Diaphragmatic hernia symptoms treatment. What is a diaphragmatic hernia

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Diaphragmatic hernia is the movement of organs abdominal cavity into the chest through a physiological opening or a pathological defect in the diaphragm. Hernial protrusion consists of a gate, a bag, and also contents. They fall into a bag, in this case, the esophagus, intestines or stomach. The bag forms the peritoneum. The disease causes a lot of discomfort to the patient. The peculiarity of diaphragmatic hernia is in its hidden initial course. Medical therapy effective in the absence of severe complications.

What is hiatal hernia

The diaphragm is a kind of muscular frame that separates the chest and abdominal cavity. A hernia is formed when this anatomical structure fails. The disease causes severe functional changes digestive organs.

Through the esophageal opening of the diaphragm can exit:

• hernia of the stomach;
• sections of the intestine;
• abdominal esophagus.

Pathology is characteristic of people old age(up to 80% of cases). Age-related changes in muscle structures contribute to this. Under the influence of these factors, a kind of diaphragm defect is formed. There is a movement of organs from the abdominal (abdominal) cavity into space chest.

What causes pathology

Diaphragmatic hernia is a partly idiopathic disease, that is, the reasons for the formation of a defect are not fully understood.

Factors contributing to the development of the disease:

• heredity;
• height abdominal pressure;
• frequent hiccups;
• reflux disease (gastric reflux) of hydrochloric acid into the esophagus)
• anatomical displacement of organs.

Organs go out due to diseases gastrointestinal tract(GIT). The esophagus leaves the boundaries of its anatomical bed. This is facilitated by the following chronic diseases of the gastrointestinal tract:

• gastrointestinal motility disorders (colitis, gallbladder dyskinesia, irritable bowel syndrome);
• stenosis, tumor, diverticula of the organ itself.

The main factor contributing to the development of the disease is the age-related relaxation of the diaphragm. In older people, the muscular ring of the esophageal opening atrophies, and the ligaments also relax.

Traumatic diaphragmatic hernias are also distinguished. They develop against the background hard hit in the chest (accident, fighting, professional boxing).

Along with age-related changes, high intra-abdominal pressure matters. Causes of increased pressure in the abdomen:

• hacking cough;
• profuse vomiting;
• bloating;
• ascites or peritonitis;
• massive tumors of the digestive tract, ovaries, kidneys;
• pregnancy, childbirth, especially numerous.

Types and symptoms of HH

The clinic depends on the stage of the disease. In adults, discomfort is due to reflux esophagitis. The main symptom of a hernia is pain of varying intensity. Pain occurs after eating. In some cases, there are night pains.

Discomfort features:

• retrosternal location;
• burning character;
• intensifies under heavy static loads, as well as in a horizontal position.

A hernia of the esophageal opening of the diaphragm (HH) is also manifested by the following symptoms:

1. Heartburn (burning sensation in the chest). Evidence of erosive action gastric juice on the mucosa of the esophagus. Appears after eating or when bending forward.
2. Belching. It can be "sour", "bitter" and even "rotten" character. Vomiting occurs after eating. Worried when bending down. Do not confuse belching with vomiting. The latter is characterized by specific urges.
3. Dysphagia (impaired swallowing). Patients complain that food "gets stuck" in the chest area. Because of this, patients refuse food, quickly lose weight.
4. Bleeding. Usually, blood loss is not noticeable. It can be detected by analyzing stool for occult blood. In some cases, there is vomiting of "coffee grounds", as well as melena (black stools). With a complicated course - vomiting of scarlet blood appears. Bleeding erosions and peptic ulcers.
5. Reflex dysfunction of the heart. Interruptions are associated with food intake or exacerbation of esophagitis.

Classification of diaphragmatic hernias:

• Axial hernia: esophageal, cardiac, cardio-fundic.
• Paraesophageal type of HH: fundic, pyloric, intestinal (large and small intestine), mixed, omental.
• Giant hernia: subtotal, total.
• Shortened esophagus I and II degree: acquired and congenital origin.

The disease must be diagnosed in the early stages. During this period, the disease responds well to medical treatment.

Diagnostic methods

Examination of a patient with HH should be comprehensive. Instrumental and laboratory methods research. For the diagnosis of paraesophageal hernia is enough survey radiograph(no contrast). Against the background of the heart, a round formation is determined.

Sliding hernias can only be determined in the supine position. In such patients lower section the esophagus is expanded, deployed. The upper part of the stomach is fixed above the diaphragm. A picture with contrast will be more indicative.

To establish the presence of reflux, an endoscopic examination is performed.

Indications for esophagoscopy:

• suspicion of a tumor;
• peptic stricture, narrowing of the esophagus;
• erosion, ulcer;
• bleeding.

