Hiatal Hernia Flashcards
What is a hiatal hernia and what else is it called
Herniation of portion of stomach into esophagus through an opening or hiatus in diaphragm
Also referred to as diaphragmatic hernia and esophageal hernia
Most common abnormality found on upper GI x-ray
More common in older adults and in women
What are the 2 types?
Paraesophageal or rolling
Esophagogastric junction remains in place, but fundus and greater curvature of stomach roll up through diaphragm
Acute paraesophageal hernia is a medical emergency: Strangulates
What causes hiatal hernia
Structural changes
Weakening of muscles in diaphragm
Increased intraabdominal pressure
Obesity
Pregnancy
Heavy lifting
Factors that contribute to hiatal hernia
Increasing age
Trauma
Poor nutrition
Forced recumbent position: Getting up to quick from a side lying position
Congenital weakness
Symptoms
May be asymptomatic
Heartburn
After meal or when lying supine
Dysphagia
Why do they get dysphagia
delayed emptying, hernia applies pressure to the esophagus
Diagnostic studies
Esophagogram
Endoscopy
What can an esophagram show and what else is it called?
barium swallow
May show protrusion of gastric mucosa through esophageal hiatus
What does endoscopy show
Visualize lower esophagus
Information on degree of inflammation or other problems
What lifestyle modifications are needed
Eliminate alcohol
Elevate head of bed
Stop smoking
Avoid lifting/straining
Reduce weight, if appropriate
Use antisecretory agents and antacids: antisecretory like PPI prevents secretion of acids
What are the 2 surgical options
Herniotomy
Herniorrhaphy
What is Herniotomy
Excision of hernia sac
What is Herniorrhaphy
Closure of hiatal defect
Overall Goals
Reduce hernia
Provide acceptable lower esophageal sphincter (LES) pressure
Prevent movement of gastroesophageal junction from moving up
How is surgery performed
Laparoscopically performed Nissen and Toupet techniques are standard antireflux surgeries
Thoracic or open abdominal approach is used, depending on the individual patient
