Pain in the diaphragm

Pain in the diaphragm can be caused by several factors, among which are the following:

• Injuries (open or closed);
• Diaphragmatic hernia (associated with trauma or non-traumatic, which in turn can be congenital or acquired);
• Hernias of the esophageal aperture of the diaphragm (gliding or paraeophageal). In the first case, part of the stomach adjacent to the cardia is shifted and is a segment of the hernial sac.

Such a hernia can be fixed or non-fixed, innate or acquired. In the second case, the gastric vault or part of the intestine moves to the middle section of the thoracic cavity, while the cardia remains in its original place. With paraseophageal hernia there is a risk of infringement, while with sliding it is excluded.

• Relaxation of the diaphragm (congenital or acquired, absolute or incomplete) is the thinning and movement of the diaphragm into the thoracic cavity with a number of located abdominal organs. The attachment area of the diaphragm remains in its original position.

[1], [2], [3], [4]

Causes of pain in the diaphragm

The causes of pain in the diaphragm include damage, as well as a hernia of the diaphragm. Closed diaphragm damages can occur in road accidents, falls from a high altitude and with strong pressure on the stomach. Due to the rapid increase in intra-abdominal pressure, a diaphragm rupture can occur. As a rule, the affected area is concentrated in the region of the tendon center or at the point of its connection with the muscular segment of the diaphragm. In almost all cases, its left dome is torn.

The cause of pain in the diaphragm can be diaphragmatic hernia. As a result of this pathology, the peritoneal organs move into the thoracic cavity through the affected regions of the diaphragm. With a true hernia, there are hernia and bag. If the hernia is not associated with injury to the diaphragm, its formation may be caused by the presence of any defects in the diaphragm. The congenital hernia is due to the fact that the fetus during the intrauterine period did not have a complete fusion of the connections between the thoracic and abdominal cavities. The true hernia of the weakened zones of the diaphragm is formed with increasing pressure inside the peritoneum and is characterized by the exit of the peritoneum organs through the sterno-rib department or the lumbar-rib department. When the hernia of the esophagus through it into the chest cavity shifts the lower segment of the esophagus, part of the stomach, and sometimes the loops of the intestine.

The cause of pain in the diaphragm can be its relaxation. If the muscles of the diaphragm are not sufficiently developed, the relaxation is considered congenital. If there is damage to the nerve of the diaphragm, we are talking about the acquired relaxation. When the diaphragm relaxes, it becomes thinner and shifts into the thoracic cavity together with nearby organs.

[5]

Symptoms of pain in the diaphragm

Symptoms of pain in the diaphragm in the acute period include disturbances in the work of the cardiovascular and respiratory systems, bleeding, accumulation in the pleural cavity of blood and air, bone fractures, compression of the lungs, displacement of the organs of the mediastinum region. Symptoms of diaphragm injury can be the presence of characteristic sounds when tapping the chest, as well as in the intestines with special listening, problems with evacuation, in particular, intestinal obstruction. When the diaphragmatic hernia appears a feeling of heaviness and pain in the epigastric region, in the chest, under the ribs, breathing becomes heavier, the palpitation breaks down, the symptoms can intensify after a tight meal. In the chest, rumbling sounds may occur, in the lying position, dyspnea is felt more strongly, and after eating a vomiting reaction may occur. If there is a kink of the esophagus, liquid food is digested much worse than a solid one.

Symptoms of pain in the diaphragm with a hernia of the esophageal opening of the diaphragm include pain behind the sternum, which can cause both burning sensation and blunted pain. With a hernia of the esophagus, there are discomfort and painful sensations under the spoon, in the hypochondrium, which give to the region of the heart, as well as to the shoulder and scapula. In the lying position and with physical activity, pain increases, belching and heartburn may occur, anemia develops.

Pain under the diaphragm

The main causes of pain under the diaphragm, in addition to injuries and injuries, include diaphragmatic hernia, hernia of the esophagus of the diaphragm or its relaxation. The resulting phenomena are often similar to each other and can include the following factors:

• Feeling of heaviness and tenderness in the epigastric zone;
• Pain in the chest;
• Soreness under the ribs;
• Dyspnea (becomes stronger in lying position);
• Rumbling sounds in the chest from the affected side;
• Heart palpitations;
• Anemia;
• Bleeding (often hidden, sometimes manifested in vomit masses, may appear tarry chair);
• Vomiting, difficult passage of liquid food (occurs when the esophagus is bent).

