Diaphragmatic paralysis pathophysiology: Difference between revisions

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{{Diaphragmatic paralysis}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{MA}}
==Overview==
==Overview==
The exact pathogenesis of [disease name] is not fully understood.


OR
It is thought that diaphragmatic paralysis is the result of [[paralysis]] of cervical nerve roots( C3-C5 ). Diaphragmatic paralyses can be unilateral or bilateral according to involvemnet of one or two leaflets of [[diaphragm]]. In the case of unilateral diaphragm paralysis, it is compensated by other hemidiaphragm or [[accessory muscles of respiration]]. In bilateral diaphragmatic paralysis, accessory muscles do  all of the work of breathing and finally it may lead to ventilatory failure. Early diaphragmatic paralysis may be one of the manifestations of genetic neuromuscular disorders such as [[spinal muscular atrophy]] ([[Werdnig-Hoffman disease|Werdnig-Hoffmann disease]]) and [[acid maltase deficiency]]. On gross and microscopic pathology, there are no characteristic findings of diaphragmatic paralysis.


It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
==Pathophysiology==
The main muscles of [[inspiration]] include:
* [[Diaphragm]] (most important)


OR
* [[Scalene muscles|Scalenes]]
* [[External intercostal muscles|External intercostals]]
* [[Sternomastoid muscle|Sternomastoids]]
The muscles of [[expiration]]:
* [[Internal intercostal muscles|Internal intercostals]]
* Muscles of the abdominal wall
** Rectus abdominus
** [[Abdominal internal oblique muscle|Internal]] and [[Abdominal external oblique muscle|external obliques]]
** Transversus abdominus


[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
===Pathogenesis===
 
* The [[diaphragm]] is the musculo-fibrous membrane. It has two parts: non-contractile central fibrous  and peripheral muscular components. <ref name="pmid1936230">{{cite journal |vauthors=Mizuno M |title=Human respiratory muscles: fibre morphology and capillary supply |journal=Eur. Respir. J. |volume=4 |issue=5 |pages=587–601 |year=1991 |pmid=1936230 |doi= |url=}}</ref><ref name="pmid4041660">{{cite journal |vauthors=Sánchez J, Medrano G, Debesse B, Riquet M, Derenne JP |title=Muscle fibre types in costal and crural diaphragm in normal men and in patients with moderate chronic respiratory disease |journal=Bull Eur Physiopathol Respir |volume=21 |issue=4 |pages=351–6 |year=1985 |pmid=4041660 |doi= |url=}}</ref><ref name="pmid7050712">{{cite journal |vauthors=Roussos C, Macklem PT |title=The respiratory muscles |journal=N. Engl. J. Med. |volume=307 |issue=13 |pages=786–97 |year=1982 |pmid=7050712 |doi=10.1056/NEJM198209233071304 |url=}}</ref>
OR
* Peripheral muscular section has two fibers:
 
** Type 1: slow and fatigue resistant fibers: play roles in low intensity, continual cycle of breathing
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
** Type 2: fast fibers: play roles in rapid and intense situations such as:
*** Talking
*** Singing,
*** Sneezing,  
*** Defecation
*** Acute hyperventilation
The diaphragm create negative intrathoracic pressure and facilitates movement of air into the lungs. It is innervated by cervical nerve roots ( C3-C5 ) via the [[Phrenic nerve|phrenic nerves.]]<ref name="pmid4265565">{{cite journal |vauthors=Lieberman DA, Faulkner JA, Craig AB, Maxwell LC |title=Performance and histochemical composition of guinea pig and human diaphragm |journal=J Appl Physiol |volume=34 |issue=2 |pages=233–7 |year=1973 |pmid=4265565 |doi=10.1152/jappl.1973.34.2.233 |url=}}</ref><ref name="pmid9619305">{{cite journal |vauthors=Fell SC |title=Surgical anatomy of the diaphragm and the phrenic nerve |journal=Chest Surg. Clin. N. Am. |volume=8 |issue=2 |pages=281–94 |year=1998 |pmid=9619305 |doi= |url=}}</ref>


OR
Diaphragmatic paralysis can be unilateral or bilateral according to involvemnet of one or two leaflets of [[diaphragm]]. 


Diaphragmatic paralysis is an uncommon cause of [[dyspnea]].


[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
It is understood that diaphragmatic paralysis is the result of paralysis of cervical nerve roots (C3-C5 ).  


OR
In the case of unilateral diaphragm paralysis, it is compensated by other hemidiaphragm or [[accessory muscles of respiration]].   


The progression to [disease name] usually involves the [molecular pathway].
In bilateral diaphragmatic paralysis, accessory muscles do  all of the work of breathing and finally it may lead to ventilatory failure.  


OR
Bilateral diaphragmatic paralysis is usually seen with generalized muscle weakness. In some cases, the diaphragm is the only muscle involved.    
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.
 
