الفهرس 
Embryology Development of the DiaphramOnly 14 pages are availabe for public view
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Abstract
Diaphragmatic Hernia is the main surgical condition of the diaphragm. This condition can be classified into; congenital, traumatic and hiatus hernia.
Congenital diaphragmatic hernia is a simple diaphragmatic defect with no known etiology, but is associated with many congenital anomalies. Antenatal diagnosis of CDH is based on detailed ultrasonographic examination of the fetus during the routine antenatal care.
CDH can present immediately after birth, days, months or even many years after birth. For most cases diagnosis can be made using plain x-rays. While x-ray with contrast may be needed to confirm the diagnosis. CT or MRI is used to discover very small diaphragmatic defects that could not be verified by other imaging procedures especially in late presenting CDH.
Techniques of fetal surgery in management of CDH cases have been developed, improved, and switched from the more closure of the fetal diaphragmatic hernia through a large hysterotomy to the less complicated fetendo tracheal occlusion using a balloon that is introduced through a single small uterine port.
The rationale for prenatal therapy in severe CDH is to reverse pulmonary hypoplasia and restore adequate lung growth. Postnatal management of CDH is a shared work between the pediatric surgeon and the neonatal Intensive care unit (NICU), for which most of the job is done inside the NICU, and even surgical management sometimes is done inside the NICU in some institutions to avoid accidents which could happen to the risky infant during the trans portation process.
Recent techniques of ventilation, the use of inhaled Nitric oxide gas, surfactant installation, and ECMO all have been contributing to the improved survival rate in equipped medical centers all over the world.
Traumatic diaphragmatic ruptures are most frequently occur from penetrating wounds of the lower chest and upper abdomen, although wounds in remote areas of the body cause diaphragmatic injury. There are three phases of traumatic diaphragmatic ruptures; acute phase, interval phase, and phase of obstruction or strangulation. The diagnosis of traumatic diaphragmatic reptures; acute phase, interval phase, and phase of obstruction or strangulation. The diagnosis of traumatic diaphragmatic hernia should be suspected in any paient who has sustained blunt or penetrating trauma of the trunk, particularly the lower chest and in whom the chest radiography shows an abnormal diaphragmatic silhouette or lower lung field. Because of the danger of development of respiratory and even circulatory embarrassment or visceral obstruction with incarceration or strangulation of the involved portion of the gastrointestinal tract, diaphragmatic injury should be repaired as soon as possible as the diagnosis is established and the patient’s condition permits.
Hiatal hernia is classified as type I, II, III, and IV depending on the specific abnormality present. Obesity and pregnancy are important contributing factors, the increased intra abdominal pressure in these conditions causes stretching and weakening of the diaphragmatic attachments of the esophagus, setting the stage for herniation. The classical symptoms of hiatal hernia are heartburn, regurgitation, odynophagia, globus and occasionally waterbrush. Surgical therapy for an asymptomatic type I hernia is inappropriate. The presence of symptoms is an indication for elective surgical repair. The repair may be done either by open technique or laparoscopic technique. The laparoscopic technique found to be associated with low morbidity and mortality rates, short hospital stay, decreased postoperative pain, and early return to full activity.