Hiatal Hernia
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This document appears to be notes from a medical student on the topic of gastroesophageal reflux disease (GERD). It includes bullet points on the history, symptoms, diagnosis, and treatment of GERD. It notes that about one-third of patients fail to respond to initial medical treatment and half of those who initially respond will ultimately relapse and require surgery. It also includes two citation in APA format.
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Hiatal Hernia
- 1. Abdul Mannan Chattha M09021 Phase III medical Student
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- 37. • • • • About one-third of patients fail to respond to initial medical treatment, and half of those who initially respond will ultimately relapse and require surgery.
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- 49. • • HTTP://LINK.SPRINGER.COM/ARTICLE/10.1007/S00595-013-0609-2/FULLTEXT.HTML • • • AJR AM J ROENTGENOL. ABBARA S KALAN MM LEWICKI AM • • • "SURGICAL THERAPY FOR GASTROESOPHAGEAL REFLUX DISEASE" DOI
Editor's Notes
- Patient swallowed barium on command. Normal swallowing mechanism. Sliding hiatus hernia noted on rest in supine posture which increased in size on Valsalva manuver.It reduced spontaneously in erect Posture. Oesophagus shows normal motility, calibre and mucosal outline. No filling defect or extrinsic compression seen. No spontaneous gastroesophageal reflux noted during current examination.
- Patient swallowed barium on command. Normal swallowing mechanism. Sliding hiatus hernia noted on rest in supine posture which increased in size on Valsalva manuver.It reduced spontaneously in erect Posture. Oesophagus shows normal motility, calibre and mucosal outline. No filling defect or extrinsic compression seen. No spontaneous gastroesophageal reflux noted during current examination.
- The phrenoesophageal ligament is formed by fusion by endothoracic and endoabdominal fascia at the esophgeal hiatus
- A very large hiatal hernia may be present with no symptoms at all.
- Worse when patient supine/leaning Lump or feeling that food is stuck beneath the xiphoid Late symptoms of dysphagia and vomitting may suggest stricture
- Cameron lesions are ulcers in the hiatal sac of patients with hiatal hernia. They are usually asymptomatic. In rare conditions they may cause acute or chronic GI bleeding and iron deficiency anemia. Massive bleeding is rare
- Incarceration of a hiatal hernia is rare and is observed only with paraesophageal hernia. When this occurs, it can present abruptly, with a sudden onset of vomiting and pain, sometimes requiring immediate operative intervention.
- Muscle weakening and loss of elasticity as people age is thought to predispose to hiatus hernia, Conditions such as chronic esophagitis may cause shortening of the esophagus by causing fibrosis of the longitudinal muscles and, therefore, predispose to hiatal hernia. However, which comes first, the hiatal hernia worsening the reflux or the reflux-induced shortening of the esophagus, remains unknown.
- —Classification of hiatal hernias. Drawing of type 1 sliding hiatal hernia shows esophagogastric junction (thick straight arrow) displaced into thorax. Phrenicoesophageal membrane (arrowheads) is circumferentially weakened and stretched without focal defect. Note endothoracic and endoabdominal fascia (thin straight arrows) and peritoneum (curved arrow).
- —Classification of hiatal hernias. Drawing of type 2 paraesophageal or rolling hiatal hernia shows fundus and other portion of stomach (straight arrow) herniated into chest through focal defect of phrenicoesophageal membrane. Esophagogastric junction remains in normal position at level of hiatus. Curved arrow indicates visceral peritoneum.
- Resp symptoms Borchardt’s triad sever epigastric pain Retching without vomiting Inability to pass NG This type of hernia has a focal defect in the anterior and lateral aspect of the phrenicoesophageal membrane. The gastric cardia and the esophagogastric junction remain below the diaphragm The fundus is usually the lead point of the herniation through the diaphragmatic defect. The rest of the stomach may then migrate upward, leading to an intrathoracic stomach. The term “parahiatal hernia” is reserved for rare cases in which some fibers of the crura of the diaphragm are interposed between the esophagus and the herniated stomach
- —Classification of hiatal hernias. Drawing of type 3 compound or mixed hiatal hernia shows displacement of esophagogastric junction, gastric fundus, and body (arrow) into chest.
- complications such as erosive esophagitis, ulcers in the hiatal hernia, Barrett esophagus, or tumor.
- However, young patients with severe or recurrent complications of GERD, such as strictures, ulcers, and bleeding, who cannot afford lifelong PPI treatment or would prefer to avoid taking medications long term, may be surgical candidates.
- are tendinousstructures that extend inferiorly from the diaphragm to attach to the vertebral column. Forming a tether for muscular contraction, Close crura posterior to esophagus…..
- Whenever the stomach contracts, it also closes off the esophagus instead of squeezing stomach acids into it. This prevents the reflux of gastric acid (in GERD). In the Nissen-Rossetti modified fundoplication, the anterior wall of the fundus alone is used to construct a 360-degree wrap around the distal esophagus
- In the traditional Nissen fundoplication, the posterior and anterior walls of the stomach are united anteriorly around the gastric fundus to provide a complete 360-degree 4-5 cm wrap around the lower esophagus containing a large intraesophageal bougie (see the image below).
- ^ Minjarez, RC; Jobe BA. "Surgical therapy for gastroesophageal reflux disease". GI Motility online. doi:10.1038/gimo56 (inactive 2008-06-21).