Hiatus herniae Flashcards
What are the types of Hiatus Herniae?
I. Sliding Hiatus Hernia
- Paraoesophageal Hiatus Hernia
- Mixed Hiatus Hernia
- Other ado organ into thorax (spleen / bowel)
What is a sliding hiatus hernia?
Herniation of both the stomach and gastrooesopageal junction into thorax. 90% of oesophageal hernias.
RFx for sliding hiatus hernia?
- Age
- Increased intra-abdominal pressure (obesity, pregnancy, coughing, heavy lifting).
- Smoking
Clinical features of sliding hiatus hernia?
-Mostly asymptomatic +/- GERD (decreased competence of GE junction)
Complications of sliding hiatus hernia?
- GORD
- Other = rare and related to reflux (oesophagitis, stricture, BE, oesophageal carcinoma) + extra oesophageal reflux (pneumonia, aspiration pneumonitis, cough, laryngitis)
Ix in hiatus hernia?
- Imaging: CXR, barium swallow, endoscopy or oesophageal manometry.
- Gastroscopy w/ biopsy: r/o oesophagitis, BE and carcinoma.
Lifestyle Rx of hiatus hernia?
-Lifestyle: smoking, weight loss, elevate head of bed, no food >3h pre sleep. Avoid trigger foods
Rx sliding hiatus hernia?
- Antacid
- H2 antagonist
- PPI
- Prokinetic agent
Surgical Mx sliding hiatus hernia (+ when is it indicated)?
-Fundoplication (fundus of stomach wrapped around lower oesophagus and suture in place).
Indicated on failure of medical therapy, oesophageal stricter, severe nocturnal aspiration of BE.
What is a paraoesophagheal hiatus hernia?
Herniation of all or part of the stomach through the oesophageal hiatus into the thorax with an undisplayed GE junction.
Complications of paraoesophagheal hernia?
- Haemorrhage
- Incarceration/ strangulation/ obstruction
- Gastric stasis ulcer
Treatment of paraoesophagheal hernia?
Surgical to prevent severe complications.
Reduce hernia and excise sac, repair defect at hiatus, anti-reflux fundoplication.
