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Finals: Medicine > Hiatus Hernia > Flashcards

Hiatus Hernia Flashcards

1
Q

Define Hiatus Hernia

A

Tthe protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus - usually the stomach

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2
Q

What is the name of the narrow opening in the diaphragm, allows the oesophagus to pass from the thoracic to abdominal cavity

A

The oesophageal hiatu

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3
Q

Name the two major types of hiatus hernia

A

Sliding hiatal hernia

Rolling hiatal hernia

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4
Q

Which type of hiatus hernia is the most common

A

Sliding hiatus hernia (Accounts for 80% of hiatus hernia cases)

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5
Q

Describe the characteristics of a sliding hiatal hernia

A

The stomach slides up through the diaphragm, with the gastro-oesophageal junction passing up into the thorax

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6
Q

Describe the characteristics of a rolling hiatal hernia

A

The gastro-oesophageal junction remains in the abdomen, but part of the stomach protrudes into the chest alongside the oesophagus

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7
Q

Which type of hiatus hernia rquires more urgent treatment

A

Rolling hiatal hernia

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8
Q

Name 3 risk factors for hiatus hernia

A

Increasing age

Obesity

Increase in intra-abdominal pressure e.g. chronic cough, pregnancy

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9
Q

Name some of the clinical features of hiatus hernia

A
  • Dyspepsia (indigestion)
  • Heartburn
  • Dysphagia (swallowing difficulties)
  • Acid regurgitation
  • Halitosis (bad breath)
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10
Q

Define the term “dyspepsia”

A

Indigestion

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11
Q

Define the term “Dysphagia “

A

Swallowing difficulties

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12
Q

What is the medical term for indigestion

A

Dyspepsia

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13
Q

What is the medical term for swallowing difficulties

A

Dysphagia

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14
Q

How is hiatus hernia diagnosed

A

Can be diagnosed using:

  • Barium swallow – most sensitive investigation
  • Endoscopy
  • Oesophageal manometry
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15
Q

Hiatus hernias can be intermittent. How does this affect investigating it

A

It may not be seen on investigations

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16
Q

What is the most sensitive investigation for hiatus hernia

A

Barium swallow

17
Q

Name some of the conservative management of hiatus hernia

A
  • Lose weight
  • Elevate the head of the bed
  • Avoid large meals and eat 3-4 hours before bedtime
  • Avoiding alcohol and acidic foods
  • Stop smoking
18
Q

Name the medications that relaxes the lower oesphageal sphincter

A

Calcium-channel blockers

Nitrates

Beta-blockers

19
Q

Name the medication used in the medical management of hiatus hernia

A

PPI use

Trial for 4-8 weeks to assess responsiveness

20
Q

What is the name of the surgery used to surgical manage hiatus hernias

A

Laparoscopic fundoplication

21
Q

A trial of PPI should be used to assess the responsivenss in the management of hiatus hernia.

How long is the trial

A

4-8 weeks

22
Q

When is surgical management offered in the treatment of hiatus hernia

A

Offered if there is a high risk of complications or symptoms are resistant to medical treatment

23
Q

What is involved in Laparoscopic fundoplication

A

Involves tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter

24
Q

What is the gold standard investigation for hiatus hernia

A

Oesophagogastroduodenoscopy (OGD)

25
Q

There are two aspects of hiatus hernia surgery

Name these two parts

A

Cruroplasty – The hernia is reduced from the thorax into the abdomen and the hiatus reapproximated to the appropriate size. Any large defects usually require mesh to strengthen the repair.

Fundoplication – The gastric fundus is wrapped around the lower oesophagus and stitched in place

26
Q

Name some of the complication of hiatus hernia surgery

A

Recurrence of the hernia

Abdominal bloating

Due to an inability to belch

Dysphagia may occur if the fundoplication is too tight or if the crural repair is too narrow

Fundal necrosis, if the blood supply via the left gastric artery and short gastric vessels has been disrupted.

27
Q

Name some of the complications of hiatus hernia

A

Incarceration and strangulation

Gastric volvulus - whereby the stomach twists on itself by 180 degrees, leading to obstruction of the gastric passage and tissue necrosis

Finals: Medicine (91 decks)

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