Diaphragmatic hernia (DH) 2% of all hernias. This disease occurs in 5-7% of patients with gastric complaints during a radiological investigation.
The first description of diaphragmatic hernia belongs to Ambroise Pare (1579). Under diaphragmatic hernia should be understood penetration of internal organs through a defect in the diaphragm from one cavity to another.
It should be recalled brand viagra online that the development of the diaphragm is due to the connection on both sides plevroperitonealnoy membrane, transverse septum and mezoezofagusa.
Disorders arising from complications of embryonic development, can lead to newborn partial or complete defect of the diaphragm. When violations occur before the formation of membrane aperture, then the hernia is not a hernia sac (correct to speak of eventration). At later stages of development, when it was formed membranous diaphragm and only generic viagra delayed the development of muscle, a muscle containing no penetration occurs hernial hernial sac, consisting of two serous films.
Site of entry sternocostal hernias (sternokostalnyh) is devoid of muscle area connection with the sternum and ribs. This place is known as the triangle sternokostalnogo Larrea, and such hernias are known as the triangle hernia Larrea. In the absence of serous cover a hole sternokostalnoe Morgan.
In connection with the anatomical location of the front and back muscles within the lumbar costal triangle Bochdalek in this place might hernial protrusion.
Classification of diaphragmatic hernia in Petrovsky:
I. Traumatic hernia:
* True;
* False.
II. Nontraumatic:
* False congenital hernia;
* True hernia weak zones diaphragm;
* True hernia atypical localization;
* Hernia orifices Aperture:
a) the esophageal opening;
b) rare hernia orifices diaphragm.
Traumatic hernia due to injuries mostly false, indoor injuries - true and false.
When only non-traumatic hernia false hernia is congenital - a defect the diaphragm, spina between the thoracic and abdominal cavities.
Of the weak zones diaphragm - a hernia zone generic levitra sternocostal triangle (the gap Bogdaleka). Thorax in these areas is separated from the abdominal cavity of a thin plate of connective tissue between the pleura and peritoneum.
Underdeveloped area of the chest diaphragm - retrosternal hernia
Rare (extreme) hernia gap sympathetic nerve, vena cava, the aorta. In frequency in the first place - hiatal hernia (HH), they constitute 98% of all non-traumatic diaphragmatic hernia of origin.
Hiatal hernia
Anatomical features. The esophagus passes from the chest cavity through the abdominal hiatus oesophagcus, formed from the muscles that make up the diaphragm. Muscle fibers, which form the right and left legs of the diaphragm, formed as the front loop, which in most cases is derived from the right leg. Behind the legs of the diaphragm of the esophagus are not connected intimately, forming a V-shaped defect. In normal esophageal opening is wide enough diameter, at approximately 2.6 cm through which food passes freely. The esophagus goes through the hole obliquely, above the hole he is in front of the aorta below the holes left her somewhat. Described 11 different anatomical muscles in the esophageal opening. In 50% of the oesophageal hiatus is formed from the right crus of diaphragm, 40% are the inclusion of muscle fibers of the left leg. Both diaphragmatic legs start at the lateral surfaces of I-IV of the lumbar vertebrae. Oesophageal ring slightly decreases during inspiration, resulting in increased bending of the esophagus in the esophageal opening. Abdominal segment of the esophagus is small, its length is variable, averaging about 2 cm esophagus enters the stomach at an acute angle. The bottom of the stomach is located above and left of the esophageal-gastric connection, occupying almost all the space under the left dome of the diaphragm. Acute angle between the left edge of the abdominal esophagus and the medial edge of the bottom of the stomach is called the angle of branch block. Folds of mucous membrane of the esophagus, descending into the lumen of the stomach from the top angle (valve Gubareva), play a role of an additional valve. With the rise of pressure in the stomach, especially in the area of its bottom, the left half of the semiring of esophageal-gastric connection shifts to the right, overlapping with the entrance into the esophagus. Fore-stomach at the junction of the esophagus is a narrow ring about 1 cm in diameter. The structure of this department is very similar to the structure of the pyloric stomach. Submucosa is loose, parietal and chief cells are absent. The eye can see the connection of esophageal mucosa to gastric mucosa. The junction is located near the mucosal anastomosis, but not necessarily be consistent with it.
conduct group
no significant effect
daily diet
a peck of salt
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