Hiatus Hernia

Question 1

def

Answer 1

herniation of contents of the abdominal cavity, most commonly stomach, through the oesophageal hiatus of the diaphragm into the mediastinum

Question 2

what are the different types of hiatus hernia

Answer 2

type 1 (sliding)
-gastro-oesphageal junction is above the diaphragm
type 2 (rolling/para-oesophageal)
-defect in the phreno-oesophageal membrane + the GOJ does not move but the gastric fundus is the lead point of herniation
type 3
-type 1 +2
type 4
-large defect with herniation of organs such as colon, pancreas

Question 3

aetiology

Answer 3

1 congenital
2 acquired
-thinning + increased laxity of the phreno-oesophageal ligament with age
-associated with obesity, GORD, chronic oesophagitis

Question 4

epi

Answer 4

type 1 most common
more common with age
95% are sliding (type 1)
5% are rolling (type 2)

Question 5

history

Answer 5

1 mostly asymptomatic
2 reflux symptoms
-heartburn
-indigestion

Question 6

investigations

Answer 6

1 endoscopy
-diagnosis of hernia
2 radiology
-CXR (large hernias can appear as a gastric air bubble behind the heart)
3 high resolution manometry
-diagnosis of sliding hernias

Question 7

management

Answer 7

1 advice
-weight loss
-avoid late night meals
2 medical
-antacids
-H2 antagonists
-PPIs
3 surgical
-for patients with complications of reflux despite medical treatment
-for patients with mass reflux or pulmonary complications
-often completed laparoscopically
-hernial reduction

Question 8

complications

Answer 8

1 oesophageal complications

• oesophagitis
• erosions or ulceration
• barretts oesophagus

Question 9

prognosis

Answer 9

good

sliding hernias have better prognosis than rolling hernias