2. Hiatal Hernia
• A hiatal hernia occurs when the
upper part of the stomach pushes
through an opening in the
diaphragm, and up into the chest.
This opening is called a
esophageal hiatus or
diaphragmatic hiatus.
OR
• A hiatus hernia or hiatal hernia is
the protrusion of the upper part
of the stomach into
the chest through a tear or
weakness in the diaphragm.
3. Pathpysiology
• Normally, the esophagus or food tube passes
down through the chest, crosses the diaphragm,
and enters the abdomen through a hole in the
diaphragm called the esophageal hiatus. Just
below the diaphragm, the esophagus joins the
stomach.
• In individuals with hiatal hernias, the opening of
the esophageal hiatus (hiatal opening) is larger
than normal, and a portion of the upper
stomach slips up or passes through the hiatus
and enter into the chest.
4.
5. Types Of Hiatal Hernia
There are 2 types of hiatal hernia.
Sliding hiatal hernia:
• The sliding type, as its name
implies, occurs when the junction
between the stomach and
esophagus slides up through the
esophageal hiatus during
moments of increased pressure in
the abdominal cavity.
• When the pressure is relieved, the
stomach falls back down with
gravity to its normal position.
• Approximately 90% of all hiatal
hernias are the sliding type.
6. Paraesophageal hiatal hernia
• Paraesophageal hiatal hernia:
• In paraesophageal hiatal there
is no sliding up and down. A
portion of the stomach
remains stuck in the chest
cavity.
• These hernias remain in the
chest at all times.
• This type is less common.
7.
8. Causes Of Hiatal Hernia
• Increased pressure within the abdomen caused by:
o Heavy lifting or bending over.
o Frequent or hard coughing.
o Hard sneezing.
o Pregnancy and delivery.
o Vomiting.
o Constipation.
o Obesity.
9. Clinical Manifestation
The patient with sliding hernia may have,
• Heart burn
• Regurgitation and
• Dysphagia but at least 50% are Asymptomatic.
The patient with paraoesophageal hernia usually
feels a sense of fullness after eating or may be
asymptomatic.
10. Medical Diagnosis
• Various tests are used to diagnose a hiatal hernia, the
following tests are routinely used:
• chest x-ray
• Barium x-rays: Barium x-rays, also known as barium
swallow, are diagnostic x-rays in which barium is used to
diagnose abnormalities of the digestive tract, including
hiatal hernias.
• Upper endoscopy: The upper endoscopy (also known as
esophagogastroduodenoscopy or EGD) allows the doctor
to examine the inside of the patient's esophagus,
stomach, and duodenum (the first part of the small
intestine) with an instrument called an endoscope.
11. Treatment
• Medical treatment for hiatal hernia may include
prescription-strength antacids & PPIs
• When hernia symptoms are severe and chronic
acid reflux is involved, surgery is sometimes
recommended,
• The surgical procedure used is called Nissen
fundoplication.
• In fundoplication, the gastric fundus(upper part)
of the stomach is wrapped, or plicated, around
the inferior part of the esophagus, preventing
herniation of the stomach through the hiatus in
the diaphragm and the reflux of gastric acid.