During FGDS (fibrogastroduodenoscopy), the size of the esophagus is determined, the severity of ulcerative defects is assessed, as well as the degree of insufficiency of the pylorus of the stomach.

Diagnosis of diaphragmatic hernia also includes esophagomanometry. The method allows to identify a sliding hernia on early stage. The study also fixes minimal reflux.

Be sure to take a general analysis and biochemistry of blood. Check feces for occult blood. Take an ECG.

What is dangerous HH

Diaphragmatic hernia is often diagnosed at the stage of complications. During this period, the patient needs emergency hospitalization with intensive treatment.

Possible complications of diaphragmatic hernia:

• infringement;
• solar syndrome;
• gastrointestinal bleeding;
• erosion and ulcers of the esophagus;
• organ stenosis;
• wall perforation (formation of a through defect);
• metaplasia gastric epithelium(growth of foreign epithelium);
• inflammation of the stomach;
• posthemorrhagic anemia.

Strangulated diaphragmatic hernia is a formidable complication of the disease. The organ of the gastrointestinal tract, located in the hernial sac, cannot be set back. Vascular bundle is pinched, which threatens with necrosis of its wall.

Harassment symptoms:

• severe pain syndrome;
• hematemesis;
• shortness of breath, palpitations, pressure drop, pallor;
• the chest is unevenly involved in the act of breathing.

Solar Syndrome is inflammation. solar plexus. Symptoms:

• burning pain in the area of ​​the solar plexus, aggravated by palpation;
• pain is relieved by bending forward.

Bleeding from an ulcer is one of the most formidable complications. Distinguish between chronic and acute blood loss. In the acute variant, the patient is rapidly bled. Chronic is difficult to diagnose, but responds well to therapy.

The pain gradually increases, is not removed by eating. The patient's condition is deteriorating. Without proper help, pathology leads to the death of the intestine or stomach. Organs are infringed due to a sharp narrowing of the lumen.

Signs of blood loss in diaphragmatic hernia:

• vomiting with streaks of blood;
• dark stool;
• weakness, malaise;
• V general analysis blood signs of anemia low level hemoglobin and erythrocytes).

Sometimes anemic syndrome is the only manifestation of HH. In this case, an analysis is prescribed for occult blood in the feces. If the answer is positive, they look for a bleeding source.

Stenosis of the esophagus is manifested by a violation of swallowing and a sharp weight loss of the patient.

In case of violation of the heart (reflex angina pectoris), the patient is worried about shortness of breath, Blunt pain behind the chest. The diagnosis is often misdiagnosed as coronary artery disease.

How to get rid of pathology

Diaphragmatic hernias respond well to treatment. It is better to start therapy in the early stages of the disease. During this period, the effect of it is maximum.

Conservative therapy

Often, patients with diaphragmatic hernia are treated with conservative therapy. If the disease is an accidental “discovery”, and the patient does not complain, then the treatment is not carried out, but dynamically observed.

Diaphragmatic hernia treatment is indicated when symptoms of reflux esophagitis appear. Patients are prescribed a special diet, diet and medication support.

Heavy lifting, bending over, squatting with weight should be avoided. An integral part of the treatment is the fight against constipation, as they cause an increase in abdominal pressure. Patients are prescribed special nutrition, as well as laxatives. Slimming is also essential component treatment. Patients sleep on large pillows, since without a raised head end, the risk of recurrent reflux is high.

Meals should be fractional and frequent. Patients are advised to eat 5-6 times a day regularly. For breakfast and lunch, eat the bulk of the food. Do not eat 2-3 hours before bedtime. After eating, you need an hour in a horizontal position. Recovery occurs even without the use of drugs.

During an exacerbation of the disease, mechanically sparing food is prescribed. It is important to provide the body with proteins to speed up recovery. Take 1 capsule before meals fish oil or any vegetable oil (1 tablespoon).

During remission, there are no strict restrictions. But they observe the regime and frequency of nutrition, and also refuse spicy, canned food, dry food and strong alcohol.

Conduct a course of treatment with mineral waters. Essentuki and Borjomi will be effective in this case. Drink warm water an hour before meals. The gas is released first.

Of the drugs prescribed:

• inhibitors proton pump latest generation(Rabeprazole, Esomeprazole);
• motility stimulants (Ganaton, Motilium);
• nonabsorbable antacids (Almagel, Maalox, Gaviscon);
• H2 receptor blockers (Ranitidine, Famotidine).

Do not eat or drink 2 hours before and 2 hours after taking antacids. The protective film formed on the stomach inhibits absorption and digestion processes.

Folk methods

In the early stages of reflux esophagitis, the disease can be cured with a combination traditional medicine and diet therapy.

