Podcast
Questions and Answers
What is the most common location for congenital diaphragmatic hernia?
What is the most common location for congenital diaphragmatic hernia?
- Left sided (correct)
- Morgagni CDH
- Bilateral
- Right sided
Which embryonic element does NOT contribute to the formation of the diaphragm?
Which embryonic element does NOT contribute to the formation of the diaphragm?
- Esophageal mesentery
- Septum transversum
- Pleuroperitoneal folds
- Lung buds (correct)
What percentage of congenital diaphragmatic hernia cases are associated with other anomalies?
What percentage of congenital diaphragmatic hernia cases are associated with other anomalies?
- 30%
- 25%
- 50%
- 40% (correct)
At what gestational week is the fusion of diaphragm components completed?
At what gestational week is the fusion of diaphragm components completed?
Which type of congenital diaphragmatic hernia accounts for 90% of cases?
Which type of congenital diaphragmatic hernia accounts for 90% of cases?
What is the estimated incidence rate of congenital diaphragmatic hernia?
What is the estimated incidence rate of congenital diaphragmatic hernia?
Congenital diaphragmatic hernia is more commonly observed in which gender?
Congenital diaphragmatic hernia is more commonly observed in which gender?
Which anomaly is NOT typically associated with congenital diaphragmatic hernia?
Which anomaly is NOT typically associated with congenital diaphragmatic hernia?
What parameter indicates evidence of good tissue perfusion after stabilization?
What parameter indicates evidence of good tissue perfusion after stabilization?
Which surgical approach is most commonly used for repairing congenital diaphragmatic hernia?
Which surgical approach is most commonly used for repairing congenital diaphragmatic hernia?
What occurs during inspiration in a normally functioning diaphragm?
What occurs during inspiration in a normally functioning diaphragm?
What is the primary feature seen in the diagnosis of Morgagni hernia on a chest radiograph?
What is the primary feature seen in the diagnosis of Morgagni hernia on a chest radiograph?
What is the primary cause of congenital diaphragmatic eventration?
What is the primary cause of congenital diaphragmatic eventration?
Which symptom is commonly associated with Morgagni hernia in children?
Which symptom is commonly associated with Morgagni hernia in children?
Which symptom is NOT commonly associated with diaphragmatic eventration in children?
Which symptom is NOT commonly associated with diaphragmatic eventration in children?
What type of tissue repair may be used if the diaphragmatic defect is large?
What type of tissue repair may be used if the diaphragmatic defect is large?
Which of the following statements about diaphragmatic eventration is true?
Which of the following statements about diaphragmatic eventration is true?
Which imaging technique is primarily used to confirm diaphragmatic eventration?
Which imaging technique is primarily used to confirm diaphragmatic eventration?
What surgical procedure is indicated for a large diaphragmatic eventration causing pulmonary impairment?
What surgical procedure is indicated for a large diaphragmatic eventration causing pulmonary impairment?
What is the treatment method for Morgagni hernia?
What is the treatment method for Morgagni hernia?
In which scenario would a hernia sac most likely be present?
In which scenario would a hernia sac most likely be present?
In which scenario might minimal symptoms of diaphragmatic eventration be observed?
In which scenario might minimal symptoms of diaphragmatic eventration be observed?
What is a common feature of acquired diaphragmatic eventration?
What is a common feature of acquired diaphragmatic eventration?
What result can occur from large congenital diaphragmatic eventration?
What result can occur from large congenital diaphragmatic eventration?
What initial management step is crucial in the resuscitation of newborns with congenital diaphragmatic hernia?
What initial management step is crucial in the resuscitation of newborns with congenital diaphragmatic hernia?
Which laboratory test is primarily used to evaluate acid-base status in congenital diaphragmatic hernia?
Which laboratory test is primarily used to evaluate acid-base status in congenital diaphragmatic hernia?
