Hiatus Hernia

Question 1

What is Hiatus Hernia?

Answer 1

• protrusion of an organ from abdominal cavity to thoracic cavity

Question 2

Which organs can form hiatus hernia?

Answer 2

• stomach (most common)
• small bowel
• mesentery

Question 3

What are the 2 types of hiatus hernia

Answer 3

• Sliding hiatus hernia (80%)
  
  • cardia of stomach moves upwards through diaphragmatic hiatus into thorax
• Rolling hernia (20%)
  
  • upward movement of gastric fundus

Question 4

What are the RF of hiatus hernia

Answer 4

• Age
  
  • loss of diaphragmatic tone
• pregnancy
• obesity
• ascites

Question 5

What are the clinical features of hiatus hernia?

Answer 5

• asymptomatic (majority)
• GOR sx
• V
• weight loss
• swallowing difficulties
• Ex is normal

Question 6

What are the differential diagnosis for hiatus hernia

Answer 6

• cardiac chest pain
• gastric/pancreatic cancer
• GORD

Question 7

What Ix would you order for hiatus hernia

Answer 7

• OGD (gold standard)
  
  • upward displacement of z-line
• Incidental finding on CT/ MRI
• Contrast swallow

Question 9

How would you Mx hiatus hernia?

Answer 9

• Conservative
  
  • PPI
  • advise on lifestyle modifications
  • stop smoking and reduce alcohol
• Surgical
  
  • cruroplasty
  • fundoplication

Question 10

What are the indications for surgical mx of hiatus hernia?

Answer 10

• remian symptomatic despite pharmacological mx
• high strangulation risk - rolling type
• nutritional failure

Question 11

What are the cx of hiatus hernia surgery?

Answer 11

• recurrence
• abdominal bloating
• dysphagia - if fundoplication too tight/narrow
• fundal necrosis - if left gastric artery and short gastric vessels disrupted

Question 12

What are the Cx of hiatus hernia?

Answer 12

• rolling type
  
  • incarceration
  • strangulation
• Gastric volvulus
  
  • present c Borchardt’s triad

Question 13

What is Borchardt’s triad?

Answer 13

• Severe epigastric pain
• Retching without vomiting
• Inability to pass an NG tube