The following recipes are effective for diaphragmatic hernia:

• 1 tbsp. coltsfoot herb, flaxseed, foliage peppermint, Althea root. Pour 1 l cold water and insist an hour. Put on a slow fire and simmer for 5-7 minutes. Cool, filter with gauze. Drink up to 10 times a day for half a glass of infusion.
• 1 tsp cumin seeds, fennel, mint leaves and 5 drops essential oil anise. pour a glass hot water and boil for a quarter of an hour. Infuse for an hour. Cool, filter and drink 0.5 cup up to 5 times a day before meals.
• 1 tbsp gooseberry leaves pour 1 liter of water and leave for 2-3 hours. Take ½ cup before meals up to 5 times a day.
• To eliminate constipation, they drink a glass of kefir before going to bed, after adding 1 tbsp to it. vegetable oil (perfect option- linen).

Phytotherapy has a cumulative effect. Treatment takes from several months to several years.

Breathing exercises

This technique, when performed correctly, speeds up recovery. Proper breathing improves blood flow internal organs by reducing intra-abdominal pressure.

Respiratory complexes with diaphragmatic hernia:

1. Lie on your right side, put your head on the pillow. Inhale and inflate your stomach as much as possible. Exhale and relax. Repeat 8 times.
2. Get on your knees. While inhaling, bend the spine in thoracic region, while exhaling - take the starting position. Repeat 5-6 times.
3. Lie on your back. Breathe evenly and rhythmically, turning in different sides the whole body. Repeat 4-7 times on each side.

Exercises

Every day they make a complex simple exercises, which do not require effort, but effectively fight high intra-abdominal pressure.

List of effective exercises for diaphragmatic hernia:

1. Lie on your back. raise upper part torso. Place your fingers along the midline of the abdomen. Exhaling, press on the abdominal wall.
2. Sit down, lean forward. Put your fingers under the ribs, exhaling, insert them under the ribs.
3. Stand up, place your hands along the body, align your back. Rotate the upper body around its axis. Important: the pelvis must remain motionless.
4. Lie on your back, bend your knees, cross your arms behind your head. Bring your right elbow to your left knee and vice versa. Repeat 10 times.
5. Lying on your back, relax your body. Inhale deeply and hold your breath for 10 seconds, then exhale slowly.
6. Get on your knees, put your hands on the floor. Tilt your body down, sliding your hands along the floor. The exercise is called "cat".
7. Lie on your side, hold your head with your hand. Pull the other hand back. Repeat 10 times on each side.

Surgical intervention

If the protrusion of the abdominal organs is not amenable to conservative therapy, and also gives the patient a lot of anxiety, they resort to surgical intervention.

The operation is performed by open (laparotomy) or closed (laparoscopic) method. During the intervention, the organ is released from the infringement. The gate is sutured. fundus of the stomach and abdominal part the esophagus is sutured to the front of the diaphragm.

Indications for surgery for diaphragmatic hernia:

• multiple erosions;
• ulcers;
• internal bleeding;
• severe posthemorrhagic anemia;
• hernia more than 10 cm;
• metaplasia of the esophageal mucosa ("settlement" of the gastric epithelium).

Diet after surgery

Postoperative diet inhibits gas formation and diarrhea, and also promotes accelerated recovery.

Features of nutrition after surgery for diaphragmatic hernia:

1. Eat 6 to 8 times a day in small portions.
2. After the main course, drink no more than ½ cup of liquid (tea, water, juice).
3. Posture while eating should be straight. Do not lie down for 30 minutes after eating.
4. It is important to chew your food thoroughly.
5. Avoid flour products.
6. Do not drink through a straw, do not chew gum and tobacco.
7. Exclude legumes, all varieties of cabbage, onions.
8. Do not drink carbonated drinks and alcohol.

Treatment prognosis

The prognosis for recovery is favorable. Diaphragmatic hernia recurrence can occur if postoperative diet. It is important to limit the load on the abdominal press, as well as avoid exercises that increase intra-abdominal pressure.

Diaphragmatic hernia is a pathology that develops as a result of an increase in the width of the physiological opening in the diaphragm. Through the enlarged opening, organs located in the abdominal cavity can partially penetrate into the chest area. Usually we are talking about the cardia of the stomach, less often - about fragments small intestine. Treatment of a hernia of the esophageal opening of the diaphragm (HH) is carried out with the help of conservative therapy or through surgical intervention. Suitable Method is selected taking into account the type of GPOD, features clinical case, severity of the course, actual and predicted complications.

The proportion of this type of hernia in total mass similar diseases is 2%. Usually, a diaphragm defect is detected after receiving the results of a fluoroscopic examination. The reason for the appointment of a diagnostic examination is often the complaints of patients about various disorders in the gastrointestinal tract. If a diaphragmatic hernia is left untreated, the acidic contents of the stomach get into the walls of the esophagus. As a result, the mucous membrane of the organ is damaged, pathologies such as esophagitis, stenosis, peptic ulcer, perforation of the esophagus, etc.

