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Diaphragmatic hernia

When part of the stomach slips through an opening in the diaphragm into the chest, it is called a diaphragmatic hernia. In many cases, this is discovered only by chance, as the patient does not show any symptoms. Read here when a diaphragmatic hernia is dangerous and how it can be treated.

What is a diaphragmatic hernia?

What are the causes of a diaphragmatic hernia?

What are the symptoms of a diaphragmatic hernia?

How does the doctor recognize a diaphragmatic hernia?

How is a diaphragmatic hernia treated?

How can I prevent it?

What are the chances of recovery after a diaphragmatic hernia?

What is a diaphragmatic hernia?

What is popularly called the diaphragmatic hernia is considered by medical professionals Hiatal hernia known. It is used to describe the fact that part of the stomach passes through an opening in the diaphragm relocated to the chest. The diaphragm is the most important muscle in the respiratory muscles and separates the abdominal and chest cavities. It has three openings, which are technically referred to as the hiatus; The esophagus goes through one of these slits into the stomach. In the case of a diaphragmatic hernia, this gap is enlarged and the upper part of the stomach passes through.

With around 80 to 90 percent of cases, the most common form of the diaphragmatic hernia is axial sliding hernia: The entrance to the stomach is pushed along the esophagus towards the mouth and there forms a kind of extension of the esophagus. It is far rarer paraesophageal hernia, in which the penetrated part of the stomach rests like a sack next to the esophagus on the diaphragm. There are also mixed forms of axial and paraesophageal hernias.

The so-called upside-down stomach or, respectively, is a special form total chest stomach dar: In this case, the entire stomach is shifted into the chest cavity. Per year in Germany about 10,000 diaphragmatic hernias diagnosed. Women in general and people over 50 years of age are particularly affected.

What are the causes of a diaphragmatic hernia?

One distinguishes one congenital and one acquiredshape of the diaphragmatic hernia. If the hiatal hernia is congenital, there is usually one Malformation of the diaphragm behind. If the hiatal hernia does not develop until old age, it is often one Connective tissue weakness the cause: the tissue wears out as a result of wear and tear, so that the esophageal slit widens. In addition, the ligaments between the stomach and diaphragm can loosen, making the esophagus flow into the stomach flatter than usual, increasing the risk of a diaphragmatic rupture.

Basically, the likelihood of suffering a diaphragmatic hernia is increased if the Pressure on the abdomen increases. This can be the case, for example, if you are overweight, if you are constipated or during pregnancy. For very overweight people presses the body fat in the abdomen onto the organs, especially when lying down. This can shift the organs and promote a diaphragmatic hernia.

The situation is similar with pregnant women: The growing child in the uterus needs more and more space so that the abdominal organs are pushed upwards. After the birth, any diaphragmatic hernia usually regresses without any problems. Another risk factor is strong pressing: When the abdominal muscles contract, for example from exerting a bowel movement, lifting heavy objects or doing strength training, the pressure on the abdominal cavity increases.

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What are the symptoms of a diaphragmatic hernia?

Whether and how a hiatal hernia manifests itself depends on its shape. Many patients who have an axial hiatal hernia show no symptoms whatsoever. Some do not even know that a small part of their stomach has passed into the chest, so the diaphragmatic hernia is often discovered by accident - for example during a gastroscopy. When discomfort occurs, it is usually a sign of a gastroesophageal reflux disease, which is colloquially called heartburn.

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The widening of the esophageal slit and the displacement of the stomach into the chest cavity causes more stomach acid to get into the esophagus, which would normally prevent the constriction in the diaphragm. The consequences of this reflux, technically called reflux, can cramping pain in the upper abdomen, difficulties swallowing, Eructation from air to difficulty breathing and shortness of breath. The pain behind the breastbone typically worsen when lying down and can also feel like back pain. S.tress can also contribute to deterioration. If other symptoms such as nausea, diarrhea and vomiting occur in addition to heartburn, this can indicate a general problem with the digestive tract.

