THRALL - Thom > 32. Diaphragm > Flashcards

32. Diaphragm Flashcards

(38 cards)

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1
Q

What structures embryologically form the diaphragm?

A
  • Septum transversum (ventrally)
  • Mesentery of foregut (dorsally)
  • 2 pleuroperitoneal folds (dorsally)
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2
Q

During queit respiration, what % of change in thoracic volume is achieved by diaphragmatic movement vs intercostal mm?

A
  • 75% diaphragm
  • 25% intercostal
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3
Q

What reason is given for potenital spread of abdominal disease to mediastinum / pleural space?

A
  • unidirectional drainage of lymph nodes -> final destination thoracic trunks
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4
Q

Detail the anatomical portions of the diaphragm?

A
  • Central tendinous part
  • Peripheral muscular part (3 areas)

Pars sternalis => attaches to xiphoid cartilage

Pars costalis => attaches to 8-13th ribs

Pars lumbalis => 2 crura. R attaches to craionventral border L4, L attaches to body of L3

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5
Q

Which 2 recesses are formed by the diaphragm?

A
  • Phrenicocostalis (costodiaphragmatic) recess

=> formed between layesrs of pleura lining diaphragm and ribs

  • Phrenicolumbalis (lumbodiaphragmatic) recess

=> formed similarly, but region dorsal to crura and ventral to vertebra (bilateral)

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6
Q

List the 3 openings within the diaphragm, and what they contain

A

Aortic hiatus

  • Aorta, hemiazygous, azygous, lumbar cistern of thoracic duct

Oesophageal hiatus

  • Oesophagus, vagus trunks

Caval hiatus

  • CaVC
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7
Q

Which portions of the diaphragm are not visible radiographically?

A
  • Visibility dependent on adjcanet opacity.
  • Accordingly majority of thoracic portion visible

EXCEPT recesses, as lung not contacting

  • Ventral portion of abdominal diaphragm may be visible if falciform fat present
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8
Q

Where is the cupula?

A

= the body

Most cranial convex portion on both DV and laterals

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9
Q

What effect can poor radiographic technique (cranial centring, rotation) have on the appearance of the diaphragm in the lateral projections?

A
  • INcreased seperation of the crura (up to 2.5 vertebral lengths)
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10
Q

In what views does the diaphragm have a dome / mickey mouse shape?

A

Dome: DV thorax, VD mid abdomen

Mickey: VD thorax, DV mid abdomen

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11
Q

Where does the diaphragm extend caudally to (intersection with spine)? How does it change with extreme resp?

A
  • Normal: T11-13
  • May vary between T9-L1
  • Extreme: More verteical, flattened / straight, tenting in the cat
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12
Q

Table - Rx signs of diaphragmatic disease

A
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13
Q

Where are the most common changes to diaphragmatic shape seen? why?

A
  • Cupula -> heart contact, patient postiioning, large breed dogs
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14
Q

What are the possible causes of asymmetry of the diaphragm? Name one way to confirm your suspicions for more unusual dx….

A
  • Unilateral tension pneumo
  • Hemiparalysis -> FLURO
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15
Q

List 5 broad types of diaphragmatic hernia

A
  • Traumatic
  • Peritoneopericardial
  • Hiatal
  • Peritoneopleural
  • Other congenital diaphragmatic defects
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16
Q

Describe the pathophys of traumatic hernia

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A
  • Increased abdominal pressure with OPEN glottis

=> leads to large peritoneo-pleural pressure gradient

  • Subsequent rent formation
17
Q

What radiographic techniques are described to better characterise diaphragmatic herniation?

Study These Flashcards
A
  • Positional radiographs
  • Removal of pleural fluid + repeat
  • Barium study (0.5ml / kg, 30%w/v)
  • +ve contrast peritneography (2ml/kg, iodinated), other selective +ve contrast techniques
  • Horizontal beam

=>LAST RESORT, position animal so accumulates cranially

  • other modalities
18
Q

Table: Radiographic features of traumatic diaphragmatic hernia

19
Q

Incidence of laterality of traumatic hernia?

Study These Flashcards
A
  • In one report equal….

BUT in dogs has been reported R>L

20
Q

Which organs are most commonly herniated in traumatic diaphragmatic hernias? And when chronic?

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A

Acute (IN ORDER)

Liver > small intestine > stomach > spleen > omentum

Chronic (IN ORDER)

Liver > small intestine > omentum > spleen > stomach > colon > pancreas

21
Q

What are the most consistent radiographic features of traumatic diaphragmatic hernia?

Study These Flashcards
A
  • Abdo organs in thorax
  • Displacement of abdo/thoracic organs
  • loss of thoracic diaphgramatic surface
  • assym / altered slope on lateral
  • Pleural fluid
22
Q

What specific life-threatening complication occurs secondary to tension gastrothorax?

Study These Flashcards
A
  • Potential / actual cardiovascular tamponade
23
Q

What feature is a consistent finding with chronic diaphragamatic hernias?

Study These Flashcards
A
  • Pleural fluid

=> also consistent if strangulated organ is present

24
Q

Approximately what % of diaphragmatic hernias are congenitally predisposed?

25
Which cats (and with what means of inheritance / rate of incidence) are predisposed to congenital DH?
- Himalayans and DLH - Simple autosomal recessive in cats, reported 1:500 to 1:1500 incidence
26
What comorbidity has been associated with herniation of liver in PPDH?
- Hepatic cysts
27
Box; Radiographic features of PPDH
28
What is a consistent feature of PPDH in cats?
Dorsal peritoneopericardial mesothelial remnant
29
List three proposed causes of hiatal hernia
1) Congenital 2) Traumatic 3) Contraction of longitudinal oesophageal muscle
30
Hiatal hernia classification
1) sliding 2) Paraoesophageal 3) Combo of 1 and 2 4) EITHER herniation of other organ OR GO intussusception
31
Which breed have congenital hiatal hernia?
Shar pei
32
Rx signs of sliding HH
33
What presdisposing features for GO intussusception are reported?
- Male - GSD - Pre-existing oesophageal dilation
34
Box: Radiographic features of GO intussusception
35
Congenital diaphragmatic defects have beend described in the dog in certain locations. List them
1) Muscular portion, dorsolateral location 2) Membranous (central) in association with umbilical hernia
36
What causes for diaphragmatic motor disturbances are reported?
Traumatic Myopathy Neuropathy Pneumonia Idiopathic
37
Features of diaphragmatic paralysis
- Unilateral: Cranial displacement of one crus, unequal movement - Bilateral: Cranial displacement of both crura, minimal or no movement NB: Diaphragmatic flutter reported -\> Contracture synchronous with heart beat THINK FLURO FOR THESE
38
Features of muscular dystrophy
- Dystrophin deficiency, dogs and cats - Rx: Diaphragmatic assymetry, undulation, and GO hiatal hernia, scalloping of diaphragm with muscular HYPERTROPHY (chec with US). Hiatal thickening / obstruction can cause megaO
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