Hiatus Hernia

Question 1

What is a hiatus hernia?

Answer 1

A hiatus hernia occurs when all or part of the stomach enters the chest through the oesophageal hiatus in the diaphragm.

Question 2

What is the estimated prevalence of hiatus hernia in people over 50 years old?

Answer 2

It is estimated that 10-40% of people aged over 50 have a hiatus hernia.

Question 3

What are the two main types of hiatus hernia?

Answer 3

Sliding (Type I) and paraoesophageal (Types II-IV).

Question 4

What characterizes a sliding hiatus hernia (Type I)?

Answer 4

The cardia of the stomach herniates upwards, with resultant upward migration of the gastro-oesophageal junction (GOJ).

Question 5

What characterizes a paraoesophageal hiatus hernia (Type II)?

Answer 5

Part of the stomach fundus is displaced upwards through the diaphragm, alongside the oesophagus, with the GOJ remaining in its original location.

Question 6

What is a Type III hiatus hernia?

Answer 6

A combination of sliding and rolling types, where both the GOJ and part of the stomach enter the mediastinum.

Question 7

What is a Type IV hiatus hernia?

Answer 7

Both the stomach and other abdominal organs have herniated into the thoracic cavity through a large defect.

Question 8

What are common risk factors for developing a hiatus hernia?

Answer 8

Increasing age, female sex, obesity, pregnancy, chronic cough, chronic obstructive pulmonary disease (COPD), and other causes of raised intraabdominal pressure.

Question 9

What are typical symptoms of a hiatus hernia?

Answer 9

Many patients are asymptomatic, but symptoms can include epigastric discomfort or pain, gastro-oesophageal reflux disease (GORD), dysphagia, and regurgitation.

Question 10

What complications can arise from a hiatus hernia?

Answer 10

Gastric volvulus, iron deficiency anaemia, and, in severe cases, strangulation of the herniated stomach.

Question 11

What is the first-line investigation for diagnosing a hiatus hernia?

Answer 11

Upper gastrointestinal endoscopy.

Question 12

How can a barium swallow be useful in hiatus hernia diagnosis?

Answer 12

It can demonstrate the presence and type of hiatus hernia by visualizing the herniated portion of the stomach.

Question 13

What lifestyle modifications are recommended for managing hiatus hernia symptoms?

Answer 13

Weight loss, avoiding large meals, not lying down after eating, elevating the head of the bed, and avoiding foods that trigger reflux.

Question 14

What medications are commonly used to treat symptoms associated with hiatus hernia?

Answer 14

Antacids, proton pump inhibitors (PPIs), and H2 receptor blockers to reduce gastric acid secretion.

Question 15

When is surgical intervention considered for hiatus hernia?

Answer 15

In cases of persistent or severe symptoms not responsive to medical therapy, or in paraoesophageal hernias at risk of complications.

Question 16

What is the most common surgical procedure for hiatus hernia repair?

Answer 16

Laparoscopic fundoplication, such as Nissen fundoplication, often combined with crural repair.

Question 17

What is the role of 24-hour pH monitoring in hiatus hernia evaluation?

Answer 17

It assesses acid reflux severity and correlates symptoms with acid exposure, aiding in diagnosis and management planning.

Question 18

How does a chest X-ray assist in diagnosing a hiatus hernia?

Answer 18

It may show an air-fluid level in the posterior mediastinum, suggesting the presence of a herniated stomach.

Question 19

What is the significance of manometry in hiatus hernia assessment?

Answer 19

Manometry measures oesophageal motility and lower oesophageal sphincter function, which can be affected by a hiatus hernia.

Question 20

What is the potential risk of untreated large paraoesophageal hernias?

Answer 20

They can lead to complications such as gastric volvulus, obstruction, or strangulation, which may require emergency surgical intervention.

Question 21

How does obesity contribute to the development of a hiatus hernia?

Answer 21

Increased intraabdominal pressure associated with obesity can weaken the diaphragmatic hiatus, facilitating herniation of the stomach.

Question 22

What is the relationship between hiatus hernia and gastro-oesophageal reflux disease (GORD)?

Answer 22

A hiatus hernia can impair the function of the lower oesophageal sphincter, increasing the likelihood of acid reflux and GORD symptoms.

Question 23

Why might a patient with a hiatus hernia experience dysphagia?

Answer 23

Dysphagia can occur due to mechanical obstruction from the herniated stomach or inflammation caused by acid reflux.

Question 24

What is the purpose of crural repair in hiatus hernia surgery?

Answer 24

Crural repair involves tightening the diaphragmatic hiatus to prevent recurrence of the hernia after repositioning the stomach.

Question 25

How can pregnancy influence the development of a hiatus hernia?

Answer 25

Pregnancy increases intraabdominal pressure and can lead to relaxation of the diaphragmatic muscles, predisposing to the development of a hiatus hernia.