==Pathophysiology==
 
===Pathogenesis===
*The exact pathogenesis of [disease name] is not fully understood.
OR
*It is understood that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
*[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
*Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
*[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
*The progression to [disease name] usually involves the [molecular pathway].
*The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Genetics==
==Genetics==
*[Disease name] is transmitted in [mode of genetic transmission] pattern.
Early diaphragmatic paralysis may be one of the manifestations of genetic [[Neuromuscular disease|neuromuscular disorders]] such as [[spinal muscular atrophy]] ([[Werdnig-Hoffman disease|Werdnig-Hoffmann disease]]) and [[acid maltase deficiency]].<ref name="pmid2407409">{{cite journal |vauthors=Sivan Y, Galvis A |title=Early diaphragmatic paralysis. In infants with genetic disorders |journal=Clin Pediatr (Phila) |volume=29 |issue=3 |pages=169–71 |year=1990 |pmid=2407409 |doi=10.1177/000992289002900305 |url=}}</ref>
*Genes involved in the pathogenesis of [disease name] include [gene1], [gene2], and [gene3].
*The development of [disease name] is the result of multiple genetic mutations.
 
==Associated Conditions==


==Gross Pathology==
==Gross Pathology==
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*On gross pathology, there are no characteristic findings of diaphragmatic paralysis.


==Microscopic Pathology==
==Microscopic Pathology==
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*On microscopic histopathological analysis, there are no characteristic findings of diaphragmatic paralysis.  


==References==
==References==
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[[Category:Pulmonology]]
[[Category:Up-To-Date]]

Latest revision as of 21:22, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]

Overview

It is thought that diaphragmatic paralysis is the result of paralysis of cervical nerve roots( C3-C5 ). Diaphragmatic paralyses can be unilateral or bilateral according to involvemnet of one or two leaflets of diaphragm. In the case of unilateral diaphragm paralysis, it is compensated by other hemidiaphragm or accessory muscles of respiration. In bilateral diaphragmatic paralysis, accessory muscles do all of the work of breathing and finally it may lead to ventilatory failure. Early diaphragmatic paralysis may be one of the manifestations of genetic neuromuscular disorders such as spinal muscular atrophy (Werdnig-Hoffmann disease) and acid maltase deficiency. On gross and microscopic pathology, there are no characteristic findings of diaphragmatic paralysis.

Pathophysiology

The main muscles of inspiration include:

The muscles of expiration:

Pathogenesis

  • The diaphragm is the musculo-fibrous membrane. It has two parts: non-contractile central fibrous  and peripheral muscular components. [1][2][3]
  • Peripheral muscular section has two fibers:
    • Type 1: slow and fatigue resistant fibers: play roles in low intensity, continual cycle of breathing
    • Type 2: fast fibers: play roles in rapid and intense situations such as:
      • Talking
      • Singing,
      • Sneezing,
      • Defecation
      • Acute hyperventilation

The diaphragm create negative intrathoracic pressure and facilitates movement of air into the lungs. It is innervated by cervical nerve roots ( C3-C5 ) via the phrenic nerves.[4][5]

Diaphragmatic paralysis can be unilateral or bilateral according to involvemnet of one or two leaflets of diaphragm.

Diaphragmatic paralysis is an uncommon cause of dyspnea.

It is understood that diaphragmatic paralysis is the result of paralysis of cervical nerve roots (C3-C5 ).

In the case of unilateral diaphragm paralysis, it is compensated by other hemidiaphragm or accessory muscles of respiration.

In bilateral diaphragmatic paralysis, accessory muscles do all of the work of breathing and finally it may lead to ventilatory failure.

Bilateral diaphragmatic paralysis is usually seen with generalized muscle weakness. In some cases, the diaphragm is the only muscle involved. 

Genetics

Early diaphragmatic paralysis may be one of the manifestations of genetic neuromuscular disorders such as spinal muscular atrophy (Werdnig-Hoffmann disease) and acid maltase deficiency.[6]

Gross Pathology

  • On gross pathology, there are no characteristic findings of diaphragmatic paralysis.

Microscopic Pathology

  • On microscopic histopathological analysis, there are no characteristic findings of diaphragmatic paralysis.

References

  1. Mizuno M (1991). "Human respiratory muscles: fibre morphology and capillary supply". Eur. Respir. J. 4 (5): 587–601. PMID 1936230.
  2. Sánchez J, Medrano G, Debesse B, Riquet M, Derenne JP (1985). "Muscle fibre types in costal and crural diaphragm in normal men and in patients with moderate chronic respiratory disease". Bull Eur Physiopathol Respir. 21 (4): 351–6. PMID 4041660.
  3. Roussos C, Macklem PT (1982). "The respiratory muscles". N. Engl. J. Med. 307 (13): 786–97. doi:10.1056/NEJM198209233071304. PMID 7050712.
  4. Lieberman DA, Faulkner JA, Craig AB, Maxwell LC (1973). "Performance and histochemical composition of guinea pig and human diaphragm". J Appl Physiol. 34 (2): 233–7. doi:10.1152/jappl.1973.34.2.233. PMID 4265565.
  5. Fell SC (1998). "Surgical anatomy of the diaphragm and the phrenic nerve". Chest Surg. Clin. N. Am. 8 (2): 281–94. PMID 9619305.
  6. Sivan Y, Galvis A (1990). "Early diaphragmatic paralysis. In infants with genetic disorders". Clin Pediatr (Phila). 29 (3): 169–71. doi:10.1177/000992289002900305. PMID 2407409.

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