HIATAL HERNIA Flashcards
what is a hiatal hernia?
protrusion of stomach through diaphragmatic hiatus
common condition that increases incidence with advancing age
what are the 2 main types of hiatal hernias?
- sliding hiatal hernia
- paraesophageal hiatal hernia
what is the most common type of hiatal hernia?
sliding hiatal hernia
what is the location of sliding hiatal hernia?
gastroesophageal junction and a portion of the stomach are above the diaphragm
what kind of hiatal hernia is a higher-risk condition?
paraesophageal hiatal hernia
-this is because patient can have ischemia to that part of the stomach
(higher risk compared to sliding)
what is the location of paraesophageal hiatal hernia?
gastroesophageal junction is in the normal location, but a portion of the stomach is adjacent to the esophagus in diaphragmatic hiatus
what is the distal end of the esophagus anchored by?
distal end of esophagus is anchored by diaphragm by the PHRENOESOPHAGEAL MEMBRANE
what are the 2 causes of a weakened phrenoesophageal membrane?
- repetitive stress (swallowing, abdominal straining, vomiting) causes wear and tear on the phrenoesophageal membrane
- tonic contraction of the esophageal longitudinal muscle induced by gastroesophageal reflux and mucosal acidification causing stress on the phrenoesophageal membrane
what is the number one s/sx of hiatal hernias?
TRICK QUESTION
MOST PATIENTS ARE ASYMPTOMATIC
what are some actual s/sx of hiatal hernias?
chest pain, dysphagia, reflex symptoms- heartburn, cough, belching
how are >40% of hiatal hernias found?
incidentally found on x-ray
what is the dx studies fot hiatal hernias?
- barium swallow
-best study for discovering a small hiatal hernia (small=worse) - chest x-ray
- upper endoscopy
what is the tx for a sliding hiatal hernia in an asymptomatic patient?
no treatment required
what is the tx for a sliding hiatal w/ associated GERD?
PPI
what is the tx for a sliding hiatal w/ persistent symptoms?
offer surgical repair
