Hiatus hernia

• What is a hiatus hernia?

  Herniation of the stomach up through the diaphragm
• What are the different types of hiatus hernia?

  Type 1 -> sliding

  Type 2 -> rolling

  Type 3 -> combination of sliding & rolling

  Type 4 -> large opening with additional abdo organs entering thorax
• What is the difference between a sliding & rolling hernia?

  Sliding

  • stomach slides up through diaphragm
  • gastro-oesophageal junction passes into thorax

  Rolling

  • separate portion of stomach folds around & enters through diaphragm opening

  
• What are the RFs for a hiatus hernia?

  Increasing age

  Obesity

  Prior hiatal surgery

  Increased intra-abdominal pressure (e.g. chronic cough, multiple births, ascites)
• What are the signs & symptoms of a hiatus hernia?

  Dyspepsia

  Painful swallowing

  Reflux

  Burping

  Bloating

  Halitosis

  Chronic cough

  OSB

  Possibly chest pain

  Bowel sounds present in chest

  NOTE: Hernias can be intermittent
• What are the Inx for a hiatus hernia?

  Full Hx & examination

  Endoscopy (OGD)

  CXR

  Oesophageal manometry

  Barium swallow
• What are the DDx of hiatus hernia?

  GORD

  Peptic ulcer disease

  Gastritis

  Gastric/oesophageal cancer
• What is the management of hiatus hernias?

  Weight loss

  Avoidance of large meals

  Avoid alcohol & acidic foods

  Smoking cessation

  PPI (4-8 wks, then assess response)

  Surgery (if medically-resistant)

  • laparoscopic fundoplication -> tying fundus around LOS