Hiatal Hernia

• Hiatial hernia : A condition characterized by an opening in the diaphragm through which the esophagus passes becomes enlarged
• Sliding (type 1) : 90%; upper stomach and gastroesophageal junction are displaced upward and slide in and out of the thorax
• Paraesophageal hernia (type 2, 3, 4): All or part of the stomach pushes through the diaphragm beside the esophagus
• Clinical Manifestations of Sliding hernia :

  • 50% asymptomatic
  • heartburn
  • regurgitation
  • dysphagia
• Clinical manifestations of paraesophageal hernia:

  • maybe asymptomatic
  • sense of fullness or chest pain after eating
• may appear in both sliding and paraesophageal hernia:

  • hemorrhage
  • obstruction
  • strangulation
• Assessment and diagnostic findings:

  • x-ray
  • barium swallow
  • fluoroscopy
• Management:

  • frequent and small feedings that can pass freely though the esophagus
  • avoid reclining 1hr after eating
  • elevate head of bead 4-8in (10-20cm)
  • surgery: 15% of patients
• Management:

  Paraesophageal hernia: same medical and surgical management with GERD however they may require emergency surgery to correct torsion (twisting) of the stomach or other body organ that leads to restriction of blood flow to that area