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Flashcards in HH and HHS Deck (20)
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describe a sliding HH vs a paraesophageal HH
which is more common?
which kind can we fix with manipulation?

sliding HH: GE jxn moves above the diaphragm, into the chest cavity
paraesophageal HH: part of the stomach moves above the diaphragm, into the chest cavity
sliding HH is more common
can fix sliding HH w/manipulation


definition of a HH

widened hiatus of the diaphragm w/ or w/o extension of portions of the stomach into the chest


some common causes of a HH (8)

impact of jumping or falling
belly flop
blow to the abd
exertion/straining w/breath holding


what is the area called which helps keep the LES below the diaphragm and prevent a HH?

angle of His


what shaped hiatus is ideal for preventing a HH? what part of the diaphragm forms a sling around the distal eso and acts as an outer sleeve to support that area of high pressure?

the right crus of the diaphragm


what is normally formed at the esophagogastric jxn? what is the purpose of it?

anatomical flap valve
valve keeps the distal part of the LES in the abd and maintains the angle of His


what %age of americans have a sliding HH?



are HH usu symptomatic or asx?

main sxs are those associated w/reflux and its complications


does the size of a hernia affect the severity of sxs?



what are some sxs a large HH can cause? (4)

atelectasis, fatigue, SOB and cardiac arrhythmias


what is the difference b/w a HH and HHS?

HHS is when a pt has (+) fxnal tests for a HH and their sxs match the dx of a HH but you don't have imaging yet to prove it
HH once they have (+) fxnal tests, sxs and imaging to prove it


clinical picture of someone with a HH? (general/emotional, respiratory, cardiac and GI)

general emotional: fatigue, anxiety, mental dullness, "spare tire bulge"
respiratory: shallow breathing, chest oppression, stitching pains, tickling cough, pallor
cardiac: non-cardiac chest pn, arrhythmia including A. fib
GI: easy satiety, reflux, regurgitation, flatulence, dysphagia, globus, aversion to constriction


what are 4 scenarios that would make you think HH if the pts sxs came on after the scenario?

starting a new exercise regime
following an illness w/vomiting or violent coughing
seem to hold their breath, feel restricted or don't use their diaphragm


what are the 4 reflex points to test for a HH?

left of xyphoid process (HHS point)
4th ICS mid clavicular
4th ICS mid axillary
T10-11 left paravertebral area


what other fxnal test can you do to test for a HH?

muscle test: test a strong muscle then re-test same muscle while compressing the stomach into the diaphragm


where is the HH point?

1 inch finger length below and to the L of the xyphoid process


what are 3 tx options for a HH?

visceral manipulation
functional breathing
NMT/MR as needed w/special focus at the occiput and T10-11


describe the visceral technique

apply pressure with fingers of non-dominant hand over HH point, traction, continue traction and follow the rotation (CCW), follow the rotation again (up and over) and then CW 3 times


post manipulation, what are 3 exercises you can have the pt do to prevent relapse?

heel drop: pt drinks 12-16 oz of warm water fairly quickly then bounces on heels 11 times
leg raise: lying supine pt raises legs 12-18 in off the surface, slowly abducts and adducts the legs then lowers to resting, that is one, gradually increase # of reps over time
knee raise: sitting in a chair, support upper body and keeping the knees abducted, inhale then w/exhale flex the legs at the trunk, at the next inhale extend the legs at the trunk and rest the feet on the floor, repeat


what is the procedure called where they surgically wrap part of the gastric fundus around the distal esophagus and what is it's purpose?

Nissan gastric fundoplication
purpose is to support the LES and to protect against reflux