Hiatus Hernia

Question 1

What is a hiatus hernia?

Answer 1

herniation of the stomach up through the oesophageal hiatus in the diaphragm

Question 2

At which spinal level is the oesophageal hiatus of the diaphragm found?

Answer 2

T10

Question 3

What is the name given to the opening in the diaphragm that the oesophagus passes through?

Answer 3

oesophageal hiatus

Question 4

Which structure should be found be found at the same level as the oesophageal hiatus to prevent reflux?

Answer 4

oesophageal sphincter

Question 5

Why is it advantageous for the oesophageal hiatus to be narrow?

Answer 5

it helps maintain the oesophageal sphincter, stopping acid and stomach contents refluxing into the oesophagus

Question 6

What is a type 1 hiatus hernia?

Answer 6

sliding hiatus hernia

Question 7

What is a type 2 hiatus hernia?

Answer 7

Rolling hiatus hernia

Question 8

What is a type 3 hiatus hernia?

Answer 8

combination of sliding and rolling hiatus hernia

Question 9

What is a type 4 hiatus hernia?

Answer 9

a large opening that allows additional abdominal organs to enter the thorax through the oesophageal hiatus (e.g. bowel, pancreas or omentum)

Question 10

Describe a sliding (type 1) hiatus hernia:

Answer 10

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

Question 11

Describe a rolling (type 2) hiatus hernia:

Answer 11

where a separate portion of the stomach (i.e. the fundus) folds around and enters the oesophageal hiatus, alongside the oesophagus

Question 12

Name 3 risk factors for hiatus hernias:

Answer 12

1) pregnancy
2) obesity
3) increasing age

Question 13

Give 6 symptoms associated with hiatus hernias:

Answer 13

1) heart burn
2) acid reflux
3) reflux of food
4) burping
5) halitosis (offensive smelling breath)
6) bloating

Question 14

True or false: hiatus hernias can be intermittent and therefore not always seen on investigation

Answer 14

true

Question 15

Give 4 investigations used to image hiatus hernias:

Answer 15

1) CXR
2) CT
3) endoscopy
4) barium swallow test (gold standard)

Question 16

Describe conservative management of hiatus hernias:

Answer 16

medical treatment for the gastro-oesophageal reflux (symptomatic relief)

Question 17

When is surgery used to treat a hiatus hernia? (2)

Answer 17

1) when there are high risks of complications
2) GORD symptoms are resistant to treatment

Question 18

What surgery is used to treat hiatus hernias?

Answer 18

laparoscopic fundoplication

Question 19

Describe the process of laparoscopic fundoplication:

Answer 19

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