There are axial (sliding) and paraesophageal hernia. The first type occurs in 90% of cases. Axial hernia of the esophageal opening of the diaphragm, in contrast to the paraesophageal variety, is characterized by penetration into the space of the chest of the cardia (valve) of the stomach.

Pathological changes often lead to insufficiency of the cardia, which in turn causes esophagitis and other complications.

Sliding hernias often cause internal bleeding. Paraesophageal hernias are usually complicated by tissue strangulation. Depending on the causes of origin, congenital and acquired pathologies of the diaphragm are distinguished.

Causes of defect formation and symptoms of the disease

The diaphragm is a thin film that separates the chest and abdomen. The film is composed of muscle and connective tissue. Normally, it is statically attached to the ribs and spine. Physiological openings in the area of ​​the diaphragm are intended for the spine, esophagus, blood vessels. When the food opening of the diaphragm increases in size, organs can penetrate through it into the space of the chest digestive system, including the stomach. If the stomach area protrudes through the diaphragmatic opening, the patient develops unpleasant symptoms. Among them:

• heartburn that occurs immediately after eating;
• pain localized in the hypochondrium or in the lower part of the sternum and aggravated by physical stress(leaning forward, coughing, etc.). Pain is more often observed if the body is in a horizontal position. They can disappear spontaneously after taking a vertical position, as well as after a reflex act of belching or vomiting;
• heart pains that are identified with coronary disease. Painful sensations will spread to the region of the scapula and left forearm. Pain is easily eliminated by taking nitroglycerin. When examining the type ECG abnormalities in the work of the heart are not detected;
• frequent belching, during which air or food remains are released;
• signs of dyspepsia, such as heaviness in the stomach, discomfort that intensifies after eating, a feeling of fullness and early satiety (when absorbing even a small portion of food);
• intestinal disorders, which are usually observed with diverticulosis or an ulcer in the duodenal region.

In cases of complications of the disease general symptoms appear more clearly. They are accompanied by other signs functional disorders- girdle pain of an acute nature, fever, chills, general weakness, profuse sweating, pale shade skin. These symptoms are typical for inflammatory processes occurring in the pancreas and gallbladder.

Therefore, before making a diagnosis, careful diagnostic examination. Main method diagnostics - radiography using contrast medium(barium suspension). Additionally, to determine the severity of the disease, fibrogastroduodenoscopy is prescribed, which is the most informative method research upper divisions stomach.

Dangerous is the condition of infringement of a part of the intestine or stomach, which is accompanied by intense retrosternal pain, vomiting, stool retention, sharp deterioration well-being. Sliding (axial) hernia of the esophageal opening of the diaphragm, proceeding in a progressive form, leads to the development of peritonitis (inflammation of the peritoneum). Symptoms of a complicated diaphragmatic hernia include disturbances in the rhythmic contraction of the heart muscle (extrasystole, tachycardia) and indicate the need emergency treatment. Main reasons:

• insufficient development of the connective tissue that forms the opening of the diaphragm, intended for the esophagus;
• increased intra-abdominal pressure, especially in cases of chronic deviation from the norm;
• traction diverticula of the esophagus (single or multiple protrusion of the wall of the esophageal muscular tube). Pathology is formed due to fusion of the wall of the esophagus and surrounding organs. Usually the deformation occurs due to the inflammatory process.

Congenital pathology is serious threat for the life of an infant. Hernia in the fetus is diagnosed in perinatal period which makes it possible to immediately provide medical care to the newborn. The main reasons for the development of congenital pathological changes- regular physical overexertion during pregnancy, chronic diseases organs of the respiratory system, found in future mother, malnutrition, smoking, alcohol abuse.

Pathology therapy

In the case when a hernia of the esophageal opening of the diaphragm is diagnosed, the treatment is carried out by conservative and operative methods. When choosing a method, how to treat a pathology, factors such as the degree of risk and the complexity of the course are taken into account. The operation is indicated in cases where therapeutic treatment does not give the desired result. conservative therapy it is advisable to use when the hernial "sac" is small, and the risk of infringement is minimal. Program drug treatment diaphragmatic hernia includes reception:

In some cases, antipsychotics, antihistamines and sedatives are indicated. medications. Patients are recommended fractional nutrition. Daily diet divided into 5-6 meals. The menu contains mostly fresh, carefully cooked dishes. Gastroenterologists advise to completely eliminate smoked, spicy, too salty foods that provoke increased secretion of hydrochloric acid.

