Hiatus hernia Flashcards
Define hiatus hernia
Prolapse of upper stomach through the diaphragmatic oesophageal hiatus
Aetiology of hiatus hernias
types: 1, 1, 3
Congenital
Traumatic
Non-traumatic:
Sliding: hernia moves in & out of chest
Para oesophageal (rolling): hernia goes through a whole in diaphragm next to the oesophagus
Mixed
Risk factors for hiatus hernia
5
Obesity Low fibre diet Chronic oesophagitis Ascites Pregnancy
Epidemiology of hiatus hernias
location, age
Common in western countries
Increased frequency w/ age (70% patients are >70 yrs old)
Presenting symptoms of hiatus hernias
general, 3
Most are ASYMPTOMATIC
Sliding hernias more likely to cause symptoms
May present w/ symptoms of GORD
heartburn
waterbrash
No correlation between size of hernia & symptoms severity
Signs of hiatus hernia on physical examination
Usually NO SIGNS
Investigations for hiatus hernia
3
Bloods
Radiology
Endoscopy
Investigations for hiatus hernia - bloods
1
FBC - check for iron deficiency anaemia
Investigations for hiatus hernia - radiology
2
CXR - gastric air bubble may be seen above diaphragm
Barium swallow
Types of management of hiatus hernia
2
Medical
Surgical
Management of hiatus hernia - medical
3
Modify lifestyle factors (e.g lose weight)
Inhibits acid production (e.g. PPIs)
Enhance upper GI motility
Management of hiatus hernia - surgical
2 general + 3
Necessary in minority of patients
Usually performed in patients w/ complications of reflux disease despite aggressive medical treatment or pulmonary complications
Nissen fundoplication
Stomach pulled down through oesophageal hiatus & part of stomach wrapped (360°) around oesophagus to make new sphincter & reduce likelihood of herniation
Belsey Mark IV fundoplication
270° wrap
Hill repair
Gastric cardia is anchored to posterior abdominal wall
Complications of hiatus hernias - types
2
Oesophageal
Non-oesophageal
Complications of hiatus hernias - oesophageal
5
Intermittent bleeding Oesophagitis Erosions Barrett’s oesophagus Oesophageal strictures
Complications of hiatus hernias - non oesophageal
2
Incarceration of hiatus hernia (only paraoesophagheal hernias)
Can lead to strangulation & perforation
