Pediatric Surgery

Posted by e-Medical PPT
Congenital Abnormality
Defects in the abdominal wall (diaphragmatic hernia, gastroschisis, omphalocele)
Neurological system(brain, spinal cord, etc.)
Cardiovascular and pulmonary abnormality
Malformation of digestive system
Malformation of urological and reproductive system
Limbs and vertebra abnormality

Congenital Posterolateral Diaphragmatic Hernia (CDH)
One of most severe conditions of neonate
Defect in diaphragm during early fetal development
Left side most commonly affected

Pathophysiology
1、Hypoplasia of the lung
Pulmonary weight (ipsilateral+contralateral)↓
Alveoli number↓
Hypertrophy of the media of pulmonary arteriole
Resistance of the vessels↑

2、Pulmonary hypertension
Abdominal viscera into the thoracic cavity → compression of the lung, PaO2↓PaCO2↑→ acidosis, hypoxemia(PH less than 7.30)→pulmonary vessels spasm →vessel resistance↑, right to left shunting through patent ductus arteries and foramen ovale↑→aggravate acidosis and hypoxemia in the body circulation (fetal circulation syndrome)

Diaphragmatic hernia clinical manifestations:
1,Severe respiratory distress,cyanosis, vomit
2,Breath sounds: diminished on the side of hernia
3,Heart sounds: deviated to the contralateral
chest
4,Scaphoid abdomen

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