Hiatus hernias

Question 1

What is a hiatus hernia

Answer 1

prolapse of upper stomach through diaphragmatic esophageal hiatus

Question 1

What are the 2 types of hiatus hernia

Answer 1

Sliding - 80% - hernia moves in and out of chest , acid reflux as LOS becomes less competent

Rolling - 20%- hernia goes through hole in diaphgram next to oesophagus

Question 2

What are risk factors for a hiatus hernia

Answer 2

things that increase intra-abdominal pressure

– obesity , weightlifting, pregnancy

Question 3

What may someone with a hiatus hernia present with

Answer 3

Usually asymptomatic
GORD symptoms - worse when lying flat

Palpitations/ hiccups indicate pericardial irritation

Question 4

What investigations are required for someone with a hiatus hernia

Answer 4

Chest X-ray - retrocardiac bubble

Barium oesophagram

Consider OGD/CT/MRI and high resolution oesophageal manometry and pH monitoring

Question 5

How do you manage Hiatus hernias

Answer 5

Weight loss
PPI
Surgery if symptomatic paraoeosphageal