Hiatus Hernia

Question 1

What is a hiatus hernia?

Answer 1

herniation of part of the stomach above the diaphragm.

Question 2

What are the two types of hiatus hernia?

What is the most common type?

Answer 2

There are two types:
I) sliding: accounts for 95% of hiatus hernias, the gastroesophageal junction moves above the diaphragm

II) rolling (paraoesophageal): the gastroesophageal junctions remains below the diaphragm but a separate part of the stomach herniates through the oesophageal hiatus

Question 3

Clinical features

Answer 3

Dyspepsia 
dysphagia
regurgitation
, odynophagia
shortness of breath
chronic cough 
chest pain

Question 4

Diagnosis

Answer 4

Barium meal / swallow (best)
Endoscopy
Oesophageal manometry

Question 5

Risk factors

Answer 5

Obesity
Previous hiatal surgery
Increased intra-abdominal pressure (such as chronic cough, multiparity or ascites)

Question 6

Management

Answer 6

Surgical management is usually preferred if there are complications, such as bleeding, volvulus or obstruction.

Sliding herniae are treated medically like GORD.