To completely cure the disease, one has to resort to surgical intervention. If the hernia reaches an alarming size and signs of infringement of the internal organs are revealed, the patient is scheduled for surgery. During surgical intervention the hernial sac is removed, and the enlarged diaphragm opening is sutured. If there is a deficiency of own tissue, narrowing diaphragmatic opening carried out using "patches" made of artificial materials.

Treatment of the disease at home

Conservative treatment of diaphragmatic hernia requires compliance with certain rules that will help to avoid further progression of the disease. General recommendations patients for effective therapy at home:

If you drink bicarbonate-sodium mineral water, the discomfort from high acidity disappears, the balance of acids and alkalis is restored, and the manifestations of heartburn decrease. Symptoms of the pathology are aggravated when the patient assumes a horizontal position. For this reason, it is recommended to eat no later than three hours before bedtime.

Features of nutrition and recipes of folk remedies

Plays an important role in improving well-being and recovery proper nutrition. Principles diet food for the diagnosis of HH:

• replenishment of the diet easily digestible products With high content squirrel;
• careful heat treatment and mechanical grinding of food. Preference is given to dishes with a light, soft, liquid consistency (soufflé, mashed soups, pureed cereals). It is allowed to cook porridge from any cereals with the exception of rice. When preparing porridge, water should be taken 1.5 times more than indicated in the recipe. Then the mass will turn out boiled. Meat dishes it is better to cook from chopped minced meat (steam cutlets and meatballs);
• plentiful drink. It is recommended to drink at least seven glasses of water daily.

Immediately after eating, you should not burden the body with physical activity. However, doctors also do not advise to go to bed. Horizontal position contributes to the formation of heartburn and the manifestation of other unpleasant symptoms illness.

Traditional medicine recipes:

The action of these drugs is aimed at eliminating unpleasant symptoms (heartburn, belching, bloating) and normalizing the stool, which leads to a decrease in intra-abdominal pressure.

A hiatal hernia (diaphragmatic hernia) is a congenital or acquired defect in the muscular septum that separates the chest cavity from the abdominal cavity. Various negative factors during prenatal development fetus or already in an adult lead to weakness individual sections diaphragm, from which the physiological opening (esophageal) expands and passes through itself not only the abdominal part of the esophagus, but also the cardial part of the stomach (in advanced cases, the entire organ). Such an anomaly is often found in premature babies, which is associated with insufficient development of muscle tissue or the appearance of a defect during pregnancy. In adult patients, the disease is associated with high loads, in the wrong way life and overweight.

There are many risk factors, and if there is a predisposition to this disease, then any systemic ailment, increased load, cough can provoke pathological disorder position of the abdominal and thoracic organs. You can observe the symptoms of diaphragmatic hernia already from the first stage, if you pay attention to minor changes in the body, such as discomfort in the chest, hiccups, heaviness after eating, the appearance of pain while bending the torso forward.

Diaphragmatic hernia or HH is chronic illness associated with the mixing of the organs of the abdominal cavity through the diaphragm. Displaced organs begin to compress the lungs and heart, because as soon as it is possible to determine the disease, conservative or less often surgical treatment begins.

Specific symptoms of HH

A hernia may be asymptomatic, but this is not quite the right definition. Any disease has its manifestations, but a person does not attach importance to them. To such weak pronounced signs include deterioration of health, heaviness after eating, belching, heartburn. These symptoms can go separately or in combination, but they gradually increase, and the disease itself progresses, as it proceeds in four stages.

In 97% of patients with a hernia of the POD, reflux is manifested (reverse reflux of food from the stomach into the esophagus), and this pathology most often allows you to determine the diaphragm defect, as it has severe symptoms.

The severity of manifestations also depends on the form of the hernia. In the case of a paraesophageal hernia, symptoms may indeed be absent, but for a short time, moreover, such hernias are most often infringed and lead to serious consequences.

For any type of hernia POD:

1. Pain - localized in the stomach, radiates to the back, sometimes has a girdle character, which leads to an incorrect preliminary diagnosis;
2. Reflux esophagitis - with diaphragmatic hernia, reflux disease occurs, painful, belching, regurgitation, dysphagia;
3. Disorders of the digestive tract - there is bloating, nausea, vomiting, constipation.

Features of pain in diaphragmatic hernia

Differential diagnosis of diaphragmatic hernia necessarily includes heart disease, because there are cases when HH occurs along with ischemic disease taking into account the incidence among the elderly.

About 30% of patients complain of pain in the heart, which is taken for angina pectoris and even myocardial microinfarction.

During the diagnosis, the following factors are taken into account:

1. Time of onset of pain: with a diaphragmatic hernia, pain in the stomach and chest appears mainly after eating, during exercise, when the body is tired, sneezing, coughing, bloating;
2. The subsidence of pain occurs after belching, deep breath, at vertical position body, after a glass of alkaline water;
3. With a hernia, it is extremely rare sharp pains, they are rather dull, moderate and have a temporary pattern;
4. Bending forward is accompanied by pain.

