Diaphragmatic hernia pathophysiology

Diaphragmatic hernia Main page
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Differentiating Diaphragmatic hernia from other Diseases
Epidemiology
Risk factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Radiological tests
Treatment
Medical treatment
Surgical treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Diaphragmatic hernia occurs due to a defect in the diaphragm allowing the viscera to herniate into the thoracic cavity. The herniated viscera impairs the normal development of the alveoli and the the bronchial tree and pushes the mediastinum to the contralateral side.

Pathophysiology

• The herniated viscera decrease the area needed by the lung to develop appropriately.
• According to the degree of herniation, the degree of pulmonary hypoplasia is determined.
• The herniated viscera impairs the development of the bronchial tree.
• As a consequence, the alveoli development is also slowed.
• The development of the pulmonary artery tree is halted too resulting in excessive masculinization of the arteries.
• The increased pulmonary pressure leads to increased pressure on the right ventricle leading to the development of a right to left shunt.
• As most of the cases of diaphragmatic hernias are unilateral, the pulmonary hypoplasia is also usually unilateral, but it can be bilateral if the mediastinum is pushed by a massive unilateral hernia.
• The abnormal alveolar development can lead to hypoxemia leading to pulmonary vasoconstriction which aggravates the condition.