HIATAL HERNIA 1 P a g e HIATAL HERNIA P 975 977 Herniation of a portion of the stomach into the esophagus through an opening or hiatus in the diaphragm Found on x ray examination of the upper GI tract Occurs more women in men Types of Hiatal Hernias Sliding junction of the stomach and esophagus aboud the hiatus of the diaphragm occurs when patient is supine and back to abdominal cavity when patient is upright most common type of hiatal hernia Paraesophageal or rolling fundus and the greater curvature of the stomach roll up through diaphragm medical emergency Etiology and Pathophysiology Weakening of the muscles in the diaphragm around the esopgagogastric opening Factors that increase intraabdominal pressure o Obesity o o o o o Heavy lifting Pregnancy Ascites Tumors Intense physical exertion Clinical Manifestations Some are asymptomatic Similar to GERD Heartburn after a meal or after lying supine Bending over but relieved by standing Factors that precipitate o o o Large meals Alcohol Smoking Nocturnal symptoms o Common Dysphagia Complications GERD Esophagitis Hemorrhage from erosion Stenosis Ulcerations of the herniated portion of the stomach Strangulation of hernia Regurgitation with tracheal aspiration Diagnostic Studies Barium swallow shows protrusion of gastric mucosa Endoscopic visualization of the lower esophagus Conservative Therapy Similar to that described under GERD Lifestyle modifications Reduction of intraabdominal pressure by eliminating o o o o Stricting garments Lifting and straining Alcohol and smoking Elevate head of bed o Reduce body weight if overweight Surgical Therapy Reduction of the herniated stomach into the abdomen Herniotomy excision of the hernia sac Herniorraphy closure of the hiatal defect Antireflux procedure Gastroprexy attachment of the stomach HIATAL HERNIA 2 P a g e
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