What causes pain in diaphragmatic hernia?

1. When the stomach passes into the chest cavity, it is compressed nerve endings fundus and cardia;
2. Increased acidity of gastric juice and irritation of the esophagus with reflux;
3. Spasms and hypermotor dyskinesia of the esophagus;
4. In gastroesophageal reflux, the walls of the esophagus stretch.

Reflux esophagitis and hernia

Most of the symptoms are associated with reflux, which indicates the weakness of the gastric sphincter and the need for surgical treatment to eliminate the defect.

Gastroesophageal reflux in HH shows the following symptoms:

1. Swallowing disorder or dysphagia is a temporary symptom that appears suddenly and disappears for a while. This phenomenon is more often observed when taking liquid and soft foods. It is connected with psychological trauma when eating is accompanied by pain. Treatment includes a course of psychotherapy, since the traumatic factor remains the main one. Once it becomes constant symptom, it is necessary to conduct a differential diagnosis with esophageal cancer, peptic ulcer;
2. Belching, regurgitation (regurgitation) - appears after eating, at night, when a person lies down after eating. Constant burping and spitting up can lead to pneumonia. Treatment is carried out with medication and diet, it is necessary to reduce the acidity of gastric juice;
3. Dental diseases and burning of the tongue are caused by the ingress of acidic stomach contents into oral cavity which causes mucosal burns. Vapors of hydrochloric acid, in turn, adversely affect the enamel, corroding it (decalcification process), which leads to hypersensitivity and stains on teeth. Treatment at the dentist does not give any results while the underlying disease is present.

Running esophagitis leads to erosions and ulcers of the esophagus, which is especially dangerous for patients with a predisposition to oncology.

Conservative treatment

Non-surgical treatment of a subcutaneous hernia includes the following medications:

1. Maalox - antacid, is used to envelop the gastric mucosa and neutralize hydrochloric acid. Treatment with this drug allows you to eliminate bloating, normalize digestion;
2. Almagel Neo - antacid, absorbs harmful elements, reduces the aggressiveness of hydrochloric acid and reduces bloating;
3. Gastal - combined remedy that neutralizes hydrochloric acid. Treatment eliminates belching, reduces pain. The drug has a prolonged action;
4. Phosphalugel is an antacid agent that has an adsorbing, enveloping action. Treatment is carried out in order to neutralize hydrochloric acid and eliminate the symptomatic complex.

Belching food or air, attacks of suffocation. Often, such patients also point to malfunctions in the work of the heart, which especially bother them at night if they ate a very large amount of food for dinner. As for pain in the region of the heart, in the presence of this pathology, they tend to intensify immediately after a person assumes a horizontal position.

If you have been diagnosed with a diaphragmatic hernia, then it is very important to clearly follow some fairly simple rules, namely:
1. Don't wear tight belts;
2. Do not make sharp bends forward;
3. Don't overeat;
4. Do not lift weights;
5. Avoid the development of constipation;
6. Take your last meal three to four hours before going to bed;
7. Regularly perform special gymnastic exercises for recovery muscle tone diaphragms;
8. Clearly follow all the rules of a healthy lifestyle.

Recipe three: take one tablespoon of goose cinquefoil herb and steam the raw material for one hundred and twenty minutes in one glass boiled water. The resulting infusion will need to be carefully filtered and taken orally in a third of a glass in the morning, afternoon and evening before meals. Each time before taking the infusion, it is recommended to warm it up slightly.

Recipe four: take thirty grams of sweet hernia herb, fill the raw material with one liter of boiled water and let it boil for three to five minutes. After that, leave the broth to cool, filter it and take half a glass inside in the morning, afternoon and evening.

In conclusion, we note that before applying one or another folk remedy to deal with a diaphragmatic hernia, it is best to get a specialist consultation first.

One of the most obvious signs this disease it is customary to consider pain in the chest, epigastric region and hypochondria, which especially bother patients after taking very a large number food. In addition to pain, patients may also experience a feeling of heaviness in the same areas, palpitations and shortness of breath, rumbling in the chest. Vomiting is another symptom of diaphragmatic hernia, which again makes itself felt after eating. If there is a twisting of the stomach, then paradoxical dysphagia also makes itself felt. In this case, the patient's body perceives solid food much better than liquid. If, on the face, a hernia is infringed, then it can not do without quite sharp pains in epigastric region which are of a paroxysmal nature. Often in the same case, patients also indicate signs of acute intestinal obstruction. If there is an infringement hollow organ, then the development of necrosis is quite possible.

