Hiatus Hernias

Question 1

What is a hiatus hernia?

Answer 1

Protrusion of part of the stomach through the diaphragm into the thoracic cavity. They are often asymptomatic but can lead to GORD due to the loss of angle of entry of the oesophagus to the stomach.

Question 2

What is a sliding hiatus hernia?

Answer 2

The gastro-oesophageal junction slides into the thoracic cavity. Most common type.

Question 3

What is a rolling hiatus hernia?

Answer 3

The gastro-oesophageal junction remains in place but the stomach herniates into the thoracic cavity next to it. It is less common but more at risk of complications (dysphagia, volvulus, strangulation).

Question 4

What are the risk factors for a hiatus hernia?

Answer 4

Obesity
Pregnancy
Ascites

Question 5

What is the aetiology of hiatus hernias?

Answer 5

Widening of the diaphragm hiatus.
Oesophageal shortening = stomach pulled up.
Increased intra-abdominal pressure = stomach pushed up.

Question 6

What investigations are performed when a hiatus hernia is suspected?

Answer 6

Plain CXR - can see soft tissue opacity.

Endoscopy.

Question 7

What is the management of a hiatus hernia?

Answer 7

Mainly medical management of GORD.

Surgery.