Week 6 - Hiatal Hernia

Question 1

what is a hiatal hernia

Answer 1

• herniation of a portion of the stomach into the esophagus thru an opening (hiatus) in the diaphragm

Question 2

what are the 2 types of hiatal hernias

Answer 2

• rolling

- sliding

Question 3

what is a rolling hiatal hernia

Answer 3

• when the esophagogastric junction remains in normal place
• but the fundus and greater curvature of the stomach rolls of thru the diaphragm , forming a pocket alongside the esophagus

Question 4

what is a sliding hernia

Answer 4

• the junction of the stomach and esophagus is above the hiatus of the diaphragm
• part of the stomach slides thru the hiatus into the diaphragm
• most common*

Question 5

describe how a sliding hernia changes w position

Answer 5

• stomach slides into the thoracic cavity when supine

- slides back into abdominal cavity when standing upright

Question 6

what factors contribute to the formation of a hiatal hernia (6)

Answer 6

• structural changes
• factors that increase intra-abdominal pressure
• increased age
• trauma
• poor nutrition
• forced recumbent position

Question 7

what is an example of a structural change that contributes to the formation of a hiatal hernia

Answer 7

• weakening of muscles in the diaphragm

Question 8

what are examples of factors that increase intra abdominal pressure (6)

Answer 8

• obesity
• pregnancy
• ascites
• tumours
• tight corsets
• intense physical exertion & heavy lifting on daily basis

Question 9

describe the symptoms of a hiatal hernia (5)

Answer 9

• may be asymptomatic
• similar to gerd
• mimic gallbladder disease
• mimic PUD
• mimic angina

Question 10

what are symptoms of a hiatal hernia (2)

Answer 10

• heartburn (esp after meal or lying supine, bending over)

- dysphagia

Question 11

what is discomfort and reflux in hiatal hernia associated w

Answer 11

• position

Question 12

what are precipitating factors of pain w a hiatal hernia (5)

Answer 12

• bending over
• consumption of large meals
• alcohol
• smoking
• eating before sleeping (nocturnal symptoms)

Question 13

what are complications of a hiatal hernia (6)

Answer 13

• gerd
• hemorrhage from erosioon
• stenosis
• ulcerations of herniated portion of stomach
• strangulation of hernia
• regurgitation w tracheal aspiration

Question 14

what diagnostics can be used for a hiatal hernia (3)

Answer 14

• barium swallow **
• endoscopic visualization of lower esophagus
• other diagnostics similar to those for gerd

Question 15

what does conservative therapy for a hiatal hernia include (3)

Answer 15

similar to for gerd

• lifestyle mod
• meds

Question 16

list some lifestyle mods for hiatal hernia (6)

Answer 16

• avoid constricting garments
• elevate HOB
• avoid bending over
• avoid lying down 2-3 h after eating
• eliminate alcohol
• eliminate smoking
• encourage weight loss

Question 17

what meds are used for hiatal hernia (3)

Answer 17

• antacids
• PPIs
• H2R blockers

Question 18

what is the goal of surgical therapy for hiatal hernia (3)

Answer 18

• enhance integrity of LES & increase its pressure
• reduce hernia
• prevent movement of GE junction

Question 19

what type of surgery can be done for a hiatal hernia

Answer 19

• Nissen fundoplication

Question 20

when is nissen fundoplication considered for hiatal hernia

Answer 20

• if lifestyle mods have been unsuccessful

- if additional complications beyong reflux (bleeding, strictures)

Question 21

what are 2 methods of surgery for a hiatal hernia

Answer 21

1. fundus of stomach is surgically attaches to LES = increased P in distal sphincter
2. fundus is sutured to itself = narrowed fundus = similar results to #1