal cavity and pericardial cavities do not close all the way. Blue skin, dyspnea, etc. KNOW WEEK 6 is when limb development takes place children born without limb (ex: thalidomide given to mother) know that the offending agent that disrupted this development was most likely introduced WEEK 6 of DEVELOPMENT. Lecture 30 HOX gene family limb development TBOX genes know that homozygous = lethal, etc Big concepts do not need to know all the genes within the gene families Fragile X Syndrome – most common cause of MENTAL RETARDATION ears are placed differently, large head, PLUS mental retardation Rhett Syndrome (X –linked; CpG binding ......

Words: 632 - Pages: 3

Sdfsdf

...1. Direct hernia: Usually resulting from stress, causing the peritoneum to bulge through the fascia in the groin area. The peritoneal bulge (sac) may contain abdominal viscera. 2. Indirect Hernia: Caused by a congenital defect in the internal abdominal ring, causing the peritoneum to bulge along the spermatic cord. It may or may not contain abdominal viscera. * A hernia can occur within an old scar that is usually located in the abdominal (ventral)region, and is referred to as an incision hernia. * Hernias are either reducible or irreducible that is incarcerated. The contents of an incarcerated hernia may become strangulated, compromising the viability of trapped tissues and thus necessitating their resection in addition to the herniography. Position * Supine, with arms extended on arm boards Incision Site * Groin area, right or left oblique. Packs/Drapes * Laparotomy pack or minor pack * Four-folded towels Instrumentation * Basic tray or minor tray * Self retraining retractor Supplies/ Equipment * Basin set * Suction * Needle counter * Penrose drain * Dissector sponges * Sutures * Solutions – saline, water * Synthetic mesh * Skin closure strips Procedure 1. The surgeon begins the procedure by incising the groin. 2. The incision is deepened using the Metzenbaum scissors and cautery is used to control small bleeders. 3. Both blunt and sharp dissections are used to gain access to the hernia. 4.......

Words: 733 - Pages: 3