Monday, 5 April 2010

Hiatus Hernia

Definition:
"partial or total herniation of the stomach/gastro-oesophageal junction (GOJ) through the diaphragmatic hiatus, into the thoracic cavity"

Presentation:
Common, mostly > 50yrs
Can be asymptomatic/symptoms of reflux oesophagitis

Aetiology
Increased abdo pressure
Low residue diet
Laxity of diaphragmatic hiatus or peri-oesophageal attachments

Classification:
There are two main types of hiatus hernia:
  • Sliding (most common)
In this, the GOJ is pulled up through the diaphragmatic hiatus (DH) +/- the stomach
  • Para-oesophageal (5%)
In this, a part of stomach (*greater curve), slides up through the hiatus, between the oesophagus & the diaphragm. The GOJ remains secure.
It is x 4 more common in females.
Extreme cases - "upside down stomach" when the entire stomach herniates into the thoracic cavity.

Complications
Similar to reflux oesophagitis:
  • mucosal erosions
  • ulceration
  • lower oesophageal stricture
  • bleeding
  • Barrett's Oesophagus

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