Risk factors, symptoms, diagnosis and treatment of diaphragmatic hernia.
The hearth of the esophagus of the diaphragm (diaphragmatic hernia) is displaced in the chest cavity through the interstitial esophagus of the diaphragm part of the stomach and/or intestinal loop. This condition occurs in 30-40% of people after 50 years and in 7-10% of people under the age of 30 years.
Causes of diaphragmatic hernia
In the formation of diaphragmatic hernia, the most important factor is the expansion of the natural aperture in the diaphragm, through which the esophagus, large vessels and nerves penetrate the abdominal cavity from the thoracic cavity.
The appearance of diaphragmatic hernia can lead to:
- Weakening of the muscle tone of the diaphragm, which usually occurs with age or with pronounced weakening of the general condition of the patient: in chronic disease, prolonged bed rest, etc.;
- With increased elasticity (more often congenital nature) of the ligament apparatus forming the diaphragmatic opening;
- Operations and injuries that violate the constant natural fixation of organs in the abdominal cavity;
- Occasional short-term, but marked increase in intra-abdominal pressure (with severe and prolonged delivery, during pregnancy, when lifting weight, etc.);
- Small periodic increases in intra-abdominal pressure, which, as it were "squeezed" into the chest cavity, are located next to the aperture of the organs: the abdomen of the esophagus and the adjacent part of the stomach, very rare - a small area of the small intestine. It is often found in chronic constipation, with constant cough (chronic bronchitis, bronchitis, tuberculosis, etc.), with heavy physical work or sports, associated with the rise of cargoes, tension abdominal press, with prolonged finding in a bent position, With torso of the trunk ahead, with overeating, with obesity.
This shift rarely occurs in the upright position of the human body, but mainly there is tilted forward or down in a horizontal position on the left side, abdomen, back. If one takes over vertical position, hryzhovohovypynannya under his weight back into the abdominal cavity - so called sliding hernia. The only exception is the hernia that formed in the long-term lying person, and therefore fixed with adhesions in the chest cavity - they are also called "fixed".
Main manifestations of diaphragmatic hernias
A hernia chastodiafrahmalnye accidental discovery of X-ray or endoscopic examination of the patient for another reason. But many of them show a sense of discomfort in the peritoneum and on the sternum, the appearance of heartburn (reflux esophagitis), air bubble or food eaten, which increases when the body is tilted forward or in the lying position. Periodically, such patients are concerned about hiccup attacks, as well as bust pain. Very rarely there is vomiting. These symptoms may over time grow or remain unchanged for a long time.
Their appearance is due to the neglect of acidic gastric contents in the esophagus. This leads to inflammation of the esophagus - esophagitis and even her sores, sometimes there may be some bleeding. In rare cases, in this department of the esophagus, adhesions and narrowing of its lumen (stenosis) or areas of malignant degeneration in places of persistent inflammation of the mucous membrane of the esophagus are formed.
Some elderly patients may have reflexes of pain in the heart area, as well as angina attacks. Restrictions in hernia hiatal very rare, and it may not always be otlychymo pain in the heart.
This feature displays diaphragmatic hernia is associated with dysfunction of the gastro-esophageal circular muscle sphincter valve, at the confluence of the esophagus into the stomach (cardia sphincter) due to violation of innervation of inflammatory changes in the wall of the esophagus and stomach, weak fixation organs in the abdomen.
Diagnosis of diaphragmatic hernia is possible
It can be put by a doctor-endoscopist with fibrogastroscopy. Accurate diagnosis is in the X-ray with contrast esophagus and stomach using barium suspension and study of patient body in a horizontal position. Also, the definition of the acidity of the gastric contents - pH-metry - is indicated for the development of further treatment tactics.
General principles of treatment and prevention of diaphragmatic hernia
In severe cases of frequent clinical pain, the development of complications and the formation of adhesions conduct surgery in other cases - conservative treatment and the implementation of all recommendations of the doctor:
- fractional meal (mechanically and chemically gentle) in small portions, and then stay upright body within 2-3 hours after eating;
- Avoid work in a slope, as well as physical stress associated with increased intraabdominal pressure;
- the presence of diseases and conditions that lead to increased abdominal pressure, they must be cured (constipation, cough, fight obesity, etc.);
- for healing esophageal mucosa recommended after meals and fasting using vegetable oils enriched with vitamin A (buckthorn, and karatolyn etc.).
- It is also necessary to use drugs that reduce gastric secretion and have an enveloping and anesthetic effect (almagel or almagel with anesthesin), as well as drugs-spasmolytics (no-spas, platyphilin, etc.).