What is a common finding on a chest radiograph that confirms the diagnosis of congenital diaphragmatic hernia?
What is a common finding on a chest radiograph that confirms the diagnosis of congenital diaphragmatic hernia?
Which ventilation method should be avoided in the initial management of congenital diaphragmatic hernia due to its risk of gastric distention?
Which ventilation method should be avoided in the initial management of congenital diaphragmatic hernia due to its risk of gastric distention?
What monitoring device is crucial for assessing fluid resuscitation in newborns with respiratory distress from congenital diaphragmatic hernia?
What monitoring device is crucial for assessing fluid resuscitation in newborns with respiratory distress from congenital diaphragmatic hernia?
What is the primary purpose of administering isotonic water-soluble contrast enema in newborns with simple meconium ileus?
What is the primary purpose of administering isotonic water-soluble contrast enema in newborns with simple meconium ileus?
What should be administered through the nasogastric tube to help dissolve thick secretions in the upper gastrointestinal tract?
What should be administered through the nasogastric tube to help dissolve thick secretions in the upper gastrointestinal tract?
What is a significant risk associated with using high pressure in conventional ventilation for treating congenital diaphragmatic hernia?
What is a significant risk associated with using high pressure in conventional ventilation for treating congenital diaphragmatic hernia?
Administration of which treatment is indicated for patients with extreme prematurity and congenital diaphragmatic hernia?
Administration of which treatment is indicated for patients with extreme prematurity and congenital diaphragmatic hernia?
Which of the following indicates the need for operative intervention in simple meconium ileus?
Which of the following indicates the need for operative intervention in simple meconium ileus?
What is a common postoperative intervention following surgery for either simple or complicated meconium ileus?
What is a common postoperative intervention following surgery for either simple or complicated meconium ileus?
What are the targets for adequate resuscitation in terms of blood gas levels for patients with congenital diaphragmatic hernia?
What are the targets for adequate resuscitation in terms of blood gas levels for patients with congenital diaphragmatic hernia?
What is the recommended initial course of action for managing simple meconium ileus?
What is the recommended initial course of action for managing simple meconium ileus?
What percentage range is reported for the mortality rate of infants with meconium ileus?
What percentage range is reported for the mortality rate of infants with meconium ileus?
Which surgical procedure is often created after evacuation of tenacious meconium in cases of surgical management?
Which surgical procedure is often created after evacuation of tenacious meconium in cases of surgical management?
What complication might necessitate surgical intervention due to non-operative treatment failure?
What complication might necessitate surgical intervention due to non-operative treatment failure?
What is a primary cause of congenital diaphragmatic hernia?
What is a primary cause of congenital diaphragmatic hernia?
Which of the following is NOT a characteristic of pulmonary hypoplasia associated with congenital diaphragmatic hernia?
Which of the following is NOT a characteristic of pulmonary hypoplasia associated with congenital diaphragmatic hernia?
What clinical feature is commonly observed in newborns with congenital diaphragmatic hernia?
What clinical feature is commonly observed in newborns with congenital diaphragmatic hernia?
Which of the following could lead to pulmonary hypertension in congenital diaphragmatic hernia?
Which of the following could lead to pulmonary hypertension in congenital diaphragmatic hernia?
Which of the following findings on physical examination is indicative of congenital diaphragmatic hernia?
Which of the following findings on physical examination is indicative of congenital diaphragmatic hernia?
What is a potential consequence of a right-to-left shunt in congenital diaphragmatic hernia?
What is a potential consequence of a right-to-left shunt in congenital diaphragmatic hernia?
Which symptom may present beyond the neonatal period in some cases of congenital diaphragmatic hernia?
Which symptom may present beyond the neonatal period in some cases of congenital diaphragmatic hernia?
How might the mediastinum be affected in cases of congenital diaphragmatic hernia?
How might the mediastinum be affected in cases of congenital diaphragmatic hernia?