Regular exercise can help prevent a diaphragmatic hernia. (c) Colourbox.de

In the case of a paraesophageal hernia, there are no symptoms at first. In the course of the disease, the patients feel a Feeling of pressure in the heart area, especially after eating. It can lead to complications like Stomach ulcer, internal bleeding and one Perforation of the stomach wall come. Chronic anemia, which manifests itself in paleness and poor performance, as well as severe stomach pain can be the first signs of such problems. Fortunately, life-threatening complications such as sepsis are rare. If large parts of the stomach shift, however, it can Circulatory problems, Breathing problems ranging from shortness of breath to Shortness of breath come.

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How does the doctor recognize a diaphragmatic hernia?

About two thirds of all diaphragmatic hernias do not and will not cause any discomfort discovered by chance, for example as part of a check-up. If the doctor suspects a hiatal hernia, for example because the patient complains of heartburn, difficulty swallowing or pain in the chest, he will first ask him a few questions, for example: In which situations do the problems arise? What makes them worse?

Does the person suffer from gallstones and / or have already been Protrusions of the intestinal wall found, the suspicion of a diaphragmatic hernia is obvious, since these health problems often occur together. If the pain occurs in connection with laughing, coughing or sneezing, this is more likely to indicate diaphragmitis. If rattling noises are detected while listening, pleurisy could be present.

The physical examination follows the patient interview. For example, the doctor may have one X-ray of the chest and / or an esophageal pressure measurement, a Magnetic resonance imaging (MRI) and one Endoscopy perform to make his diagnosis. If a congenital diaphragmatic defect is suspected in the unborn child, which can cause a diaphragmatic hernia, one will develop in the womb Ultrasonic made of the fetus.

How is a diaphragmatic hernia treated?

If the hiatal hernia is symptom-free, it is often no treatment necessary. However, if the patient complains of symptoms of reflux disease because of their diaphragmatic hernia, medication can be prescribed to reduce the risk of the disease Reduce acid production in the stomach. Sometimes attempts are also made to stimulate the activity of the gastrointestinal tract with medication.

In addition, there are a number of things that the patient can do themselves during therapy to get a grip on problems such as difficulty swallowing and belching: These include one targeted weight loss if overweight, a consistent one Change of diet and the Refrain from alcohol. Several small, low-fat meals are recommended throughout the day. The question remains as to when one has to operate on an axial sliding hernia. An operation is usually only necessary here if the gastric juice flows back into one severe inflammation of the esophagus comes.

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If there is a paraesophageal hernia or a mixed form, surgery is almost always performed, even if the patient shows no symptoms. The reason for this is that increased risk of serious complications, for example for a twisted stomach or trapped contents of the hernia. There are different surgical methods of varying duration. The most common is the so-called Fundoplication applied: The position of the penetrated stomach is changed in such a way that the transition from the esophagus to the stomach can be closed again. A Cuff made of stomach tissue increases the closing pressure and prevents stomach acid from flowing back.

How can I prevent it?

The risk of a hiatal hernia increases with obesity and lack of exercise. To prevent a diaphragmatic hernia, you should get rid of excess body weight and regular exercise float. An active, healthy lifestyle with a balanced diet and avoiding alcohol and cigarettes makes a significant contribution to your well-being and lowers the risk of countless diseases - including a diaphragmatic hernia.

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If you have already been diagnosed with a sliding hernia or if you suffer from heartburn, you should Refrain from medication and foodthat stimulate stomach acid production. You can also use sleep with the headboard upto prevent the abdominal organs from sliding up into the chest cavity. You will also reduce the symptoms of reflux disease that can occur in connection with a hiatal hernia.

What are the chances of recovery after a diaphragmatic hernia?

Can you heal a diaphragmatic hernia? Generally the The prognosis is pretty good: In 80 to 90 percent of cases of sliding hernia, no therapy is necessary. If an operation has to be performed, most patients will subsequently be completely free of symptoms.

A diaphragmatic hernia is especially dangerous for Newborn. Since the problem developed in the womb, one lung is often underdeveloped, which limits the lung volume. The Therefore, the mortality of babies with a diaphragmatic hernia is relatively high.