Hiatus Hernia

Question 1

Define hiatus hernia (2)

Answer 1

1 presence of part or all of Stomach in thoracic cavity

2 protruding through diaphragm’s oesophageal hiatus

Question 2

How common?

Answer 2

Very

Question 3

Which sex is predominantly affected?

Answer 3

Females

Question 4

How likely is the disease to be symptomatic?

Answer 4

Very unlikely

Question 5

What are the usual symptoms of the sliding variety? (5)

Answer 5

Symptoms of GORD:

1 heartburn
2 acid reflux
3 ‘pressure’ in chest
4 dysphagia
5 bad breath

Question 6

Risk factors? (3)

Answer 6

Obesity; previous surgery; pregnancy

Question 7

What is a ‘sliding’ hiatus hernia?

Answer 7

Proximal part of Stomach passes up into thorax

Question 8

How do the anatomical causes of rolling and sliding hiatus hernias differ? (2)

Answer 8

1 sliding due to stretching of phrenico-oesophageal membrane

2 rolling due to defect in this membrane

Question 9

Which form of the disease is most prevalent?

Answer 9

Sliding

Question 10

What is the role of OGD in investigating hiatus hernia?

Answer 10

Exclude oesophageal mucosal pathology

Question 11

How is video barium swallow used in investigation?

Answer 11

Shows the type and extent of herniation

Question 12

Which investigative technique is preferred in acute settings? (2)

Answer 12

1 CT 2 of thorax

Question 13

What are the three principle factors important to treating hiatus hernia medically?

Answer 13

1 reduction in acid secretion
2 counteracting acid secretion
3 promote oesophageal and gastric emptying

Question 14

Which pharmacological agents can be used in treatment of hiatus hernia? (4)

Answer 14

1 PPI’s (Omeprazole, Lansoprazole)
2 Antacid tablets
3 mucosal protectants (Na-alginate)
4 promotilants (metoclopramide)

Question 15

What are the common symptoms of rolling hiatus hernia? (3)

Answer 15

1 Hiccough
2 pressure in chest
3 odynophagia

Question 16

When is surgery indicated? (2)

Answer 16

1 failure of maximal medical management

2 complications of rolling hiatus hernia arise

Question 17

What are the possible complications of rolling hiatus hernia? (2)

Answer 17

1 volvulus

2 obstruction

Question 18

Which complication of rolling hiatus hernia is caused by incarceration?

Answer 18

Obstruction

Question 19

How are hiatus hernia managed surgically? (3)

Answer 19

1 laparoscopic 2 reduction of hernia 3 with nissen’s fundoplication

Question 20

How does surgical management differ in acute setting?

Answer 20

Partial gastrectomy may be performed