Flashcards
Congenital Diaphragmatic Hernia (CDH)
Congenital Diaphragmatic Hernia (CDH)
A condition where abdominal organs protrude into the chest cavity due to a birth defect in the diaphragm, the muscle separating the chest and abdomen.
Bochdalek CDH
Bochdalek CDH
The most common type of CDH, where the defect is located in the back portion of the diaphragm, near the spine.
Morgagni CDH
Morgagni CDH
A less common type of CDH, where the defect is located in the front portion of the diaphragm, near the breastbone.
Embryological Development of the Diaphragm
Embryological Development of the Diaphragm
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Septum Transversum
Septum Transversum
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Esophageal Mesentery
Esophageal Mesentery
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Pleuroperitoneal Folds
Pleuroperitoneal Folds
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Diaphragm Completion and Maturation
Diaphragm Completion and Maturation
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Blood Gas Analysis
Blood Gas Analysis
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Blood Gas Analysis in CDH
Blood Gas Analysis in CDH
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Chest X-ray
Chest X-ray
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Chest X-ray Findings in CDH
Chest X-ray Findings in CDH
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Echocardiography
Echocardiography
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Echocardiography in CDH
Echocardiography in CDH
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Renal Ultrasonography
Renal Ultrasonography
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What causes Congenital Diaphragmatic Hernia?
What causes Congenital Diaphragmatic Hernia?
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Pulmonary Hypoplasia
Pulmonary Hypoplasia
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What are the characteristics of Pulmonary Hypoplasia?
What are the characteristics of Pulmonary Hypoplasia?
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Pulmonary Hypertension in CDH
Pulmonary Hypertension in CDH
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Right-to-Left Shunt in CDH
Right-to-Left Shunt in CDH
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What are the common clinical signs of CDH?
What are the common clinical signs of CDH?
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Presentation of CDH
Presentation of CDH
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Diaphragmatic Eventration
Diaphragmatic Eventration
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Morgagni Hernia
Morgagni Hernia
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Laparotomy
Laparotomy
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Laparoscopy
Laparoscopy
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Thoracotomy
Thoracotomy
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Thoracoscopy
Thoracoscopy
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Prosthetic Mesh
Prosthetic Mesh
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Autologous Tissue Flap
Autologous Tissue Flap
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Diaphragm Function
Diaphragm Function
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Congenital Diaphragmatic Eventration
Congenital Diaphragmatic Eventration
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Acquired Diaphragmatic Eventration
Acquired Diaphragmatic Eventration
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Clinical Features of Diaphragmatic Eventration
Clinical Features of Diaphragmatic Eventration
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Fluoroscopy
Fluoroscopy
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Diaphragmatic Plication
Diaphragmatic Plication
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Observation for Diaphragmatic Eventration
Observation for Diaphragmatic Eventration
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What is Meconium Ileus?
What is Meconium Ileus?
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Non-Operative Management of Meconium Ileus
Non-Operative Management of Meconium Ileus
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N-acetylcysteine (NAC) in Meconium Ileus
N-acetylcysteine (NAC) in Meconium Ileus
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Operative Management of Meconium Ileus
Operative Management of Meconium Ileus
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What is an Ileostomy?
What is an Ileostomy?
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What is Complicated Meconium Ileus?
What is Complicated Meconium Ileus?
