Reflux + CDH

With so much talk about Reflux (GERD), I thought I'd take a post to try to explain (in my non-medical way) why reflux is a complication for many CDH kiddos. You recall that Carter was missing his Left Diaphragm (on the right side in this image)--the diaphragmatic hernia he was born with. The diaphragm on both sides helps control the Lower Esophageal Sphincter (LES). This LES is what opens/closes allowing food that is swallowed to travel down the esophagus into the stomach. In a person with normal anatomy, the LES tightens to keep food in the stomach moving on to the intestines [the first image]. In Carter, because of the absence of the left diaphragm, the LES does not have the muscle control and therefore, can not tighten/close. This allows food to easily travel back up the esophagus = vomiting [the second image].

[image courtesy of http://www.empowereddoctor.com/library/photo/gerd.jpg]

To get an idea of Carter's anatomy, this is the last xray he had BEFORE his repair surgery. I've tried my best to label it for you. For those not familiar, black on an xray designates air. As you can see, his right lung was well-aerated (about 9 ribs) but his left lung was hard to even find as the heart and stomach (lima bean shaped and full of air) were in the way. Now look back at the image above and see where the stomach and intestines are supposed to be. See why Carter has so much trouble? (if I'm not mistaken, the reason they found the CDH on the prenatal ultrasound is because the stomach was next to the heart, which is not where it's supposed to be)

And in case you didn't see the last post, scroll down for some super cuteness because Carter sat up all by himself and was so proud of himself!!!!