1. Diseases of the diaphragm Department of faculty and hospital surgery Tashkent Medical Academy

2. Wide detection of the disease in Europe and the United States leading to high operational activity in diseases of the diaphragm. Also, according to the Republic of Uzbekistan in the year 1000 performed operations aimed at correcting hiatal gastric cardia and hiatus hernia and other diseases of the diaphragm (MHC of Uzbekistan, 2010) Wide detection of the disease in Europe and the United States leading to high operational activity in diseases of the diaphragm. Also, according to the Republic of Uzbekistan in the year 1000 performed operations aimed at correcting hiatal gastric cardia and hiatus hernia and other diseases of the diaphragm (MHC of Uzbekistan, 2010) Prevalence of the diaphragm

3. Hiatal hernia (HH) - common hernias of the orifices of the diaphragm (90%). HH is often combined with other gastrointestinal diseases (2-16%): GSD - 28%, gastric ulcer and 12 duodenal ulcer - 32%, diverticula of the digestive tract, cancer esophagus, parasternal lipomas, etc. Hiatal hernia (HH) - common hernias of the orifices of the diaphragm (90%). HH is often combined with other gastrointestinal diseases (2-16%): GSD - 28%, gastric ulcer and 12 duodenal ulcer - 32%, diverticula of the digestive tract, cancer esophagus, parasternal lipomas, etc. HH among other gastroenterological diseases take 2 - 3 place, competing with peptic ulcer disease and cholecystitis HH among other gastroenterological diseases take 2 - 3 place, competing with peptic ulcer disease and cholecystitis Prevalence of the diaphragm diseases

4. The first report of a hiatal hernia, found at autopsy, was published G. Morgagni (1768). For a long time it was considered an extremely rare disease The first report of a hiatal hernia, found at autopsy, was published G. Morgagni (1768). For a long time it was considered an extremely rare disease Extensive coverage in the literature problem hiatal hernia received in 60 years Extensive coverage in the literature problem hiatal hernia received in 60 years Giovanni-Battista Morgagni (1682-1771)

5. The first mention of reflux esophagitis include the XVIII century and belongs to William Hunter, who described the discovery of the corpse inflammatory changes of esophageal mucosa The first mention of reflux esophagitis include the XVIII century and belongs to William Hunter, who described the discovery of the corpse inflammatory changes of esophageal mucosa William Hunter (1718-1783)

6. As a distinct disease reflux esophagitis was isolated Quincke (1879). As a distinct disease reflux esophagitis was isolated Quincke (1879). Many worked on a solution to this problem Allison (1946, 1951, 1956), to which belongs the term "reflux esophagitis". The author emphasized his association with hiatal hernia Many worked on a solution to this problem Allison (1946, 1951, 1956), to which belongs the term "reflux esophagitis". The author emphasized his association with hiatal hernia Heinrich Irenaeus Quincke (1842-1922)

7. Peter A. Herzen (1871-1947) Sergey Yudin (1891-1954) Mikhail Davydov Ivan Greeks (1867-1934)

8. Vasit Vakhidovich Vahidov Shavkat Ibrahimovic Karimov Nikolai Fedorovich Krotov Sadik Aliyevich Masumov

9. Duties of the general practitioner in diseases of the diaphragm - Provision of primary health and social care; - Provision of primary health and social care; - Health education (promoting healthy lifestyles); - Health education (promoting healthy lifestyles); - Preventive work (timely detection of early and latent forms of the disease, risk groups); - Preventive work (timely detection of early and latent forms of the disease, risk groups); - Dynamic monitoring; - Dynamic monitoring; - Emergency assistance in case of emergency and acute conditions; - Emergency assistance in case of emergency and acute conditions; - Timely consultation and hospitalization in the prescribed manner; - Timely consultation and hospitalization in the prescribed manner; - Medical and rehabilitation work in accordance with the qualifying characteristic; - Medical and rehabilitation work in accordance with the qualifying characteristic; - An examination of temporary disability; - An examination of temporary disability; - The organization of medical and social care and household together with the bodies of social protection and services of mercy alone, the elderly, the disabled, the chronically ill; - The organization of medical and social care and household together with the bodies of social protection and services of mercy alone, the elderly, the disabled, the chronically ill; - Maintaining the approved forms of records and reports. - Maintaining the approved forms of records and reports.

10. Anatomy of the diaphragm Aperture - the muscle-tendon education separates the chest and abdominal cavities. Muscular portion of the diaphragm begins to circle the lower thoracic inlet of the sternum, the inner surface of the cartilage VII- XII ribs and lumbar spine (sternum, ribs and lumbar diaphragm). Aperture - the muscle-tendon education separates the chest and abdominal cavities. Muscular portion of the diaphragm begins to circle the lower thoracic inlet of the sternum, the inner surface of the cartilage VII- XII ribs and lumbar spine (sternum, ribs and lumbar diaphragm).

