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Diaphragmatic elevation - causes, symptoms and treatment

Diaphragmatic elevation - causes, symptoms and treatment


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If the diaphragm is no longer in its usual place in the upper body, but is shifted upwards, this has far-reaching consequences. Breathing in particular is made significantly more difficult by such a diaphragmatic elevation. Symptoms such as difficulty breathing and shortness of breath are usually not long in coming. A high level of the diaphragm can also indicate a number of serious health problems.

Definition

The diaphragm (diaphragm) is an essential part of the respiratory muscles. It mainly consists of a muscle plate, which is located directly below the lungs (pulmo) between the chest and abdomen and is held in a stable position by various tendons. In order to guarantee breathing, the respiratory center in the brain sends nerve impulses to the diaphragmatic nerve (phrenetic nerve) at regular intervals, which ensure that the diaphragmatic muscles rise and fall again. This continuous movement stimulates the lungs from below to contract and then unfold, so that air can be inhaled and exhaled naturally.

In addition to the lungs, there are other organs in the immediate vicinity of the diaphragm that share their place in the upper body with the respiratory organs. This primarily includes the liver (Hepar), the spleen (rinsing) and the stomach (gaster). The heart (cardia) is not directly next to the diaphragm, but can also be counted among those organs that help shape the space required in the upper body.

A raised diaphragm now enormously affects this intended space distribution in the upper body. In addition, the muscle movements that are essential for the breathing process are severely affected by the organ displacement. The starting position of the diaphragmatic elevation is a displacement of the diaphragmatic dome into the chest area, whereby the lower section of the lungs experiences a permanent compression. A distinction is made between three main forms of diaphragmatic elevation, which depending on the type also give first indications of the underlying causes:

  • Left-sided diaphragm high - With the left-sided diaphragm high, only the left half of the diaphragm dome is affected by the high. It can be caused by, among other things, space-consuming changes in the digestive organs stomach and spleen, also on the left.
  • Right-sided diaphragm height - If there is a right-sided diaphragm height, the diaphragm dome is only moved up on the right side. Organ enlargements in the area of ​​the right liver are often responsible for this.
  • Double-sided diaphragm height - In the case of a double-sided diaphragm height, the entire diaphragmatic dome is affected by the high position. The causes here can be very varied and affect either the diaphragm itself or surrounding organs or tissue.

If the upper body organs move away from their original position, this almost always has to do with a lack of space in the chest. Organ enlargements, so-called megaliths, are most frequently used here for a high level of the diaphragm. However, injuries, spinal diseases, inflammation and tissue growth cannot be ruled out as the cause of the high level of the diaphragm.

Diaphragmatic elevation due to diaphragmatic diseases

The organ enlargements already mentioned can of course first of all affect the diaphragm itself. For example, if a patient suffers from diaphragmatic inflammation (inflammation of the diaphragm), inflammation-related swellings can temporarily enlarge the diaphragmatic dome, causing the dome to press against the lungs as a result. Typical causes of the - very rare - inflammation include:

  • chronic cough,
  • Nematode infections (trichinosis),
  • Injuries to the diaphragm.

A diaphragmatic hernia (hiatal hernia) is also not to be underestimated as a trigger of the high level. Similar to a serious bone fracture in which fracture fragments shift due to injury, the ancestral position of the diaphragm segments is no longer guaranteed in this scenario and the diaphragmatic dome may shift upwards.

Diaphragmatic paralysis (diaphragmatic paresis) is also conceivable as the cause of the high level of the diaphragm. The signal line between the respiratory center and the diaphragmatic nerve is interrupted, which means that the diaphragm can no longer perform its function. In addition to the lack of muscle contractions to maintain breathing, this also means that the abdominal organs below the diaphragm move more and more upwards. The reason for this is the lack of muscle tension in the diaphragm, which normally pushes the organs down.

Warning: Depending on whether the diaphragmatic nerve is paralyzed on one or both sides, very serious complications can occur! While paralysis on the left or right side triggers “only” breathing problems that the patient can usually survive unscathed thanks to adequate treatment, bilateral paralysis of the diaphragm can provoke life-threatening respiratory arrest.

High diaphragm due to liver and spleen diseases

The organs that are in the vicinity of the diaphragm can also trigger a diaphragmatic elevation if they are enlarged. In the case of right-sided diaphragm elevations, liver enlargement (hepatomegaly) is particularly important. This is most often associated with fatty liver, which shows that a person's individual lifestyle and eating habits can also contribute to the development of diaphragmatic hypertension. Furthermore, inflammation of the liver (hepatitis) can always be identified as a trigger of hepatomegaly. The causes are very diverse and range from infectious diseases such as malaria to injuries and symptoms of poisoning to metabolic and storage diseases.

On the left side of the diaphragm, on the other hand, a high level is usually triggered by an enlargement of the spleen (splenomegaly). Various inflammatory and infectious diseases of the spleen as well as chronic blood disorders come into question for the health problem. Cirrhosis of the liver can also cause splenomegaly, as this causes blood to back up into the splenic vein due to damage to the internal organs of the blood vessels.

Speaking of vessels: there are numerous heart and vascular diseases that can affect the spleen volume. From heart diseases such as right heart failure to more specific diseases such as splenic vein thrombosis or leukemia, splenomegaly can occur in a variety of ways due to circulatory disorders. Also bruises due to an accident-related splenic trauma cannot be excluded as a cause. The following diseases may also be mentioned as possible triggers for enlargement of the spleen:

  • Abscesses, cysts and tumors in the area of ​​the spleen,
  • Echinococcosis,
  • Epstein-Barr infection,
  • Spherical cell anemia,
  • Gaucher disease,
  • Whistling glandular fever,
  • Rheumatism (felty syndrome),
  • Sarcoidosis.

