Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
17 Cards in this Set
- Front
- Back
Definition DH
|
developmental defect of the diaphragm that allows abdominal viscera to herniate into the chest
|
|
lung compression by hernia leads to?
|
pulmonary hypoplasia
|
|
Diaphragm ebryology
|
formed in 8th week,
visceral herniation occurs during lung development, failure of normal closure of the pleuroperitoneal folds during the 4th to 10th |
|
Location of the Hernias
|
posterolateral (Bochdalek hernia)
peristernal (Morgagni hernia) anterior retrosternal Left side herniation 80 % |
|
describe the pulomary hypoplasia effects
|
the ipsilateral side is affected due to compression
decrease in pulmonary mass, reduction in the number of bronchial divisions, respiratory bronchioles and alveoli. These abnormalities limit the gas exchange |
|
Diaphragmatic agenesis
|
Anatomically, diaphragmatic agenesis is the most extreme form of CDH
|
|
CDH effect on lugns lead to?
|
hypoxia, hypercarbia, acidosis
|
|
Prenatal diagnosis
|
Ultrasound can be seen.
Mean gestational age is 24 weeks |
|
POSTNATAL DIAGNOSIS
|
Respiratory distress immediately after birth
tachypnea, cyanosis, chest retraction Breath sound is less audible. Can hear intestinal sounds in the chest |
|
Associated anomalies
|
in 40 -50 % of cases there are anomalies.
Chromosal abnormalities most freq one Facial dysmorphology, distal digital hypoplasia, and cardiac/renal/brain anomalies |
|
Prognostic Factors Diaphragmatic hernia
|
worse in the setting of an abnormal karyotype, severe associated anomalies, liver herniation, and fetal lung volume.
|
|
When suspect CDH ultrasound you do
|
Ultrafast fetal MRI to look for associated abnormalities and liver herniation
Fetal echocardiography Fetal karyotype |
|
Prenatal treatment of CDH
|
Glucocorticoids
|
|
Postnatal treatment of CDH
|
Low peak pressure, goal <25cm H20
to minimize lung injury Nasogastric tube to decompress abdominal contents Umbilical artery line placed for frequent monitoring of blood gases and blood pressure |
|
When is ECMO indicated?
|
Inability to maintain preductal saturations >85 percent or postductal PaO2 >30. Peak inspiratory pressure >28 cm H2O or mean airway pressure >15 cm H2O
Hypotension that is resistant to fluid and inotropic support Inadequate oxygen delivery with persistent metabolic acidosis |
|
Surgical repair
|
first vascular stabilisation most important
then surgical after 48 to 72 hours reduction of the abdominal viscera and primary closure of the diaphragmatic defect |
|
Outcome CDH
|
With a proper therapy and no associated anomalies, the survival rate is about 80%.
If we have other problems, the average survival rate is about 50%. |