Hiatus hernia

Question 1

What is a hiatus hernia?

Answer 1

Protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus

Question 2

What organ is usually involved in a hiatus hernia?

Answer 2

The stomach, but can sometimes be small bowel, colon or mesentery

Question 3

How many people over the age of 50 probably have a hiatus hernia?

Answer 3

one third

Question 4

What is a sliding hiatus hernia?

Answer 4

the gastro-oesophageal junction, the abdominal part of the oesophagus and the cardia of the stomach move or slide upwards through the diaphragmatic hiatus into the thorax

Question 5

What is a rolling or para-oesophageal hernia?

Answer 5

an upward movement of the gastric fungus occurs to lie alongside the GOJ which created a bubble of stomach in the thorax, this is a true hernia with a peritoneal sac?

Question 6

What are the risk factors for developing a hiatus hernia?

Answer 6

Age due to age related loss of diaphragmatic tone, increasing intrabdominal pressures and increased size of diaphragmatic hiatus, pregnancy, obesity, ascites

Question 7

What are the clinical features of a hiatus hernia?

Answer 7

Most are asymptomatic, some may have GORD, vomiting, weight loss, bleeding and anaemia, hiccups, palpitations, swallowing difficulties

Question 8

What are the differential diagnosis of Hiatus hernia?

Answer 8

Cardiac chest pain or gastric or pancreatic cancer, GORD

Question 9

What is the gold standard investigation for a Hiatus Hernia?

Answer 9

Oesophagogastroduodenoscopy (OGD) as will show upward displacement of the GOJ

Question 10

How can a hiatus hernia be incidentally diagnosed?

Answer 10

CT or MRI

Question 11

What is the conservative management for a hiatus hernia?

Answer 11

PPI to reduce gastric acid section and control symptoms, weight loss, alter diet and sleep with more pillows, reduce alcohol and stop smoking

Question 12

When is the surgical management for a hiatus hernia done?

Answer 12

If still symptomatic after maximal medical therapy, risk of strangulation or volvulus, nutritional failure

Question 13

What are the two aspects of hiatus hernia surgery?

Answer 13

Cruroplasty and Fundoplication

Question 14

What is Cruroplasty?

Answer 14

the hernia is reduced from the thorax into the abdomen and the hiatus reapproximated to the appropriate size, any large defects require mesh to strengthen the repair

Question 15

What is Fundoplication?

Answer 15

The gastric fungus is wrapped around the LOS and stitched in place to strengthen the LOS and prevent reflux

Question 16

What are the complications of Hiatus Hernia surgery?

Answer 16

Recurrance of the hernia, abdominal bloating (inability to belch due to anti-reflux mechanism of procedure) dysphagia if too tight or narrow, fundal necrosis (if blood supply via the left gastric artery and short gastric vessels has been disrupted

Question 17

What are the complications of Hiatus Hernias?

Answer 17

incarceration and strangulation, gastric volvulus (stomach twists on itself 180 degrees causing obstruction of gastric passage and tissue necrosis- Borchardts triad- severe epigastric pain, retching without vomiting, inability to pass NG)