Diseases of the diaphragm Department of faculty and hospital surgery Tashkent Medical Academy

Diseases of the Diseases of the diaphragmdiaphragm

Department of faculty and hospital surgery Department of faculty and hospital surgery Tashkent Medical AcademyTashkent Medical Academy

Wide detection of the disease in Wide detection of the disease in Europe and the United States leading to Europe and the United States leading to high operational activity in diseases of high operational activity in diseases of the diaphragm. Also, according to the the diaphragm. Also, according to the Republic of Uzbekistan in the year 1000 Republic of Uzbekistan in the year 1000 performed operations aimed at performed operations aimed at correcting hiatal gastric cardia and correcting hiatal gastric cardia and hiatus hernia and other diseases of the hiatus hernia and other diseases of the diaphragm (MHC of Uzbekistan, 2010)diaphragm (MHC of Uzbekistan, 2010)

Prevalence of the Prevalence of the diaphragmdiaphragm

Hiatal hernia (HH) - common hernias of Hiatal hernia (HH) - common hernias of the orifices of the diaphragm (90%). HH is the orifices of the diaphragm (90%). HH is often combined with other gastrointestinal often combined with other gastrointestinal diseases (2-16%): GSD - 28%, gastric ulcer diseases (2-16%): GSD - 28%, gastric ulcer and 12 duodenal ulcer - 32%, diverticula of and 12 duodenal ulcer - 32%, diverticula of the digestive tract, cancer esophagus, the digestive tract, cancer esophagus, parasternal lipomas, etc. parasternal lipomas, etc.

HH among other gastroenterological HH among other gastroenterological diseases take 2 - 3 place, competing with diseases take 2 - 3 place, competing with peptic ulcer disease and cholecystitispeptic ulcer disease and cholecystitis

Prevalence of the diaphragm Prevalence of the diaphragm diseasesdiseases

The first report of a hiatal The first report of a hiatal hernia, found at autopsy, hernia, found at autopsy,

was published G. was published G. Morgagni (1768). For a Morgagni (1768). For a

long time it was long time it was considered an extremely considered an extremely

rare disease rare disease Extensive coverage in Extensive coverage in

the literature problem the literature problem hiatal hernia received in hiatal hernia received in

60 years60 yearsGiovanni-Battista

Morgagni (1682-1771)

The first mention of The first mention of reflux esophagitis reflux esophagitis include the XVIII include the XVIII

century and belongs century and belongs to William Hunter, to William Hunter, who described the who described the discovery of the discovery of the

corpse inflammatory corpse inflammatory changes of changes of

esophageal mucosaesophageal mucosaWilliam Hunter(1718-1783)

As a distinct disease As a distinct disease reflux esophagitis was reflux esophagitis was

isolated Quincke (1879). isolated Quincke (1879). Many worked on a Many worked on a solution to this problem solution to this problem

Allison (1946, 1951, Allison (1946, 1951, 1956), to which belongs 1956), to which belongs

the term "reflux the term "reflux esophagitis". The author esophagitis". The author

emphasized his emphasized his association with hiatal association with hiatal

herniahernia

Heinrich Irenaeus Quincke

(1842-1922)

Peter A. Herzen (1871-1947)

Sergey Yudin (1891-1954)

Mikhail Davydov

Ivan Greeks (1867-1934)

Vasit Vakhidovich Vahidov

Shavkat Ibrahimovic Karimov

Nikolai Fedorovich Krotov

Sadik Aliyevich Masumov

Duties of the general practitioner in diseases Duties of the general practitioner in diseases of the diaphragmof the diaphragm

- Provision of primary health and social care; - Provision of primary health and social care; - Health education (promoting healthy lifestyles); - Health education (promoting healthy lifestyles); - Preventive work (timely detection of early and latent forms of the - Preventive work (timely detection of early and latent forms of the

disease, risk groups); disease, risk groups); - Dynamic monitoring; - Dynamic monitoring; - Emergency assistance in case of emergency and acute conditions; - Emergency assistance in case of emergency and acute conditions; - Timely consultation and hospitalization in the prescribed manner; - Timely consultation and hospitalization in the prescribed manner; - Medical and rehabilitation work in accordance with the qualifying - Medical and rehabilitation work in accordance with the qualifying

characteristic; characteristic; - An examination of temporary disability; - An examination of temporary disability; - The organization of medical and social care and household - The organization of medical and social care and household

together with the bodies of social protection and services of mercy together with the bodies of social protection and services of mercy alone, the elderly, the disabled, the chronically ill; alone, the elderly, the disabled, the chronically ill;

- Maintaining the approved forms of records and reports.- Maintaining the approved forms of records and reports.

