Child health · UKMLA & AKT
Diaphragmatic hernia
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise diaphragmatic hernia — the full SA Note notes add investigations, management, complications and 10 practice questions.
Key high-yield points
- Respiratory distress - tachypnoea, grunting, nasal flaring, subcostal recession, cyanosis from birth
- Absent breath sounds on the affected side (usually left) - bowel occupies thorax
- Bowel sounds in the chest - tinkling/gurgling on auscultation (highly specific)
- Displaced heart sounds - mediastinal shift pushes heart to the right; heart sounds loudest on right
- Scaphoid abdomen - abdominal contents have migrated into chest
- Cyanosis - from pulmonary hypoplasia and right-to-left shunting via persistent pulmonary hypertension (PPH)
Scaphoid abdomen + cyanosis + heart sounds displaced to the right = CDH until proven otherwise. Most neonatal respiratory distress causes a normal or distended abdomen - a sunken abdomen is the key discriminator.
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