Details Descriptions About :: Hiatal Hernia

 Hiatal hernia is a defect in the diaphragm that permits a portion of the stomach to pass through the diaphragmatic opening into the chest. Hiatal hernia is the most common problem of the diaphragm affecting the alimentary canal. Treatment can prevent complications such as strangulation of the herniated intrathoracic portion of the stomach. Age Alert Hiatal hernias are common, especially in people over age 50.

Causes for Hiatal Hernia

Causes Esophageal carcinoma Kyphoscoliosis Trauma Congenital diaphragm malformations Contributing factors Aging, obesity, trauma

Pathophysiology Hiatal Hernia

Pathophysiology Hernias typically result when an organ protrudes through an abnormal opening in the muscle wall of the cavity that surrounds it. In hiatal hernias, a portion of the stomach protrudes through the diaphragm. Three types of hiatal hernia can occur: sliding, paraesophageal (rolling), or mixed, which include features of both. In a sliding hernia, both the stomach and the gastroesophageal junction slip up into the chest, so the gastroesophageal junction is above the diaphragmatic hiatus. In paraesophageal hernia, a part of the greater curvature of the stomach rolls through the diaphragmatic defect. Hiatal hernia contributes to gastroesophageal reflux disease, which leads to erosion and fistulas between the esophagus and trachea.

Signs and symptoms Hiatal Hernia

Signs and symptoms Heartburn 1 to 4 hours after eating; aggravated by reclining, belching, or conditions that increase intra-abdominal pressure Regurgitation or vomiting Retrosternal or substernal chest pain (typically after meals or at bedtime) Feeling of fullness after eating Feeling of breathlessness or suffocation Chest pain resembling angina pectoris Dysphagia

Diagnostic Lab Test results

Diagnostic test results Chest X-ray reveals an air shadow behind the heart in a large hernia; lower lobe infiltrates with aspiration. Barium swallow with fluoroscopy detects a hiatal hernia and diaphragmatic abnormalities. Endoscopy and biopsy results identify the mucosal junction and the edge of the diaphragm indenting the esophagus; differentiate hiatal hernia, varices, and other small gastroesophageal lesions; and rule out malignant tumors. Esophageal motility studies reveal esophageal motor or lower esophageal pressure abnormalities before surgical repair of the hernia. pH studies identify reflux of gastric contents. Acid perfusion (Bernstein) test identifies esophageal reflux. Blood chemistry reveals decreased serum hemoglobin level and hematocrit in patients with paraesophageal hernia, if bleeding from esophageal ulceration is present. Fecal occult blood test reveals presence of blood. Analysis of gastric contents possibly shows the presence of blood.

Treatment for Hiatal Hernia

Treatment Restrict activities that raise intra-abdominal pressure (coughing, straining, bending) Pharmacologic agents: antiemetics, stool softeners, cough suppressants, antacids, and cholinergics Proton pump inhibitors Diet modifications: small, frequent, bland meals; not eating 2 hours prior to lying down; weight-loss programs Avoidance of foods that relax the lower esophageal sphincter, such as caffeine, mint, and chocolate Smoking cessation Surgical repair


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