Diaphragmatic hernia pathophysiology: Difference between revisions

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==Overview==
==Overview==
Diaphragmatic hernia occurs due to a defect in the diaphragm allowing the viscera to herniate into the thoracic cavity. The herniated viscera impairs the normal development of the alveoli and the the bronchial tree and pushes the mediastinum to the contralateral side.


==Pathophysiology==
==Pathophysiology==

Latest revision as of 16:54, 22 December 2017


Diaphragmatic hernia Main page

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Differentiating Diaphragmatic hernia from other Diseases

Epidemiology

Risk factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Radiological tests

Treatment

Medical treatment

Surgical treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Diaphragmatic hernia occurs due to a defect in the diaphragm allowing the viscera to herniate into the thoracic cavity. The herniated viscera impairs the normal development of the alveoli and the the bronchial tree and pushes the mediastinum to the contralateral side.

Pathophysiology

  • The herniated viscera decrease the area needed by the lung to develop appropriately.[1]
  • According to the degree of herniation, the degree of pulmonary hypoplasia is determined.
  • The herniated viscera impairs the development of the bronchial tree.
  • As a consequence, the alveoli development is also slowed.[2]
  • The development of the pulmonary artery tree is halted too resulting in excessive masculinization of the arteries.
  • The increased pulmonary pressure leads to increased pressure on the right ventricle leading to the development of a right to left shunt.
  • As most of the cases of diaphragmatic hernias are unilateral, the pulmonary hypoplasia is also usually unilateral, but it can be bilateral if the mediastinum is pushed by a massive unilateral hernia.
  • The abnormal alveolar development can lead to hypoxemia leading to pulmonary vasoconstriction which aggravates the condition.

References

  1. Langham MR, Kays DW, Ledbetter DJ, Frentzen B, Sanford LL, Richards DS (1996). "Congenital diaphragmatic hernia. Epidemiology and outcome". Clin Perinatol. 23 (4): 671–88. PMID 8982563.
  2. Keijzer R, Puri P (2010). "Congenital diaphragmatic hernia". Semin. Pediatr. Surg. 19 (3): 180–5. doi:10.1053/j.sempedsurg.2010.03.001. PMID 20610190.