Hiatus hernia

Question 1

Risk factors

Answer 1

Obesity

Increased intraabdominal pressure (ascites, multiparity)

Question 2

Types

Answer 2

Type 1: sliding

Type 2: rolling

Type 3: combination of sliding and rolling

Type 4: large opening with additional abdominal organs entering the thorax

Question 3

Sliding hiatus hernia

Answer 3

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

Question 4

Rolling hiatus hernia

Answer 4

Where a separate portion of the stomach folds around and enters through the diaphragm opening, alongside the oesophagus

Question 5

Presentation

Answer 5

Dyspepsia

Heartburn

Acid reflux

Reflux of food

Burping

Bloating

Halitosis

Question 6

Investigations

Answer 6

Barium swallow is most sensitive

Patients may have endoscopy for symptoms with hiatus hernia being found incidentally

Question 7

Treatment

Answer 7

Conservative (treatment for GORD)

Surgical repair if high risk of complications

Question 8

Surgery

Answer 8

Laparoscopic fundoplication

Tie fundus of stomach around lower oesophagus to narrow the lower oesophageal sphincter