Anatomy of the Anatomy of the diaphragmdiaphragm


Aperture - the muscle-tendon Aperture - the muscle-tendon education separates the chest education separates the chest

and abdominal cavities. Muscular and abdominal cavities. Muscular portion of the diaphragm begins portion of the diaphragm begins to circle the lower thoracic inlet to circle the lower thoracic inlet

of the sternum, the inner surface of the sternum, the inner surface of the cartilage VII-XII ribs and of the cartilage VII-XII ribs and

lumbar spine (sternum, ribs and lumbar spine (sternum, ribs and lumbar diaphragm).lumbar diaphragm).





Topographic anatomy of Topographic anatomy of the diaphragmthe diaphragm

Topographic anatomy of Topographic anatomy of the diaphragmthe diaphragm

Aperture (view from the side of the chest cavity): 1 - chest piece; 2 - costal portion; 3 - lumbar portion; 4 - aorta; 5 - thoracic duct; 6 - the esophagus; 7 - the vagus nerves; 8 - inferior vena; 9 - splanchnic nerves, sympathetic trunks; 10 - gap Larrey - Morgagni; 11 - gap Bogdaleka



Damage to the diaphragm Damage to the diaphragm Diaphragmatic hernia Diaphragmatic hernia Hiatal hernia Hiatal hernia Relaxation of the Relaxation of the

diaphragmdiaphragm

Damage to the diaphragm Damage to the diaphragm Diaphragmatic hernia Diaphragmatic hernia Hiatal hernia Hiatal hernia Relaxation of the Relaxation of the

diaphragmdiaphragm

Methods of study of the Methods of study of the diaphragmdiaphragm

Methods of study of the Methods of study of the diaphragmdiaphragm

X-ray examination X-ray examination Electrocardiography Electrocardiography Computed tomography Computed tomography Nuclear magnetic resonance Nuclear magnetic resonance

imaging imaging Ultrasound examination ofUltrasound examination of

Etiology of the diaphragm Etiology of the diaphragm damagedamage

Etiology of the diaphragm Etiology of the diaphragm damagedamage

When road and occupational injuries When road and occupational injuries A fall from a height A fall from a height When air concussion When air concussion When compression of the abdomen When compression of the abdomen A sudden increase in intra-abdominal A sudden increase in intra-abdominal

pressurepressure

Treatment of the injury of the Treatment of the injury of the diaphragmdiaphragm

Treatment of the injury of the Treatment of the injury of the diaphragmdiaphragm

At breaks and injuries of the diaphragm At breaks and injuries of the diaphragm shows an urgent operation, which consists shows an urgent operation, which consists in suturing the defect with separate sutures in suturing the defect with separate sutures nonabsorbable suture after bringing down nonabsorbable suture after bringing down the abdominal organs. Depending on the the abdominal organs. Depending on the prevalence of symptoms associated lesions prevalence of symptoms associated lesions of the abdominal or thoracic surgery begins of the abdominal or thoracic surgery begins with laparoscopic or thoracotomy. with laparoscopic or thoracotomy. Preference is given to Preference is given to thorakophrenolaparotomy. The use of thorakophrenolaparotomy. The use of video-thoracoscopic or laparoscopic repair video-thoracoscopic or laparoscopic repair techniques defect of the diaphragm is a techniques defect of the diaphragm is a promising method for the operation, as promising method for the operation, as they are less traumatic.they are less traumatic.

