A brief overview of Diaphragmatic hernia: A surgical condition manifested in animals mainly buffalo and dogs. Diaphragmatic hernia is the disruption of the diaphragm which allows abdominal organs to migrate into the chest cavity. In small animals, automobile-related trauma is a common cause of diaphragmatic hernia. Congenital defects of the diaphragm may also result in herniation (eg, peritoneopericardial hernia). In horses, diaphragmatic hernia may occur, less commonly, congenitally or after trauma, dystocia, or recent strenuous activity. Diaphragmatic hernias are extremely rare in cattle.Two types of diaphragmatic hernias occur in dogs and cats: Traumatic  ̶  caused by an event that tears the diaphragm Congenital  ̶  pets have these at birth (The most common type of this subcategory is the peritoneal-pericardial diaphragmatic hernia (PPDH). Careful physical examination, including auscultation and percussion, usually suggests the presence of thoracic disease. The definitive diagnosis is most frequently made from Radiographs. Loss of diaphragmatic contour, abdominal viscera in the thorax, and displacement of viscera from the abdomen may be apparent. Radiographic contrast studies may be necessary to make the diagnosis

1. VMD-411 ASSIGNMENT
DIAPHRAGMATIC HERNIA
VIVEK KUMAR
2015V157B-IIVER

2. INTRODUCTION
• The diaphragm is the muscular separation
between the chest and abdominal cavities that
functions as a barrier and aids in respiration
• A break in the continuity of the diaphragm allows
protrusion of abdominal viscera into the thorax.
OR
• Diaphragmatic hernia is the disruption of the
diaphragm which allows abdominal organs to
migrate into the chest cavity.

3. ETIOLOGY
• In small animals, automobile-related trauma is a
common cause of diaphragmatic hernia.
• Congenital defects of the diaphragm may also result
in herniation (eg, peritoneopericardial hernia).
• In horses, diaphragmatic hernia may occur, less
commonly, congenitally or after trauma,
dystocia, or recent strenuous activity.
• Diaphragmatic hernias are
extremely rare in cattle.

4. PATHOGENESIS
• Achalasia of reticulo-omasal sphincture or impairment
of Oesophageal groove
• Food get into Rumen but cannot pass to Abomasum
• Hypermotility due to over distention of Rumen
• FROTHY BLOAT
• Respiratory problems arise due to displacement &
compression of heart.

5. TYPES
• Two types of diaphragmatic hernias occur in dogs
and cats:
• Traumatic ̶ caused by an event that tears the
diaphragm
• Congenital ̶ pets have these at birth (The most
common type of this subcategory is the peritoneal-
pericardial diaphragmatic hernia (PPDH).

6. Peritoneal-Pericardial Diaphragmatic
Hernia (PPDH).
• This is the picture of PPDH in cats, necropsy from
right side of the cat, to the left Abdomen,
Diaphragm in middle, Thorax at the right.

7. Congenital diaphragmatic hernia in an 8-month-old Rottweiler. Most of the
intestine and stomach are lodged in the thoracic cavity as well as the spleen and part
of the liver. On the right, a clamp is holding the fibrous and regular border of the
diaphragmatic defect.

8. CLINICAL SIGNS
• A diaphragmatic hernia can cause significant
respiratory difficulty.
• The trauma that caused the hernia may also result
in rib fractures, lung lacerations, and lung bruising.
• These injuries may lead to :
• pneumothorax (air in the chest outside the
lungs),
• hemothorax (blood in the chest cavity)

9. ACUTE DIAPHRAGMATIC HERNIA
• If abdominal contents have entered the chest cavity,
this can further compromise the ability to expand
the lungs.
• Abdominal organs, displaced through a
diaphragmatic hernia, may experience compromise
to their blood supply.
• Signs associated with an acute diaphragmatic hernia are:
• Difficulty in breathing
• Rapid, shallow breathing pattern
• Abnormal breathing posture with extended
head and neck

10. Clinical Findings:
Acute & Chronic
• Dogs and cats are characteristically dyspneic in
the acute case.
• If the stomach is herniated, it may bloat and the
animal may deteriorate rapidly.
• In chronic cases, systemic signs such as weight loss
may be more prominent than respiratory signs.
• Congenital peritoneopericardial hernia is most
frequently an incidental finding.

11. Clinical findings in Horse & Cattle
• Horses most frequently present with acute,
severe colic secondary to displaced
intestines, or with respiratory signs and
dyspnea.
• In cattle and water buffalo, diaphragmatic
hernias may be associated with traumatic
reticulitis and herniation of the reticulum.

12. • Herniation of reticulum through diaphragm
Fig 2. Nails and small stones recovered from
reticulum

13. DIAGNOSIS
• Careful physical examination, including auscultation
and percussion, usually suggests the presence of
thoracic disease.
• The definitive diagnosis is most frequently made
from Radiographs.
• Loss of diaphragmatic contour, abdominal viscera in
the thorax, and displacement of viscera from the
abdomen may be apparent.
• Radiographic contrast studies may be
necessary to make the diagnosis.

14. Additional imaging tests
• Additional imaging tests to include:
• Abdominal and thoracic Ultrasound
• Contrast radiography (taking radiographs after
placing a contrast medium in gastrointestinal
system)
• Computed tomography (CT scan)

15. Normal chest x-ray of a dog.
The dog’s head is to the left.
The diaphragm is not distinctly
visible but is the curved surface
separating the white abdominal
contents on the right from the
grey of the air-filled lungs. The
oval structure in the center of
the lung field is the heart.
• Chest x-ray of a dog with a
diaphragmatic hernia, showing
loss of the normal
diaphragmatic line. Note that
the white abdominal organs
overlap the heart and the
curve of the diaphragm is no
longer visibly distinct.

16. • Normal chest x-rays of a dog on its
back. The dog’s head is off the top
of the image. The diaphragm is the
curved dome separating the white
abdominal contents at the bottom
from the dark grey lungs. The oval
structure in the center of the lung
field is the heart.
• Chest x-ray of a dog on their
back with a diaphragmatic
hernia, showing loss of the
normal diaphragmatic line.
Note that the white abdominal
organs overlap the heart and
the curve of the diaphragm is
no longer visibly distinct along
its entire length.

17. TREATMENT
• The only treatment to repair the diaphragmatic hernia is
Surgery.
• Surgery is performed on an emergency basis if the stomach is
herniated into the chest cavity and becomes distended with
gas.
• This can prevent lung expansion and cause respiratory
distress. A needle can be passed through the chest wall into
the stomach to decompress the stomach, and then surgery
can be performed.
• Surgical repair of the diaphragmatic hernia is typically
performed by entering the abdominal cavity along the ventral
midline, retracting the abdominal organs back into the
abdomen, and suturing the tear in the diaphragm.

18. SURGICAL PROCEDURE
• Surgical repair of the diaphragmatic hernia is typically
performed by entering the abdominal cavity along the ventral
midline, retracting the abdominal organs back into the
abdomen, and suturing the tear in the diaphragm.
• If the diaphragmatic tear is chronic, it is necessary to be
especially careful with anesthesia, because reexpansion
pulmonary edema is likely fatal.

19. Aftercare & Prognosis
• A hospital stay will be required after surgery.
• It is important to encourage rest and avoid activity
during the post-operative period.
• The prognosis for animals presenting with a
traumatic diaphragmatic hernia is variable
depending on other injuries incurred. It is estimated
that roughly 15% of animals suffering traumatic
diaphragmatic hernia will die before presentation.
• Successful treatment of shock prior to surgery
results in the best survival rates.

20. THANK YOU