Hiatus Hernia

Question 1

What’s a hiatus hernia?

Answer 1

Abdominal contents protrude through an enlarged oesophageal hiatus in the diaphragm

Question 2

Which type is more common?

Answer 2

Sliding > rolling

Question 3

What’s a sliding hiatus hernia?

Answer 3

gastro-oesophageal junction slides up into the chest –> less competent sphincter causes acid reflux

Question 4

Medical and surgical management of hiatus hernia?

Answer 4

Similar to GORD:

1) PPI for 4-8wks –> assess response
2) Nissen’s fundoplication

Question 5

What’s a rolling hiatus hernia?

Answer 5

gastro-oesophageal junction remains in the chest but part of the stomach protrudes into chest alongside oesophagus.

Question 6

How and why is management of a rolling hiatus hernia different?

Answer 6

URGENT management –> volvulus can cause ischaemia + necrosis

Question 7

Risk factors?

Answer 7

1) obesity
2) prev. hiatal surgery
3) increased abdo pressure - chronic cough, multiparity, ascites

Question 8

Clinical features?

Answer 8

• heartburn / chest pain
• dysphagia / odynophagia
• regurgitation
• SOB / chronic cough

Question 9

Diagnosis?

Answer 9

• Barium swallows (upper GI series)

Look at pics!

Question 10

Conservative management?

Answer 10

Lifestyle (as GORD):

• lose weight
• avoid alcohol, spicy food
• avoid smoking (relaxes LOS)

Question 11

What antihypertensive makes reflux symptoms worse?

Answer 11

CCBs e.g. amlodipine