Hiatus hernias Flashcards
Hiatus hernia classification
Sliding (80%)
Rolling (15%)
Mixed (5%)
Sliding hiatus hernia
- Gastro-oesophageal junction, abdominal oesophagus and cardia slides up through the diaphragmatic hiatus into the thorax
- Often associated with GORD
Rolling hernia
Para-Oesophageal
• Gastro-oesophageal junction remains in abdomen but
the fundus of stomach rolls into thorax alongside oesophagus
- LOS remains intact so GORD uncommon
- Can strangulate
Risk Factors for hernia
Age - age related loss of diaphragmatic tone
Increasing intraabdominal pressure:
- weight lifter
- pregnancy
- chronic cough
- obesity
- ascites
Clinical Features
Asymptomatic
May experience:
- GORD
- Weight loss
- Vomiting
- hiccups or palpitations
- swallowing difficulties
Hernia
Protrusion of viscera through the wall of the cavity that contains it
- typically small bowel or mesentery
Investigations for hiatus hernia
- CXR: gas bubble and fluid level in chest
- Ba swallow: diagnostic
- OGD: assess for oesophagitis - gold standard
• 24h pH + manometry: exclude dysmotility or
achalasia
Treatment for hiatus hernia
Conservative: • Lose wt. • Treat reflux - antacids/ PPI • Surgery if not controlled medically • Sleep with raised head • Smoking cessation
Surgery:
- Cruroplasty
- Fundoplication
When to do surgery
- Remain symptomatic
- Increased risk of strangulation/volvulus - all rolling hernias
- Nutritional failure
Cruroplasty
Hernia is reduced from the thorax into the abdomen and the hiatus reapproximated to the appropriate size.
Large defects usually require mesh to strengthen the repair.
Complications of surgery
Recurrence
Abdominal bloating - gas belch syndrome
Dysphagia
Fundal necrosis
Complications of hiatus hernia
Gastric volvulus
GORD
Hiatal Hernia on CXR
Air behind heart