As for the true causes of the development of congenital diaphragmatic hernia in children, they, unfortunately, are still unknown. Experts suggest that in this case, most likely, excessive physical exercise during pregnancy, non-compliance future mother all the rules of a healthy lifestyle, the presence of a pregnant woman chronic pathologies respiratory tract, difficult pregnancy and so on. Ultimately, all these factors negative impact on the intrauterine formation of internal organs, which becomes the cause of the development of this pathological condition.

To date, there are several methods for diagnosing this disease. These include both pH-metry, which is used to determine the acidity in the stomach, and X-ray examination of the stomach with barium contrast, as well as fibrogastroscopy. With the help of fibrogastroscopy, specialists can assess general state mucous membrane of the stomach and esophagus. But an X-ray examination is necessary to obtain an image of the part of the esophagus and stomach protruding into the chest.

The course of therapy for this pathological condition involves taking medications designed to reduce the acidity of the stomach, following a special diet, as well as performing surgery. With the help of special medicines manages to get rid of heartburn and belching. If there is a need, then the patient is prescribed medications to combat chronic constipation. Surgical intervention for the removal of a diaphragmatic hernia is not carried out by all patients. If the operation is nevertheless prescribed, then during its implementation the surgeon pulls back into the abdominal cavity the abdominal part of the esophagus, as well as the stomach. During surgery, it is used special method narrowing, as well as strengthening the esophageal opening of the diaphragm.

Anus atresia- another defect of newborns, which is accompanied total absence continuity of the anorectal canal. In some cases, it is characterized by a lack of communication between the anus and the rectum. According to statistics, this disease is observed in two to five cases out of ten thousand births. As for the symptoms that tend to accompany this disease, then in this case on the face all the signs of low intestinal obstruction.

In about one child out of four thousand newborns, it is possible to detect such a defect of the gastrointestinal tract as omphalocele. Given pathological condition characterized by intestinal protrusion, as well as some other abdominal organs into the cavity of the umbilical cord. In most cases, this disease occurs in children who were born from older women. The size of such a hernia can be both insignificant and gigantic. In the latter case, the defect covers the entire abdominal wall. The mortality rate of babies with giant hernias reaches fifty to sixty percent. As for the symptoms of omphalocele, in this case, there are various disorders of the respiratory process, as well as a very small chest cavity, as well as lung hypoplasia.

In conclusion, it is worth mentioning gastroschisis. This defect is accompanied by protrusion of the abdominal organs through a defect, which is noted in abdominal wall. In most cases, protrusions are directly affected by intestinal loops. It should also be noted that every year this pathological condition occurs more and more often.

It is also important to note the fact that this pathological condition can be detected already from the end of the first trimester of pregnancy. by the most early term detection of diaphragmatic hernia is twelve weeks. Most often, unfortunately, this disease can be detected only at the twenty-sixth - twenty-seventh week. In principle, this fact is not surprising, since today specialists have to work with not yet the highest quality ultrasonic equipment. Moreover, not all specialists are highly qualified in this field.

Perinatal karyotyping is another method of prenatal diagnosis of congenital diaphragmatic hernias, which is performed along with echography. In this case, it does not do without consulting a syndromologist, during which it is possible to find out how high the risk of developing a particular genetic disease in a baby is. In conclusion, we note that it is rather difficult, but still possible, to monitor the course of pregnancy, which is accompanied by this defect. To save a baby's life huge effort will have to be applied both to doctors and to the future mother herself.

Diaphragmatic hernia occurs in 0.5% of the world's population. In half of the cases, it does not manifest itself during life, and therefore patients learn about its presence only at an examination prescribed due to other pathologies. In the absence of treatment, the likelihood of complications is high, and therefore about specific symptoms and the prerequisites for the development of the disease should be known to everyone.

Diaphragmatic hernia (DH) is a protrusion of the abdominal organs into the chest, resulting from a violation of the integrity of the diaphragm. At the same time, patients experience pain in the stomach, shortness of breath and a general deterioration in well-being.

When protrusion is violated normal movement food masses in the gastrointestinal tract. This may lead to the development congestion, ulcers and erosions.

The diaphragm performs several important functions in the human body:

• separates the abdominal and chest cavity, protecting the lungs from squeezing;
• participates in the process of breathing, allowing the lungs to open better when inhaling;
• regulates pressure in the thoracic and abdominal cavities.

It is a flat muscle that is attached to the walls of the chest. The diaphragm has openings for the esophagus and inferior vena cava. Most often (about 90% of cases) a hernia occurs at the site of the esophagus. There are cases when a hernia occurred in the middle of the muscle itself.

Causes

Among the most popular reasons for the development of a hernia, I highlight the following:

• developmental pathologies that occur during prenatal period life;
• traumatic injuries of the abdominal cavity or chest;
• a strong increase in intra-abdominal pressure: frequent constipation, coughing, frequent childbirth;

  

• deterioration of muscle innervation;
• increased elasticity of the esophageal sphincter;
• pathology of the gastrointestinal tract - inflammation of the esophagus, ulcerative lesions, pancreatitis;
• advanced age over 60 years;

  

• hard physical work;
• regular weight lifting;

  

• frequent overeating;
• hormonal disorders.

