histal hernia Flashcards
what is a hiatal hernia
herniation of portion of stomach into esophagus through an opening in diaphragm
most common in women and older adults
what are the two types of hiatal hernia
sliding
rolling
what is a sliding hiatal hernia
MOST COMMON
stomach slides through hiatal opening in diaphragm when patent is supine, goes back into abdominal avocet when patient is standing upright
what is a rolling (paraesophareal) hernia
fundus and greater curvature of stomach roll up through diaphragm, forming a pocket alonside the esophagus
acute paraesophaeal hernia is a medical emergency
why do hiatal hernias occur
strucutral changes with aging
increase intraabdominal pressure- obesity, pregnancy, heavy lifting
what are clinical manifestations of hiatal hernia
asymptomatic
heartburn- after a meal or laying supine
dysphagia
what are some hiatal hernia complications
GERD esophagitiis hemorrhage from erosion stenosis ulcerations of herniated portion strangulation of the hernia - EMERGENCY SURGERY regurgitation with tracheal aspiration increased risk of respiratory problems
what are the diagnostic studies of a hiatal hernia
esophagogram (barium swallow)- may show protrusion
endoscopy- information on degree of inflammation or other problems
what are some conservative therapy for hiatal hernia
eliminate alcohol stop smoking elevate head of bead avoid lifting reduce weight use antisecretory agents and antacids
what are the goals of surgical therapy
redue hernia
provide acceptable LES pressure
prevent movements of gastroesophageal junction
what are the surgeries to reduce of the herniated stomach
heniotomy- excision of hernia sac
herniorrhaphy- closure of hiatal defect
what are the antireflux procedure
gastropexy- attachment of stomach subdiaphragmaticall to prevent reherination