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Prognosis of Meconium Ileus
Prognosis of Meconium Ileus
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Previous Mortality Rate of Meconium Ileus
Previous Mortality Rate of Meconium Ileus
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Study Notes
Congenital Diaphragmatic Hernia (CDH)
- CDH is a developmental defect in the diaphragm, allowing abdominal organs to enter the chest cavity
- Bochdalek hernias (90% of cases) are posterolateral defects, often left-sided (80%)
- Morgagni hernias (10% of cases) are anterior defects
- Incidence rate is approximately 1/2000 live births
- More common in males
- Associated with other anomalies in about 40% of cases (cardiovascular, urogenital, musculoskeletal, neurological, and chromosomal)
Etiology & Pathophysiology of CDH
- Diaphragm develops in the 4th week of gestation, involving the septum transversum, esophagus mesentery, and pleuroperitoneal folds
- Failure in the fusion of these components can lead to a diaphragmatic defect
- Herniated organs compress the lung, causing pulmonary hypoplasia
- Results in decreased airway branching and surfactant deficiency, leading to pulmonary hypertension
Clinical Features of CDH
- Newborns typically show respiratory distress and cyanosis (some delay is possible)
- Physical findings include tachypnea, chest wall retraction, grunting, and cyanosis
- Scaphoid (sunken) abdomen, increased anteroposterior chest diameter (barrel chest), decreased breath sounds bilaterally, and shifted cardiac impulse
- Intestinal obstruction/volvulus might be complications
- Symptoms can present beyond the neonatal period with respiratory infections, feeding intolerance
Investigation of CDH
- Blood gas analysis to assess PH, PaO2, PaCO2, acid-base status (hypoxemia, hypercapnia, respiratory acidosis)
- Serum lactate (elevated due to tissue hypoxia)
- Chest X-ray to show bowel loops in the hemithorax, mediastinal shift, minimal bowel gases, and nasogastric tube in thoracic cavity
- Echocardiography to assess ventricular contractility, pulmonary hypertension, right-to-left shunting, and associated cardiac defects
- Renal ultrasound, cranial ultrasound, MRI, chromosomal studies to rule out other associated anomalies
Management of CDH
- Resuscitation and stabilization (oxygen, nasogastric tube, IV fluids, arterial and venous access)
- Surfactant therapy (prematurity)
- Ventilatory support (hypoxemia/hypercapnia)
- Endotracheal intubation and conventional ventilation (pressure-controlled mode, maximum safe pressure of 25cm H2O)
- HFOV or ECMO to correct hypoxemia/hypercapnia if ventilation fails
- PaO2 > 85 mmHg, PaCO2 < 70 mmHg, pH > 7.2, evidence of good tissue perfusion (absence of cyanosis, good urine output, serum lactate < 3mmol/L)
- Surgical repair (open or minimally invasive)
- Reduction of herniated viscera, excision of hernia sac, and closure of the defect
Morgagni Hernia
- Arise from failure of fusion of sternocostal diaphragm.
- Less common (around <2% of CDH).
- Typically involves the right side.
- Contains stomach, omentum, small intestine, and colon.
- Presents in childhood with recurrent respiratory infections, epigastric discomfort, vomiting, and sometimes intestinal obstruction
Meconium Ileus
- Ileal obstruction due to extremely thick meconium.
- Frequently the first symptom of cystic fibrosis (16% of CF patients)
- Simple or complicated,
- Simple usually resolves with enema/contrast enema
- Complicated cases need surgical intervention
- Common causes of intestinal obstruction in newborns
- Incidence of 1/2000 live births
Diaphragmatic Eventration
- Diaphragmatic eventration: is abnormal paradoxical movement of diaphragm during respiration.
- Congenital: incomplete diaphragm development
- Acquired: Injury to phrenic nerve
- Signs: elevated hemidiaphragm, paradoxical movement noted on fluoroscopy, possibly respiratory distress
Surgical Management of Meconium Ileus
- In simple cases, enema treatment sometimes works
- In complicated cases, surgical intervention
- Evacuation of meconium, bowel resection/closure
- Ileostomy is usually created and closed after 4-6 weeks post-surgery
- N-acetylcysteine can be used to dissolve meconium
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Description
This quiz provides an in-depth overview of Congenital Diaphragmatic Hernia (CDH), including its etiology, pathophysiology, and clinical features. It covers the different types of hernias, their incidence, and associated anomalies in newborns. Test your knowledge and understanding of this critical condition affecting neonates.