Hiatus hernia

Question 1

What is the classification of hiatus hernia?

Answer 1

Sliding - 80%
Rolling - 15%
Mixed -5%

Question 2

What is a sliding hiatus hernia?

Answer 2

GO junction slides up into the chest

Often associated with GORD

Question 3

What is a rolling hiatus hernia?

Answer 3

GO junction remains in abdomen but a bulge of stomach rolls into the chest alongside oesophagus
LOS remains intact so GORD uncommon
Can cause strangulation

Question 4

Hiatus hernia ix

Answer 4

CXR: gas bubble and fluid level in the chest
Ba swallow: diagnostic
OGD: visualises the mucosa but cannot exclude hernia
24h pH + manometry - exclude dysmotility or achalasia

Question 5

Management of hiatus hernia

Answer 5

Lose weight
Rx reflux
Surgery if intractable symptoms despite medical Rx
- Should repair rolling hernia, even if asymptomatic as it may strangulate