Hiatus Hernia

Question 1

Hiatus Hernia Epidemiology

Answer 1

• More common in men

- Common in those with reflux oesophagitis

Question 2

Hiatus Hernia RFs

Answer 2

• Obesity
• Pregnancy
• Ascites
• Advanced age
• Genetic predisposition
• Conditions causing shortening of oesophagus e.g. acid

Question 3

Hiatus Hernia Aetiology

Answer 3

• One or more of three possible mechanisms
• Widening of diaphragmatic hiatus
• Pulling up of stomach due to oesophageal shortening
• Pushing of the stomach from increased intra-abdominal pressure
• Anti-reflux barrier is lost and larger the hernia, more impaired the clearance of acid, exacerbated GORD

Question 4

Hiatus Hernia Classification

Answer 4

• Sliding (85-95%)

- Para-oesophageal (rolling)

Question 5

Hiatus Hernia Presentation

Answer 5

• Clinical significance is contribution to GORD
• Para-oesophageal may cause obstruction, volvulus, ischaemia
• Heartburn, reflux, difficulty swallowing
• Bowel sounds in chest

Question 6

Hiatus Hernia Ix

Answer 6

• Often intermittent so investigation may be unreliable
• CXR
• Upper GI series

Question 7

Hiatus Hernia Differentials

Answer 7

• Rumination syndrome
• Chest pain
• Barrett’s, malignancy

Question 8

Hiatus Hernia Management

Answer 8

• Treatment not needed in absence of symptoms
• Other than in para-oesophageal in which case surgery might be needed to avoid complications
• Lifestyle modification
• PPIs

Question 9

Hiatus Hernia Indications for Surgery

Answer 9

• Failure of therapeutic regimes to control cough or oesophagitis
• To avoid lifelong treatment
• Respiratory complications e.g. asthma
• Symptomatic Type 2
• Laparascopic fundoplication