Hiatal herniaHiatal herniaHiatal herniaHiatal hernia

Types of diaphragmatic herniaTypes of diaphragmatic herniaTypes of diaphragmatic herniaTypes of diaphragmatic hernia

a - paraesophageal hernia; b - axial hiatal hernia; c - a true diaphragmatic hernia; d - false diaphragmatic hernia

Symptoms of diaphragmatic Symptoms of diaphragmatic herniahernia

Symptoms of diaphragmatic Symptoms of diaphragmatic herniahernia

Gastrointestinal Gastrointestinal Cardiopulmonary Cardiopulmonary GeneralGeneral

Gastrointestinal Gastrointestinal Cardiopulmonary Cardiopulmonary GeneralGeneral

Types of diaphragmatic Types of diaphragmatic herniahernia

Types of diaphragmatic Types of diaphragmatic herniahernia

Hiatal herniaHiatal herniaHiatal herniaHiatal hernia

1. Sliding hernia: 1. Sliding hernia:

cardiofundal cardiofundal

total gastric total gastric

acquired short esophagus acquired short esophagus

2. Paraesophageal hernia 2. Paraesophageal hernia

fundal fundal

antralantral

Complaints with hiatal herniaComplaints with hiatal herniaComplaints with hiatal herniaComplaints with hiatal hernia

Burning or dull pain behind the sternum at the level Burning or dull pain behind the sternum at the level of the xiphoid process, in the epigastric region, in of the xiphoid process, in the epigastric region, in subcostal area, radiating to the region of the heart, subcostal area, radiating to the region of the heart, shoulder blade, left arm shoulder blade, left arm

The pain is worse in the horizontal position and The pain is worse in the horizontal position and during exercise. When bending the torso forward during exercise. When bending the torso forward

The pain is accompanied by belching, regurgitation, The pain is accompanied by belching, regurgitation, heartburn heartburn

Over time, there Intermittent dysphagia Over time, there Intermittent dysphagia Sometimes symptoms of bleeding. Which can be Sometimes symptoms of bleeding. Which can be

hidden hidden AnemiaAnemia

Treatment of hiatal herniaTreatment of hiatal herniaTreatment of hiatal herniaTreatment of hiatal hernia Sliding herniaSliding hernia - in uncomplicated sliding - in uncomplicated sliding

hiatal hernia is more conservative treatment, hiatal hernia is more conservative treatment, which aims to reduce gastroesophageal reflux which aims to reduce gastroesophageal reflux esophagitis reduction phenomena, preventing esophagitis reduction phenomena, preventing increase intra-abdominal pressure. Surgery for increase intra-abdominal pressure. Surgery for sliding hiatal hernia is indicated for bleeding sliding hiatal hernia is indicated for bleeding peptic stricture of the esophagus, as well as peptic stricture of the esophagus, as well as the failure of long-term medical therapy in the failure of long-term medical therapy in patients with symptomatic reflux esophagitis. patients with symptomatic reflux esophagitis.

Paraesophageal herniaParaesophageal hernia - all patients - all patients surgical treatment because of the possibility surgical treatment because of the possibility of infringement of its operation is to of infringement of its operation is to downgrade the abdominal organs and downgrade the abdominal organs and suturing the edges of the hiatal (cruroraphy) suturing the edges of the hiatal (cruroraphy) behind the esophagus.behind the esophagus.

Operation of NissenOperation of Nissen

Relaxation of the Relaxation of the diaphragmdiaphragm

Relaxation of the Relaxation of the diaphragmdiaphragm

Thinning of the diaphragm Thinning of the diaphragm and change it with the and change it with the

adjacent thereto abdominal adjacent thereto abdominal organs into the chest. Line organs into the chest. Line

attachment diaphragm attachment diaphragm remain in its usual placeremain in its usual place

Treatment of the diaphragm Treatment of the diaphragm relaxationrelaxation

Treatment of the diaphragm Treatment of the diaphragm relaxationrelaxation

In the presence of marked clinical In the presence of marked clinical symptoms, surgical treatment. symptoms, surgical treatment. Operation is to downgrade displaced Operation is to downgrade displaced abdominal organs to normal position abdominal organs to normal position and education dublication thinned and education dublication thinned diaphragm or plastic mesh diaphragm or plastic mesh strengthening its polyvinyl alcohol strengthening its polyvinyl alcohol (ayvalon), skin, muscle or muscle-(ayvalon), skin, muscle or muscle-periosteal - pleural flap (autoplasty). periosteal - pleural flap (autoplasty). VATS methods for creating dublication VATS methods for creating dublication iris species are less traumatic surgery.iris species are less traumatic surgery.

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Diseases of the diaphragm Department of faculty and hospital surgery Tashkent Medical Academy