These factors create favorable conditions for the formation of a hernia in the diaphragm. With the combined effect of several of them, the likelihood of developing disorders increases.

Hernia types

The classification of protrusions was proposed by B.V. Petrovsky. It is based on the cause of occurrence and distinguishes two main types: traumatic and non-traumatic.

Traumatic hernias, in turn, are divided into:

• true (due to closed injuries);
• false (due to injuries).

Non-traumatic hernias are of the following types:

• congenital false;
• true weakened areas of the diaphragm;
• true atypical location;
• physiological openings of the diaphragm.

Hiatus hernia (HH) occurs in more than 90% of cases. With such a violation, protrusion of the coronary part of the stomach most often occurs. Less often, the intestines protrude.

Symptoms

The protrusion in the diaphragm is different specific symptoms. But the degree of manifestation of these signs is so small that patients often ignore them, causing their appearance by other reasons. In half of the cases, DG does not manifest itself at all. Bright severe symptoms occurs only in cases where the hernial sac is large.

Symptoms in children

IN childhood congenital DH is more common. At the same time, the following symptoms appear in babies:

• pallor of the skin, up to their blue;

  

• shortness of breath after feeding;
• frequent regurgitation big amount food;

  

• vomit;
• bad sleep;
• irritability.

  

Signs in adults

In adults, DG is found much more often than in children. The reason for this may be complex impact provoking factors on the body throughout life. The most common signs of DG in adults include:

• retrosternal pain resulting from squeezing organs;
• the appearance of heartburn, which is aggravated by bending forward and after meals;

  

• frequent belching with air content;
• bloating;

  

• breathing difficulties.

If left untreated, the disease can worsen. In this case, there is a high probability of developing esophagitis or bleeding from perforation of the hernial sac.



Esophagitis is a disease of the esophagus, accompanied by inflammation of its mucous membrane

Signs of acute DG include:

• acute pain in the stomach;
• nausea and vomiting;
• stool retention;
• deterioration in general well-being.



Nausea and acute pain in the stomach area - symptoms of a hernia

Such symptoms indicate severe damage and require immediate medical attention. In case of absence medical care high risk of developing peritonitis.

Diagnostic methods

As mentioned above, DG is most often found in patients during examination, and they themselves may not even be aware of its presence. There are two main types of diagnostics that allow you to confirm the diagnosis.

Radiography of the stomach



The principle of operation of this technique is the deposition of a contrast agent on the walls of the stomach. For this purpose, the patient on an empty stomach is given a special barium suspension. It tastes like chalk. The patient drinks the suspension and after 1-1.5 hours will be ready to perform the study.



The x-ray shows the shape of the stomach and the presence of hernial sacs. suspension naturally washed out of the stomach with further food. It does not have any negative effect on the body and does not cause inconvenience. Therefore, this method is often used to diagnose DG in children.



Most informative diagnostic method. This invasive technique, during which the doctor can not only check for the presence of bags and protrusions, but also assess the condition of the walls. This technique is relevant for checking for the presence of ulcerative and erosive lesions.



FGDS is performed on an empty stomach, preliminary preparation analysis is not required. The patient is injected into the stomach with a special probe, which is equipped with a camera. With the help of air flow, the walls of the stomach are cleansed of juice and food debris. The use of FGDS, despite its informativeness, is a rather unpleasant procedure, and therefore it is prescribed mainly for adults.



Methods of treatment

Therapy depends on the condition of the patient. In non-acute cases, treatment is symptomatic. It includes taking medicines. Their list is presented in the table.



"Platifillin"



"Drotaverine"



Additionally, the diet is adjusted. Meals should be at least 4 times a day. Reduced portion sizes are required to reduce stomach strain. Foods that can cause irritation of the gastric mucosa and stimulate the release of bile are completely excluded from the diet: fried, fatty, salty, smoked, spicy foods.

Surgery is performed in acute conditions:

• large size of the hernial sac;
• infringement of internal organs;
• failure to respond to standard treatment.

emergency surgical intervention performed in case of bleeding, perforation of the ulcer, perforation of the hernial sac. Surgery consists in excising the sac, eliminating hernial opening. If there are perforations in the diaphragm itself, it is possible to apply special surgical patches made of artificial material.



Diaphragmatic hernia, while minimizing the impact of provoking factors, does not pose a threat to the patient's life. But such patients require regular examinations in order to exclude exacerbations.

Video - Laparoscopic treatment of diaphragmatic hernia of the esophagus