膈疝的诊断和治疗（英文版）课件.pptVIP

DIAPHRAGMATIC HERNIASMaureen Austin Kimberly Novak Types of Hernias Diaphragmatic Hiatal Umbilical Inguinal Femoral Perineal Diaphragmatic Hernia A rent in the diaphragm that allows herniation of of abdominal viscera into the thoracic cavity. Diaphragmatic Hernias can either be Congenital or Acquired Traumatic Diaphragmatic Hernia A common outcome of blunt force trauma to the thoracic cavity Dogs: vehicle trauma, kicked by horse/cow Cats: high rise trauma, vehicle trauma Liver is the most commonly herniated **** Young males at greatest risk- another good reason to castrate!!!! Congenital Diaphragmatic Hernia Pleuroperitoneal Diaphragmatic Hernia Uncommon; autosomal recessive trait Incomplete or failed fusion of pleuroperitonel membrane Failure of pleuroperitoneal folds to incorporate muscle Located dorsolateral; those on left often result in still birth or neonatal death Stomach, spleen and small intestine most common Congenital Diaphragmatic Hernia Pericardioperitoneal Diaphragmatic Hernia (PPHD) Very common –CATS Often incidental –CATS Not inherited, 58% males Weimeraners predisposed (Conformation???) Liver, omentum, spleen, falciform ligament common- NOT STOMACH PPHD Always congenital, most common congenital diaphragmatic hernia Diaphragm and pericardium not continuous Failure of septum transversum differentiation: *teratogens, genetic defect, prenatal trauma Ventral diaphragm Associated Abnormalities Sternal defects/Pectus excavatum Cranial midline abdominal wall hernia Umbilical hernia Cardiac defects (VSD) PSS Pulmonary vascular disease Diagnostic Dilemma 20% traumatic diagnosed @ 4 weeks post trauma:*omentum plug, rent w/no hernia, failure to dx 48% PPHD 1y; 36%@ 1-4y May not be until as old as 14y: *omentum plug; formed, but weak diaphragm, often incidental-no symptoms Clinical Signs Asymptomatic ? Gravely Ill Clinical Signs Res