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Diaphragmatic Hernia

Diaphragmatic Hernia . Elaina Turner . What structure in the central tendon of the diaphragm is most at risk in repair of a traumatic diaphragmatic hernia? . Caval foramen with in the central tendon Possibly the muscular portion b/c its weaker.

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Diaphragmatic Hernia

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  1. Diaphragmatic Hernia Elaina Turner

  2. What structure in the central tendon of the diaphragm is most at risk in repair of a traumatic diaphragmatic hernia? • Caval foramen with in the central tendon • Possibly the muscular portion b/c its weaker

  3. In what morphologic type of hernia would this risk be greatest? • Radial because it goes right through the caval foramen

  4. How does diaphragmatic hernia result from blunt trauma to the abdominal wall? • When glottis is closed it creates a thoracic pressure that counteracts the “blow” pressure to the abdomen. Not as likely to get a hernia • If glottis is open (expiration) don’t have the increase in thoracic pressure to equilibrize with the abdominal pressure and therefore the abdominal “blow” will likely travel right through the diaphragm and cause rupture and herniation

  5. Will the same force of trauma to the thoracic wall cause the diaphragm to rupture? • Yes

  6. Why or why not? • same physics

  7. Is diaphragmatic hernia a pleural space disease? • yes

  8. What happens to the lungs in these cases? • Due to pressure changes and compression on the lungs the lungs will collapse

  9. Do these patients develop respiratory acidosis or alkalosis? • Respiratory acidosis is most likely to develop

  10. Why is orthopnea seen with diaphragmatic hernia more often than with pneumothorax? • In diaphragmatic hernia: the patients have orthopnea because when in a lying down position the intestines are compressing right against the lungs, but when in a sitting position, the intestines and shift and ease up on the lungs • In pneumothorax, there is no pressure relief

  11. Why, specifically, do these patients sometimes have cardiogenic shock? • Due to pressure on the vena cava causing decreased venous return

  12. Why is vomiting a common sign in patients with chronic diaphragmatic hernia? • Any manipulation to the small intestines causes vomiting • Small intestinal torsion

  13. What are typical findings on thoracic auscultation in dogs and cats with diaphragmatic hernia? • Muffled heart and respiratory sounds • Borborygma

  14. In what species would auscultation of borborygmi in the thorax be normal? • horse

  15. You are presented with a dog that has been HBC 30 mins ago and has a diaphragmatic hernia. Describe your course of action up to and including induction of anesthesia for repair of the hernia. • Stabalize, normalize electrolye/acid base abnormalities (esp.hyperK), and go to sx. Asap • Depends..if stomach has herniated, don’t have time to stabalize..go to sx!

  16. When would you choose to repair the hernia in the previous question? • Anytime from less than 24hrs to about 1yr for best results

  17. What condition might make you go to surgery sooner? • When the stomach is herniated

  18. You are presented with a cat that has a chronic diaphragmatic hernia, secondary to trauma 2 years ago. Describe your course of action with this patient, up to induction of anesthesia for hernia repair. • Get to surgery soon…these animals can decompensate and go into shock at any time

  19. What are the intra-operative and post-operative complications of diaphragmatic hernia repair? • Intra op: acid base and electrolyte abnormalities • Post op: reperfussion, reexpansion pulmonary edema, hemorrhage, pneumothorax

  20. When does each of these conditions commonly occur? • ??? Pre and post op..psyche

  21. When do most deaths from diaphragmatic hernia happen? • Pre op and during induction

  22. Peritoneopericardial diaphragmatic hernias are always congenital in dogs and cats. • ALWAYS CONGENITAL

  23. What happens to the heart at the time of traumatic diaphragmatic rupture – why is the pericardium not also ruptured? • Compession of heart, decreased venous return…. • Why is the pericardium not also ruptured?

  24. Are these hernias inhertied? • They can be but they can be associated with teratogens

  25. What concomitant abnormaliteis may be found? • Sternal deformities and cardiovascular abnormalities

  26. What are typical presenting signs and physical examination findings of peritoneopericardial diaphragmatic hernia? • Often asymptomatic • If present with signs: may be variable and intermittent, may be referrable to GI, cardiac, respiratory, or neuro signs. Ascites, muffled heart sounds, murmurs, tamponade

  27. What is the prognosis for the patient with peritoneopericardial diaphragmatic hernia? • No cardiac abnormalities: excellent • Cardiac abnormalities: depends on severity of abnormalities

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