Hiatus Hernia Flashcards
Define Hiatus Hernia
Tthe protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus - usually the stomach
What is the name of the narrow opening in the diaphragm, allows the oesophagus to pass from the thoracic to abdominal cavity
The oesophageal hiatu
Name the two major types of hiatus hernia
Sliding hiatal hernia
Rolling hiatal hernia
Which type of hiatus hernia is the most common
Sliding hiatus hernia (Accounts for 80% of hiatus hernia cases)
Describe the characteristics of a sliding hiatal hernia
The stomach slides up through the diaphragm, with the gastro-oesophageal junction passing up into the thorax
Describe the characteristics of a rolling hiatal hernia
The gastro-oesophageal junction remains in the abdomen, but part of the stomach protrudes into the chest alongside the oesophagus
Which type of hiatus hernia rquires more urgent treatment
Rolling hiatal hernia
Name 3 risk factors for hiatus hernia
Increasing age
Obesity
Increase in intra-abdominal pressure e.g. chronic cough, pregnancy
Name some of the clinical features of hiatus hernia
- Dyspepsia (indigestion)
- Heartburn
- Dysphagia (swallowing difficulties)
- Acid regurgitation
- Halitosis (bad breath)
Define the term “dyspepsia”
Indigestion
Define the term “Dysphagia “
Swallowing difficulties
What is the medical term for indigestion
Dyspepsia
What is the medical term for swallowing difficulties
Dysphagia
How is hiatus hernia diagnosed
Can be diagnosed using:
- Barium swallow – most sensitive investigation
- Endoscopy
- Oesophageal manometry
Hiatus hernias can be intermittent. How does this affect investigating it
It may not be seen on investigations
What is the most sensitive investigation for hiatus hernia
Barium swallow
Name some of the conservative management of hiatus hernia
- 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
Name the medications that relaxes the lower oesphageal sphincter
Calcium-channel blockers
Nitrates
Beta-blockers
Name the medication used in the medical management of hiatus hernia
PPI use
Trial for 4-8 weeks to assess responsiveness
What is the name of the surgery used to surgical manage hiatus hernias
Laparoscopic fundoplication
A trial of PPI should be used to assess the responsivenss in the management of hiatus hernia.
How long is the trial
4-8 weeks
When is surgical management offered in the treatment of hiatus hernia
Offered if there is a high risk of complications or symptoms are resistant to medical treatment
What is involved in Laparoscopic fundoplication
Involves tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter
What is the gold standard investigation for hiatus hernia
Oesophagogastroduodenoscopy (OGD)
There are two aspects of hiatus hernia surgery
Name these two parts
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
Name some of the complication of hiatus hernia surgery
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.
Name some of the complications of hiatus hernia
Incarceration and strangulation
Gastric volvulus - whereby the stomach twists on itself by 180 degrees, leading to obstruction of the gastric passage and tissue necrosis
