Hiatus Hernia Flashcards
Define Hiatus hernia
The protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus
Hiatus hernia risk factors
increase intra-abdo pressure
- Pregnancy
- Obesity
- Aging - loss of muscle elasticity
- Trauma - seatbelt injury
Hiatus Hernia Sx
- Dyspepsia
- Heartburn
- Burping / Belching
- N + V
- Regurgitation
intermittent / worse post-meal
Hiatus Hernia epidemiology
- more common in females
- > 50 years
Most common type of hiatus hernia
- Sliding hernia
- Rolling (paraoesophgeal) hernia
Hiatus hernia diagnostic Ix
- Barium meal
- 24-hour oesophageal pH monitoring
- OGD - to identify the hiatus hernia
what happens to the pH of the oesophagus in hiatus hernia
low pH level
Normal oesophagus pH level
near to pH 7
Hiatus Hernia 1st line Mx
symptomatic only
Lifestyle advice:
Weight loss
small meals
avoid meals before bed
smoking cessation
Reduce alcohol
Hiatus hernia medical Mx
1st line: PPI
- Antacids
- H2 receptor blockers
Hiatus hernia surgical Mx indications
- Ongoing Sx - despite max. medical Tx
- Risk of obstruction
Hiatus hernia complications
- Incarceration
- Volvulus - stomach twisting on itself
- Strangulation
common with rolling type
Volvulus appearance on Barium meal study
Bird’s beak
Gastric Volvulus clinical triad
Borchardt’s triad
Borchardt’s triad
- sudden severe epigastric pain
- retching without vomiting
- inability to pass a NG tube.
Hiatus hernia gold standard diagnostic Ix
OGD
Hiatus hernia OGD findings
- Displacement of the gastric-oesophageal junction (GOJ) ‘Z-line’
- Inflammation - oesophagitis, Barrett’s oesophagus
Anti-hypertensive contraindication in hiatus hernia
CCBs - relax the lower oesophageal sphincter
