Hiatal Hernia Flashcards
A 45-year-old woman presents with heartburn and regurgitation. Imaging reveals a portion of her stomach is located above the diaphragm. Which of the following best describes this condition?
A) Diaphragmatic hernia
B) Hiatal hernia
C) Esophageal diverticulum
D) Gastric volvulus
E) Achalasia
Answer: B) Hiatal hernia
Explanation: A hiatal hernia occurs when part of the stomach protrudes through the esophageal hiatus of the diaphragm. This is distinct from diaphragmatic hernias, which may involve other abdominal organs. These are often incidental findings but may present with symptoms. Found on X-ray are air fluid levels with displacement of mediastinal or cardiovascular components.
What is the definition of a hiatal hernia?
A condition where part of the stomach protrudes through the esophageal hiatus of the diaphragm.
Which of the following is NOT a recognized risk factor for hiatal hernia?
A) Obesity
B) Trauma
C) Pregnancy
D) Smoking
E) Autoimmune disease
Answer: E) Autoimmune disease
Explanation: Risk factors for hiatal hernia include obesity, trauma, pregnancy, and conditions that increase intra-abdominal pressure. Autoimmune diseases are not associated.
What are the risk factors for developing a hiatal hernia?
Surgery, trauma, obesity, pregnancy, or conditions causing increased intra-abdominal pressure.
Which of the following accurately describes the role of the gastroesophageal junction (GEJ) in hiatal hernias?
A) The GEJ remains in place in all hiatal hernias.
B) The GEJ is displaced above the diaphragm in sliding hernias but remains in place in paraesophageal hernias.
C) The GEJ is always displaced in paraesophageal hernias.
D) The GEJ is not involved in hiatal hernia pathophysiology.
E) The GEJ is only involved in cases with gastric volvulus.
Answer: B) The GEJ is displaced above the diaphragm in sliding hernias but remains in place in paraesophageal hernias.
Explanation: The position of the GEJ distinguishes sliding (displaced GEJ) from paraesophageal hernias (GEJ remains in place).
What are the two main types of hiatal hernias?
Sliding hiatal hernia and paraesophageal hiatal hernia.
Which of the following statements accurately differentiates between sliding and paraesophageal hiatal hernias?
A) Sliding hernias involve the gastric fundus moving above the diaphragm, while paraesophageal hernias involve the GE junction.
B) Paraesophageal hernias are more likely to cause GERD, while sliding hernias are asymptomatic.
C) Sliding hernias involve the GE junction moving above the diaphragm, while paraesophageal hernias involve the gastric fundus.
D) Paraesophageal hernias are managed conservatively, while sliding hernias require surgery.
E) Both types of hernias always present with severe symptoms.
Answer: C) Sliding hernias involve the GE junction moving above the diaphragm, while paraesophageal hernias involve the gastric fundus.
Explanation: Sliding hernias are characterized by displacement of the GE junction above the diaphragm, while paraesophageal hernias involve the upward movement of the gastric fundus through a diaphragmatic defect, with the GE junction remaining in place.
A 55-year-old man reports epigastric pain and early satiety. He underwent abdominal surgery 2 years ago. Imaging shows the gastric fundus has herniated into the thoracic cavity. Which type of hiatal hernia is most likely responsible for his symptoms?
A) Sliding hiatal hernia
B) Paraesophageal hiatal hernia
C) Morgagni hernia
D) Bochdalek hernia
E) Traumatic diaphragmatic hernia
Answer: B) Paraesophageal hiatal hernia
Explanation: Paraesophageal hiatal hernias are more likely to occur post-surgery and are associated with symptoms like epigastric pain, nausea, and gastric volvulus.
A 70-year-old man presents with nausea and abdominal pain following recent abdominal surgery. Imaging reveals a paraesophageal hernia. What is the most likely cause of this condition?
A) Increased intra-abdominal pressure due to obesity
B) Congenital diaphragmatic defect
C) Weakening of the diaphragmatic crura post-surgery
D) Chronic GERD
E) H. pylori infection
Answer: C) Weakening of the diaphragmatic crura post-surgery
Explanation: Paraesophageal hernias often occur post-surgery due to weakening of the diaphragmatic support structures.
What is the most common type of hiatal hernia?
Sliding hiatal hernia, where the gastroesophageal (GE) junction is displaced above the diaphragm.
Which type of hiatal hernia is most commonly associated with GERD-like symptoms such as heartburn and regurgitation?
A) Sliding hiatal hernia
B) Paraesophageal hiatal hernia
C) Both sliding and paraesophageal hernias
D) None of the above
E) Gastric volvulus
Answer: A) Sliding hiatal hernia
Explanation: Sliding hiatal hernias are commonly associated with GERD-like symptoms due to the displacement of the GE junction, which impairs the anti-reflux barrier.
What are the key features of a sliding hiatal hernia?
The GE junction is displaced above the diaphragm; often associated with GERD-like symptoms.
What are the key features of a paraesophageal hiatal hernia?
Upward movement of the gastric fundus through a diaphragmatic defect; GE junction remains in place.
What are the common clinical presentations of a sliding hiatal hernia?
GERD-like symptoms such as heartburn, regurgitation, and dysphagia.
What are the common clinical presentations of a paraesophageal hiatal hernia?
Often asymptomatic but can cause epigastric pain, nausea, or gastric volvulus if complicated.
In the context of trauma, the first imaging modality to evaluate a suspected hiatal hernia or diaphragmatic injury would typically be using a/an …
Chest X-ray.
CT for confirmation.
