Hiatus Hernia (2) Flashcards
What occurs here?
What are the the 2 main types? How do the treatments differ?
What are the main risk factors?
➊ Herniation of stomach up through diaphragm
• The diaphragmatic opening is at the level of the LOS, which stops acid and stomach contents refluxing back into the oesophagus – When this is compromised, the acid and contents can reflux back up
➋ (1) Sliding (80%) – Junction slides up into the chest. Sphincter becoming less competent results in acid reflux. Treatment is similar as for GORD.
(2) Rolling (20%) – Junction remains in the abdomen, but part of the stomach protrudes into the chest alongside the oesophagus. This type requires more urgent treatment as volvulus can occur, resulting in ischaemia and necrosis.
➌ Age (Muscle weakening and loss of elasticity), Obesity, Previous hiatal surgery, Increased intra-abdominal pressure (Pregnancy, Ascites, Chronic cough)
What are the presenting symptoms?
• Heartburn
• Acid reflux
• Dysphagia/odynophagia
• SOB
• Chronic cough
• Halitosis (bad breath)
Which 1st line investigations should be done?
Which 2nd line investigation options are there?
➊ • CXR
• Barium swallow
➋ • Endoscopy
• CT
Management:
What is the conservative option?
What is the medical option?
What is the surgical option?
→ When would this be considered?
➊ Lifestyle modification e.g. weight loss, avoid large meals before bed, avoid alcohol and acidic foods
➋ PPI
➌ Laparoscopic (Nissen’s) Fundoplication
→ If high risk of complications or symptoms resistant to medical treatment
