HH and HHS

Question 1

describe a sliding HH vs a paraesophageal HH
which is more common?
which kind can we fix with manipulation?

Answer 1

sliding HH: GE jxn moves above the diaphragm, into the chest cavity
paraesophageal HH: part of the stomach moves above the diaphragm, into the chest cavity
sliding HH is more common
can fix sliding HH w/manipulation

Question 2

definition of a HH

Answer 2

widened hiatus of the diaphragm w/ or w/o extension of portions of the stomach into the chest

Question 3

some common causes of a HH (8)

Answer 3

surgery
impact of jumping or falling
PG
belly flop
vomiting
obesity
blow to the abd
exertion/straining w/breath holding

Question 4

what is the area called which helps keep the LES below the diaphragm and prevent a HH?

Answer 4

angle of His

Question 5

what shaped hiatus is ideal for preventing a HH? what part of the diaphragm forms a sling around the distal eso and acts as an outer sleeve to support that area of high pressure?

Answer 5

teardrop-shaped

the right crus of the diaphragm

Question 6

what is normally formed at the esophagogastric jxn? what is the purpose of it?

Answer 6

anatomical flap valve

valve keeps the distal part of the LES in the abd and maintains the angle of His

Question 7

what %age of americans have a sliding HH?

Answer 7

> 40%

Question 8

are HH usu symptomatic or asx?

Answer 8

asx

main sxs are those associated w/reflux and its complications

Question 9

does the size of a hernia affect the severity of sxs?

Answer 9

NO

Question 10

what are some sxs a large HH can cause? (4)

Answer 10

atelectasis, fatigue, SOB and cardiac arrhythmias

Question 11

what is the difference b/w a HH and HHS?

Answer 11

HHS is when a pt has (+) fxnal tests for a HH and their sxs match the dx of a HH but you don’t have imaging yet to prove it
HH once they have (+) fxnal tests, sxs and imaging to prove it

Question 12

clinical picture of someone with a HH? (general/emotional, respiratory, cardiac and GI)

Answer 12

general emotional: fatigue, anxiety, mental dullness, “spare tire bulge”
respiratory: shallow breathing, chest oppression, stitching pains, tickling cough, pallor
cardiac: non-cardiac chest pn, arrhythmia including A. fib
GI: easy satiety, reflux, regurgitation, flatulence, dysphagia, globus, aversion to constriction

Question 13

what are 4 scenarios that would make you think HH if the pts sxs came on after the scenario?

Answer 13

starting a new exercise regime
constipation
following an illness w/vomiting or violent coughing
seem to hold their breath, feel restricted or don’t use their diaphragm

Question 14

what are the 4 reflex points to test for a HH?

Answer 14

left of xyphoid process (HHS point)
4th ICS mid clavicular
4th ICS mid axillary
T10-11 left paravertebral area

Question 15

what other fxnal test can you do to test for a HH?

Answer 15

muscle test: test a strong muscle then re-test same muscle while compressing the stomach into the diaphragm

Question 16

where is the HH point?

Answer 16

1 inch finger length below and to the L of the xyphoid process

Question 17

what are 3 tx options for a HH?

Answer 17

visceral manipulation
functional breathing
NMT/MR as needed w/special focus at the occiput and T10-11

Question 18

describe the visceral technique

Answer 18

apply pressure with fingers of non-dominant hand over HH point, traction, continue traction and follow the rotation (CCW), follow the rotation again (up and over) and then CW 3 times

Question 19

post manipulation, what are 3 exercises you can have the pt do to prevent relapse?

Answer 19

heel drop: pt drinks 12-16 oz of warm water fairly quickly then bounces on heels 11 times
leg raise: lying supine pt raises legs 12-18 in off the surface, slowly abducts and adducts the legs then lowers to resting, that is one, gradually increase # of reps over time
knee raise: sitting in a chair, support upper body and keeping the knees abducted, inhale then w/exhale flex the legs at the trunk, at the next inhale extend the legs at the trunk and rest the feet on the floor, repeat

Question 20

what is the procedure called where they surgically wrap part of the gastric fundus around the distal esophagus and what is it’s purpose?

Answer 20

Nissan gastric fundoplication

purpose is to support the LES and to protect against reflux