The Oesophagus - Hiatus Hernias

Question 1

What is a hiatus hernia?

Answer 1

Herniation of the stomach up through the diaphragm.

Question 2

Risk Factors of Hiatus Hernias (4).

Answer 2

1. Increasing Age.
2. Obesity.
3. Pregnancy.
4. Ascites.

Question 3

Types of Hiatus Hernias (4).

Answer 3

1. Type I : Sliding (95%).
2. Type II : Rolling (Paraoesophageal).
3. Type III : Combination of Sliding + Rolling.
4. Type IV : Large Opening with Additional Abdominal Organs Entering the Thorax.

Question 4

What is a Sliding Hernia?

Answer 4

The stomach slides up through the diaphragm with the GOJ (Gastro-Oesophageal Junction) passing up into the thorax.

Question 5

What is a Rolling Hernia?

Answer 5

A separate portion of the stomach i.e. fundus, folds around and enters through the diaphragm opening, alongside the oesophagus; the GOJ is below the diaphragm.

Question 6

Clinical Features of Hiatus Hernias (3).

Answer 6

1. Dyspepsia.
2. Halitosis (Bad Breath).
3. GORD Symptoms.

Question 7

Investigations of Hiatus Hernias (2).

Answer 7

1. Intermittent Visibility on CXR, CT, Endoscopy, Barium Swallow.
2. Barium Swallow - Most Sensitive.

Question 8

Management of Hiatus Hernias (2).

Answer 8

1. Conservative (GORD Treatment).

2. Surgical Repair - Laparoscopic Fundoplication if high-risk of complications or symptoms (mainly Type II).