11. Anatomy of the diaphragm

13. Topographic anatomy of the diaphragm Aperture (view from the side of the chest cavity): 1 - chest piece; 2 - costal portion; 3 - lumbar portion; 4 - aorta; 5 - thoracic duct; 6 - the esophagus; 7 - the vagus nerves; 8 - inferior vena; 9 - splanchnic nerves, sympathetic trunks; 10 - gap Larrey - Morgagni; 11 - gap Bogdaleka

14. Diseases of the diaphragm Damage to the diaphragm Damage to the diaphragm Diaphragmatic hernia Diaphragmatic hernia Hiatal hernia Hiatal hernia Relaxation of the diaphragm Relaxation of the diaphragm Damage to the diaphragm Damage to the diaphragm Diaphragmatic hernia Diaphragmatic hernia Hiatal hernia Hiatal hernia Relaxation of the diaphragm Relaxation of the diaphragm

15. Methods of study of the diaphragm X-ray examination X-ray examination Electrocardiography Electrocardiography Computed tomography Computed tomography Nuclear magnetic resonance imaging Nuclear magnetic resonance imaging Ultrasound examination of Ultrasound examination of

16. Etiology of the diaphragm damage When road and occupational injuries When road and occupational injuries A fall from a height A fall from a height When air concussion When air concussion When compression of the abdomen When compression of the abdomen A sudden increase in intra-abdominal pressure A sudden increase in intra-abdominal pressure

17. Treatment of the injury of the diaphragm At breaks and injuries of the diaphragm shows an urgent operation, which consists in suturing the defect with separate sutures nonabsorbable suture after bringing down the abdominal organs. Depending on the prevalence of symptoms associated lesions of the abdominal or thoracic surgery begins with laparoscopic or thoracotomy. Preference is given to thorakophrenolaparotomy. The use of video- thoracoscopic or laparoscopic repair techniques defect of the diaphragm is a promising method for the operation, as they are less traumatic. At breaks and injuries of the diaphragm shows an urgent operation, which consists in suturing the defect with separate sutures nonabsorbable suture after bringing down the abdominal organs. Depending on the prevalence of symptoms associated lesions of the abdominal or thoracic surgery begins with laparoscopic or thoracotomy. Preference is given to thorakophrenolaparotomy. The use of video- thoracoscopic or laparoscopic repair techniques defect of the diaphragm is a promising method for the operation, as they are less traumatic.

18. Hiatal hernia

19. Types of diaphragmatic hernia a - paraesophageal hernia; b - axial hiatal hernia; c - a true diaphragmatic hernia; d - false diaphragmatic hernia

20. Symptoms of diaphragmatic hernia Gastrointestinal Gastrointestinal Cardiopulmonary Cardiopulmonary General General Gastrointestinal Gastrointestinal Cardiopulmonary Cardiopulmonary General General

21. Types of diaphragmatic hernia

23. Hiatal hernia 1. Sliding hernia: cardiofundal cardiofundal total gastric total gastric acquired short esophagus acquired short esophagus 2. Paraesophageal hernia fundal fundal antral antral

24. Complaints with hiatal hernia Burning or dull pain behind the sternum at the level of the xiphoid process, in the epigastric region, in subcostal area, radiating to the region of the heart, shoulder blade, left arm Burning or dull pain behind the sternum at the level of the xiphoid process, in the epigastric region, in subcostal area, radiating to the region of the heart, shoulder blade, left arm The pain is worse in the horizontal position and during exercise. When bending the torso forward The pain is worse in the horizontal position and during exercise. When bending the torso forward The pain is accompanied by belching, regurgitation, heartburn The pain is accompanied by belching, regurgitation, heartburn Over time, there Intermittent dysphagia Over time, there Intermittent dysphagia Sometimes symptoms of bleeding. Which can be hidden Sometimes symptoms of bleeding. Which can be hidden Anemia Anemia

25. Treatment of hiatal hernia Sliding hernia - in uncomplicated sliding hiatal hernia is more conservative treatment, which aims to reduce gastroesophageal reflux esophagitis reduction phenomena, preventing increase intra- abdominal pressure. Surgery for sliding hiatal hernia is indicated for bleeding peptic stricture of the esophagus, as well as the failure of long-term medical therapy in patients with symptomatic reflux esophagitis. Sliding hernia - in uncomplicated sliding hiatal hernia is more conservative treatment, which aims to reduce gastroesophageal reflux esophagitis reduction phenomena, preventing increase intra- abdominal pressure. Surgery for sliding hiatal hernia is indicated for bleeding peptic stricture of the esophagus, as well as the failure of long-term medical therapy in patients with symptomatic reflux esophagitis. Paraesophageal hernia - all patients surgical treatment because of the possibility of infringement of its operation is to downgrade the abdominal organs and suturing the edges of the hiatal (cruroraphy) behind the esophagus. Paraesophageal hernia - all patients surgical treatment because of the possibility of infringement of its operation is to downgrade the abdominal organs and suturing the edges of the hiatal (cruroraphy) behind the esophagus.

26. Operation of Nissen

27. Relaxation of the diaphragm Thinning of the diaphragm and change it with the adjacent thereto abdominal organs into the chest. Line attachment diaphragm remain in its usual place

28. Treatment of the diaphragm relaxation In the presence of marked clinical symptoms, surgical treatment. Operation is to downgrade displaced abdominal organs to normal position and education dublication thinned diaphragm or plastic mesh strengthening its polyvinyl alcohol (ayvalon), skin, muscle or muscle- periosteal - pleural flap (autoplasty). VATS methods for creating dublication iris species are less traumatic surgery. In the presence of marked clinical symptoms, surgical treatment. Operation is to downgrade displaced abdominal organs to normal position and education dublication thinned diaphragm or plastic mesh strengthening its polyvinyl alcohol (ayvalon), skin, muscle or muscle- periosteal - pleural flap (autoplasty). VATS methods for creating dublication iris species are less traumatic surgery.