hiatus hernia

Question 1

definition

Answer 1

Hiatus hernia is the protrusion of intra-abdominal contents through an enlarged oesophageal hiatus of the diaphragm. A hiatus hernia most commonly contains a variable portion of the stomach; less commonly, it may contain transverse colon, omentum, small bowel, or spleen, or some combination of these organs. The herniated contents are usually contained within a sac of peritoneum.

Question 2

risk factors

Answer 2

obesity, increased intra-abdominal pressure from various conditions, and a previous hiatus operation.

Question 3

symptoms

Answer 3

May be asymptomatic or may present with heartburn, dysphagia, odynophagia, hoarseness, asthma, shortness of breath, chest pain, anaemia or haematemesis, or some combination of these.

Question 4

investigations

Answer 4

1st investigations:

• CXR
• upper GI series (aka upper GI or as a barium oesophagram) – MAIN INVESTIGATION

Question 5

complications

Answer 5

obstruction, bleeding, volvulus with and without strangulation or necrosis, and Barrett’s oesophagus.

Question 6

treatment

Answer 6

Uncomplicated sliding hiatus hernias are treated symptomatically with medical therapy (omeprazole), although some patients may select surgical therapy.

Complicated hiatus hernias (those with bleeding, volvulus, or obstruction) have a stronger indication for surgical repair (laparoscopic or open transabdominal repair +/- anti reflux procedure).

irreversible organ ischaemia/necrosis will involve surgical resection.