Pain in the diaphragm area

Pain in the diaphragm requires careful examination, as well as differential diagnosis with neoplasms of the lungs, the liver, the pericardial bag. Pain in the diaphragm area associated with injuries requires urgent medical attention. When the hernia is formed and exacerbated, the patient is assigned an X-ray. Depending on the results of the study and accompanying symptoms, a qualified specialist is assigned prompt or conservative treatment.

Pain in the diaphragm in pregnancy

Pain in the diaphragm during pregnancy can be associated with the development of a hernia of the esophageal opening of the diaphragm. There are several types of such pathology: gliding, parasophageal or mixed, and also a congenital short structure of the esophagus with thoracic placement of the stomach is also possible. Slipping hernias in pregnant women are more common than others, in most cases in women over thirty, more often in multiparous women. The development of such pathology during pregnancy is facilitated by a decrease in the tone of the diaphragm and the lower sphincter of the esophagus, increased pressure inside the abdominal cavity, diffuse spasm of the esophagus with toxicosis of pregnant women accompanied by vomiting. Clinical manifestations during pregnancy, as a rule, do not differ from the general ones. Often this burning sensation in the epigastric region, heartburn, eructation, violation of the swallowing process.

A sign of hernia of the esophageal opening may be the secretion of vomit that occurs during the last month of pregnancy. Indication of the presence of a hernia can also be anemia that does not go away after a period of sixteen weeks. The approach to treatment in pregnant women is always individual and requires careful diagnosis based on the full picture of the disease.

Diagnosis of pain in the diaphragm

Diagnosis of pain in the diaphragm is carried out by tapping the thoracic area, listening to the intestine, as well as carrying out the X-ray of the peritoneal organs, chest cavity, stomach, small and large intestine. The method of X-ray examination is the leading method for diagnosing pain in the diaphragm.

When diagnosing a diaphragmatic hernia, the presence of trauma is taken into account, the mobility of the chest, the condition of the intercostal space on the affected side is assessed. In some cases, in order to diagnose a patient, the cavity of the peritoneum is filled with gases, which makes it possible to better see on the roentgenogram neoplasms in the peritoneum and their connection with nearby organs. Pneumoperitoneography (artificial introduction of gases) is carried out on an empty stomach under local anesthesia after devastation of the intestine and bladder.

If a hernia of the esophagus is suspected, in addition to radiographic examination, esophagoscopy can be performed - examination of the internal surface of the esophagus with a special instrument.

[6], [7]

Treatment of pain in the diaphragm

Treatment of pain in the diaphragm when it is ruptured or injured is due to urgent surgical intervention, which consists in stitching the defects after displacement to the bottom of the abdominal organs.

With diaphragmatic hernia, surgical intervention is also indicated in case of a risk of contraction. If the size of the defects is too large, it is possible to establish nylon, nylon, lavsan or other prostheses. When the hernia is infringed, the displaced organ is lowered into the abdominal cavity, in cases where this is not possible, it is ectomy, then the defect is sewn. In the hernia of the esophagus, in the absence of complications, conservative methods of treatment are used, including preventing the increase in pressure inside the abdominal cavity and reducing the inflammatory processes of the mucosa of the esophagus. The patient during sleep is advised to observe the elevated position of the head, it is also important to monitor the functioning of the intestine. The patient should not be in positions that contribute to the appearance of reflux. Power is recommended fractional, but frequent. Just before bedtime, food is not taken. The patient is prescribed a protein-rich diet, as well as medicines for local anesthesia, antispasmodics and astringents, sedatives and vitamin preparations. In cases of development of bleeding, as well as in the ineffectiveness of conservative methods of treatment, surgical intervention is prescribed. Treatment of pain in the diaphragm when it is relaxed is also carried out in an operative way.

Prevention of pain in the diaphragm

Prevention of pain in the diaphragm, in particular, the prevention of exacerbation of hernia includes fractional, but frequent meals. After eating, avoid standing in a horizontal position for several hours. The patient should not be physically overextended, the increase in intra-abdominal pressure should be avoided, the functioning of the intestine should be monitored, normal body weight maintained, and falls and injuries avoided.