Other causes of diaphragmatic elevation

Organ malformations should also be mentioned with a view to high diaphragm height. In addition, pregnancy naturally represents an organ enlargement, namely that of the uterus. It generally leads to a displacement of numerous organs and can also influence the position of the diaphragm.

In the area of ​​the gastrointestinal tract, digestive problems such as chronic flatulence (meteorism) tend to cause a high level of the diaphragm. The persistent gas accumulation in the gastrointestinal tract causes the digestive organs to expand permanently, so that the diaphragm can bulge easily.

Symptoms of high diaphragm

Symptoms of diaphragmatic hypertension mainly result from impaired lung function, which can lead to persistent breathing difficulties if the cause is not remedied. In addition, there may also be sensations and impaired gastrointestinal functionality. Overall, patients suffering from diaphragmatic hypertension can expect the following symptoms:

  • Difficulty breathing,
  • Shortness of breath,
  • Shortness of breath,
  • Feeling of pressure in the upper abdomen.

Diagnosis of high diaphragm

The first signs of a diaphragmatic elevation can be discovered during the diagnosis during a patient consultation about existing symptoms and possible previous illnesses. Thereafter, however, imaging procedures are necessary to obtain a reliable finding and to confirm the bulging of the diaphragm. For example, CT, X-rays or ultrasound can be considered. Laboratory tests, for example to determine infections, are also conceivable.

Therapy for high diaphragm height

Fortunately, a high level of the diaphragm can usually be treated easily today. However, the prerequisite is that the underlying cause has been determined. Depending on the cause of the disease, the treatment can then include the following steps:

Medication

Infections and inflammation of the organs naturally require medication if the diaphragm is high. Antibiotics are just as possible as anti-inflammatory drugs. Heart and vascular diseases may require the use of hypotensive agents or beta blockers. If there is a tumor, it is highly likely that cytostatics and chemotherapy drugs will be inevitable.

Medicinal herbs

Medicinal herbs can be a good help for many causes and complaints that cause diaphragmatic height. Herbal teas made from fennel or anise, for example, help alleviate flatulence by relieving the gastrointestinal tract. Herbal oils such as caraway or peppermint oil have the same effect, while peppermint oil also has a respiratory stimulating effect.

Everyday measures

Therapeutic breathing exercises are recommended to improve breathing during and after the therapy of the diaphragmatic height. A visit to the physiotherapist is particularly advisable for pregnant women, because the bulging of the diaphragmatic dome can cause increasing breathing difficulties until birth. Patients with a high level of diaphragm should of course also avoid tobacco, since cigarette smoke on the one hand aggravates the difficulty in breathing and on the other hand can also cause irritating nerve stimuli on the diaphragm.

If overweight, fatty liver or another liver disease has caused the diaphragm to become high, it is very important to change your diet. The less pressure exerted on the diaphragm and liver by excess tissue, the better. In addition, some foods additionally worsen the state of health in such a case. In this context, high-fat meals should not only be avoided with obesity. Appropriate foods also have a severe impact on the liver. The liver should also be spared roasts, such as those found in coffee and grilled meat, in the event of illness. The same naturally applies to alcohol, the breakdown of which is particularly hard on the liver. With the corresponding causes for the diaphragmatic high, the focus is therefore on a high-fiber diet with lots of fresh fruits and vegetables. Artichokes in particular and the use of milk thistle extract are said to be particularly beneficial for liver health in this regard.

Surgical treatment

Surgical measures are necessary in the case of a diaphragmatic high point, if tissue proliferation or wounds are behind the disease. Abscesses and cysts may need to be emptied here during a surgical procedure. Internal injuries can be surgically treated, sewn or stapled. In the case of tumors, doctors usually decide on a case-by-case basis whether suitable medication is used before surgery to reduce cell degeneration.

If organs or the diaphragm as such are permanently out of position, an operation is aimed more at putting them back in their original position. In the worst case, emergency operations, for example in the event of impending shortness of breath, are quite conceivable and can even include surgical lung volume reduction.

Causes of diaphragmatic hypertension: diaphragm inflammation, diaphragmatic fracture, paralysis of the diaphragm, hepatomegaly, splenomegaly, accident injuries, organ malformations, meteorism, pregnancy, obesity. (Ma)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Miriam Adam, Barbara Schindewolf-Lensch

Swell:

  • Wiesemann, S. / Haager, B. / Passlick, B .: Surgical therapy for acquired unilateral paralysis of the diaphragm: indication and results, Zentralbl Chir, 2016, thieme-connect.com
  • Merck & Co., Inc .: Diaphragmatic hernia (accessed: July 16, 2019), msdmanuals.com
  • Montalva, Louise / Antounians, Lina / Zani, Augusto: Pulmonary hypertension secondary to congenital diaphragmatic hernia: factors and pathways involved in pulmonary vascular remodeling, Pediatric Research, 2019, nature.com
  • German Society for Pediatric Surgery (DGKCH): S1 guideline diaphragmatic hernia, diaphragmatic defect, as of April 2016, detailed view of guidelines
  • Stanford Children's Health: Diaphragmatic Hernia (accessed: July 16, 2019), stanfordchildrens.org
  • Centers for Disease Control and Prevention (CDC): Facts about Diaphragmatic Hernia (accessed: July 16, 2019), cdc.gov

ICD codes for this disease: Q79ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: Surgical Treatment of Phrenic Nerve Injury (May 2022).


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