Hernia (hiatus)

Question 1

Define hiatus hernia

Answer 1

Protrusion of intra-abdominal content through oesophageal hiatus of the diaphragm
most common-stomach
rarely-bowel, colon, momentum, spleen

Question 2

Aetiology and risk factor of hiatus hernia

Answer 2

Unclear, but when swallowing the oesophagus shorten, which combined with straining (cough) can push the distal oesophagus/stomach up. normally countered by ligaments, but can weaken expands hiatus and cause stomach to permanently lie above
Sliding-distal oesophagus junction/body of stem In thorax (type 1)
type 2-fundus passes but body junction doesn’t (bottom up)
type 3 -1+2
type 4-organs have come

Risk factors:
Obesity
GORD
Masses in abdo (raise in pressure)
Male
Age older
collagen issues

Question 3

Epidiemology of hiatus hernia

Answer 3

estimated-can often be asymptomatic
ranges estimate 50% :O
closely follows GORD, which is 10-20%
Sliding is by far the most common (95%)

Question 4

Signs and Sx of hiatus hernia

Answer 4

Most common -asympto, but bowel sounds in chest

classically-heartburn
regurgitation-acid liquid, food-especially when lie flat

chest pain in more complicated hernia
can come with fever, hematemasis, confusion dysphagia (obstruction, ischemia,bleed)
SOB from smaller thorax
wheeze from aspiration

Question 5

Investigations of Hiatus hernia

Answer 5

CXR-easiest, fastest and cheapest-see intrathrocix bubbles, signs of bowels in chest, stomach in chest (no lung markings

upper GI series-diagnostic gold standard-contrast ehanced XRAY-swallow barium

Question 6

Management of hiatus hernia

Answer 6

Most -manage Sx
Lifestyle-lose weight, elevate head of bed, avoid large meals, avoid nicotine, caffeine,

if GORD as well-PPI

Rest is surgical if needed-mesh repair
not complicatied-laproscopic. in type 1 might not even be needed

complicated-resection-and can even lead to need to remove big parts and anastomose parts of stomach-avoid in frail

Question 7

Complications of hiatus hernia

Answer 7

bloating after surgery

volvulus-fondus and Antrum exchange position-can be asympto or cause fulgurant necrosis-always surgery

Obstruction-more type II and 3-hematemasis-surgery

GI bleeds-chronic blood loss
Barrets oesophagus

Question 8

Prognosis of Hiatus hernia

Answer 8

Uncomplicated sliding-mainly Sx relief goes well from lifestyle +ppi
Surgery + PPI-very good
but mainly for larger hernias