HIATUS HERNIA Flashcards
WHAT IS A HIATUS HERNIA?
Protrusion of an organ (typically stomach) from abdominal cavity into thorax through oesophageal hiatus.
WHAT ARE THE 2 TYPES OF HIATUS HERNIA?
1) Sliding hiatus hernia- majority/ GOJ slides up into chest
2) Rolling hernia - upward movement of gastric fundus occurs to lie alongside normally positioned GOJ.
WHAT ARE THE RISK FACTORS OF HIATUS HERNIA?
1) Age (loss of diaphragmatic tone, increase abdominal pressure due to repetitive cough, increase size of diaphragmatic hiatus)
2) Pregnancy
3) Obesity
WHAT ARE THE CLINICAL FEATURES OF HIATUS HERNIA?
1) Majority asymptomatic
2) Burning epigastric pain worse on lying flat (GORD)
3) Vomiting and weight loss
4) Bleeding and anaemia (secondary to ulceration)
5) Hiccups or palpitations (irritation of pericardial sac or diaphragm)
6) Swallowing difficulties
WHAT ARE THE DIFFERENTIAL DIAGNOSIS FOR HIATUS HERNIA?
1) Cardiac chest pain
2) Gastric or pancreatic cancer
3) GORD
WHAT IS THE GOLD STANDARD INVESTIGATIONS FOR HIATUS HERNIA?
- OGD - shows upward displacement of GOJ
WHAT IS THE LIFESTYLE MANAGEMENT FOR HIATUS HERNIA?
1) weight loss
2) alter diet (low fat, early meals, smaller portions)
3) sleep with more pillows
4) smoking cessation
5) reduce alcohol intake
WHAT IS THE SURGICAL MANAGEMENT FOR HIATUS HERNIA?
1) Cruroplasty - hernia reduced from thorax into abdomen, large defects repaired with mesh
and
2) Fundoplication - gastric fundus wrapped around lower oesophagus and stitched in place
WHEN IS SURGERY INDICATED?
1) when remaining symptomatic despite maximal medical therapy
2) risk of strangulation
3) nutritional failure (due to gastric outlet obstruction)
WHAT ARE THE COMPLICATIONS OF HIATUS HERNIA?
1) Rolling hernia - incarceration and strangulation
2) Gastric volvulus - stomach twists on itself leading to obstruction of gastric passage and tissue necrosis.
WHAT DOES A GASTRIC VOLUVLUS PRESENT WITH?
Borchardt triad
1) severe epigastric pain
2) retching without vomiting
3) inability to pass NG tube
