Hiatus Hernias

Question 1

What is a hiatus hernia

Answer 1

Protrusion of the stomach from the abdominal cavity into the thorax

Question 2

What are the type main types of hiatus hernias

Answer 2

Sliding hernias - 80%

Rolling ( para-Oesophageal) hernias - 20%

Question 3

What happens in a sliding hiatus hernia

Answer 3

GOJ,abdominal part of stomach and the cardia of the stomach slides up into the thorax

Question 4

What happens in a rolling/para-oesophageal hernia

Answer 4

GOJ stays in the same position but gastric fundus moves up alongside GOJ

Question 5

What are the risk factors of hiatus hernias

Answer 5

Age - due to age related diaphragmatic loss of tone, increasing intrabdo pressures ( more coughing )

Pregnancy

Obesity

Ascites

Question 6

What are the clinical features of hiatus hernias

Answer 6

Most are asymptomatic

GORD

Vomiting

Weight loss

Bleeding

Hiccups

Swallowing problems

Question 7

what are the differential diagnosis of hiatus hernias

Answer 7

Cardiac chest pain
GORD
Gastric cancers

Question 8

How are hiatus hernias investigated

Answer 8

OGD is gold standard - will show you GOJ displacement

Question 9

What are the conservative management options for hiatus hernias

Answer 9

Life styles modifications:

• weight loss
• alter diet - less spicy food, low fat, smaller portions
• smoking cessation
• stop drinking

Question 10

What medical management options are there for hiatus hernias

Answer 10

PPI is first line to be taken before food

Question 11

When is surgery indicated for hiatus hernias

Answer 11

• Conservative and Medical management has failed and there fore you remain symptomatic
• increased risk of strangulation eg - rolling hernia
• nutritional failure

Question 12

What are the two types of surgery that are available for the treatment of hiatus hernias

Answer 12

• cruroplasty - hernia is reduced back into the abdominal cavity. Large defects need mesh to strengthen the repair
• fundoplication - fundus is wrapped around the LOS

Question 13

What are the complications of surgery

Answer 13

Recurrence of the hernia

Abdominal bloating - cant burp

Dysphagia - if too tight

Fundal necrosis - if the blood supply to the lesser curve disrupted

Question 14

What are the complications of hiatus hernias

Answer 14

Incarceration

Strangulation

Gastric volvulus

Question 15

What is the triad of symptoms that patients present with when you suspect gastric volvulus

Answer 15

• epigastric pain
• retching without vomiting
• inability to pass a NG tube