hiatus hernia
TRANSCRIPT
Hiatus herniaFrom Wikipedia, the free encyclopediaJump to: navigation, search
Ventricular herniaClassification and external resources
ICD-10K 44. , Q 40.1
ICD-9553.3, 750.6
OMIM 142400DiseasesDB 29116MedlinePlus 001137
eMedicinemed/1012 radio/337
MeSH D006551
A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.
Contents
[hide]
1 Classification 2 Signs and symptoms 3 Risk factors 4 Diagnosis 5 Treatment 6 Prognosis 7 Epidemiology 8 Notes and references 9 External links
[edit] Classification
Schematic diagram of different types of hiatus hernia. Green is the esophagus, Red is the diaphragm, blue is the HIS-angle. A is the normal anatomy, B is a pre-stage, C is a sliding hiatal hernia, and D is a paraesophageal type
There are two major kinds of hiatus hernia: [1]
The most common (95%) is the sliding hiatus hernia, where the gastroesophageal junction moves above the diaphragm together with some of the stomach.
The second kind is rolling (or paraesophageal) hiatus hernia, when a part of the stomach herniates through the esophageal hiatus and lies beside the esophagus, without movement of the gastroesophageal junction. It accounts for the remaining 5% of hiatus hernias. [2]
A third kind is also sometimes described, and is a combination of the first and second kinds.
[edit] Signs and symptoms
Hiatal Hernia has often been called the "great mimic" because its symptoms can resemble many disorders. For example, a person with this problem can experience dull pains in his or her chest, shortness of breath (caused by the hernia's effect on the diaphragm), and heart palpitations (due to irritation of the vagus nerve).
In most cases however, a hiatal hernia does not cause any symptoms. The pain and discomfort that a patient experiences is due to the reflux of gastric acid, air or bile. While there are several causes of acid reflux, it does happen more frequently in the presence of hiatal hernia.
[edit] Risk factors
The following are risk factors that can result in a hiatus hernia.
Increased pressure within the abdomen caused by:
o Heavy lifting or bending overo Frequent or hard coughingo Hard sneezingo Pregnancy and deliveryo Violent vomiting o Straining with constipation
o Obesity (extra weight pushes down on the abdomen increasing the pressure)
o Use of the sitting position for defecation [3] (See epidemiology below)
Heredity Smoking Drug use , such as cocaine.[citation needed]
Stress Diaphragm weakness[citation needed]
[edit] Diagnosis
A large hiatus hernia on Xray marked by open arrows in contrast to the heart borders marked by closed arrows.
Upper GI endoscopy depicting hiatus hernia.
The diagnosis of a hiatus hernia is typically made through an upper GI series, endoscopy or High resolution manometry.
[edit] Treatment
In most cases, sufferers experience no discomfort and no treatment is required. However, when the hiatal hernia is large, or is of the paraesophageal type, it is likely to cause esophageal stricture and discomfort. Symptomatic patients should elevate the head of their beds and avoid lying down directly after meals until treatment is rendered. If the condition has been brought on by stress, stress reduction techniques may
be prescribed, or if overweight, weight loss may be indicated. Medications that reduce the lower esophageal sphincter (or LES) pressure should be avoided. Antisecretory drugs like proton pump inhibitors and H2 receptor blockers can be used to reduce acid secretion.
Where hernia symptoms are severe and chronic acid reflux is involved, surgery is sometimes recommended, as chronic reflux can severely injure the esophagus and even lead to esophageal cancer.
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. The procedure is now commonly performed
laparoscopically. With proper patient selection, laparoscopic fundoplication has low complication rates and a quick recovery.[4]
Complications include gas bloat syndrome, dysphagia (trouble swallowing), dumping syndrome, excessive scarring, and rarely, achalasia. The procedure sometimes fails over time, requiring a second surgery to make repairs.
[edit] Prognosis
A hiatus hernia per se does not cause any symptoms. The condition promotes reflux of gastric contents (via its direct and indirect actions on the anti-reflux mechanism) and thus is associated with gastroesophageal reflux disease (GERD). In this way a hiatus hernia is associated with all the potential consequences of GERD - heartburn, esophagitis, Barrett's esophagus and
esophageal cancer. However the risk attributable to the hiatus hernia is difficult to quantify, and at most is low.[citation needed]
Besides discomfort from GERD and dysphagia, hiatal hernias can have severe consequences if not treated. While sliding hernias are primarily associated with gastroesophageal acid reflux, rolling hernias can strangulate a portion of the stomach above the diaphragm. This strangulation can result in esophageal or GI tract obstruction and the tissue can even become ischemic and necrose.
Another severe complication, although very rare, is a large herniation that can restrict the inflation of a lung, causing pain and breathing problems.
Most cases are asymptomatic.
[edit] Epidemiology
Incidence of hiatal hernias increases with age; approximately 60% of individuals aged 50 or older have a hiatal hernia.[5] Of these, 9% are symptomatic, depending on the competence of the lower esophageal sphincter (LES). 95% of these are "sliding" hiatus hernias, in which the LES protrudes above the diaphragm along with the stomach, and only 5% are the "rolling" type (paraesophageal), in which the LES remains stationary but the stomach protrudes above the diaphragm. People of all ages can get this condition, but it is more common in older people.
According to Dr. Denis Burkitt, "Hiatus hernia has its maximum prevalence in economically developed communities in North America and Western Europe....In contrast the disease is rare in situations typified by rural African communities."[3] Burkitt attributes the disease to insufficient
dietary fiber and the use of the unnatural sitting position for defecation. Both factors create the need for straining at stool, increasing intraabdominal pressure and pushing the stomach through the esophageal hiatus in the diaphragm.[6]
[edit] Notes and references
1. ̂ 01011 at CHORUS2. ̂ Lawrence, P. (1992). Essentials of
General Surgery. Baltimore: Williams & Wilkins. p. 178. ISBN 0-683-04869-4.
3. ^ a b Burkitt DP (1981). "Hiatus hernia: is it preventable?". Am. J. Clin. Nutr. 34 (3): 428–31. PMID 6259926. http://www.ajcn.org/cgi/reprint/34/3/428.pdf.
4. ̂ Lange CMDT 20065. ̂ Goyal Raj K, "Chapter 286.
Diseases of the Esophagus". Harrison's Principles of Internal Medicine, 17e.
6. ̂ Sontag S (1999). "Defining GERD". Yale J Biol Med 72 (2-3): 69–80. PMID 10780568.
[edit] External links
Wikimedia Commons has media related to: Hiatal hernia
01011 at CHORUS
[show] v • d • e
Digestive system · Digestive disease · Gastroenterology (primarily K20–K93,
530–579)EsophagusEsophagitis (Candidal,
Herpetiform) · rupture (Boerhaave syndrome, Mallory-Weiss syndrome) · UES (Zenker's diverticulum) · LES (Barrett's esophagus) · Esophageal motility
disorder (Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, Gastroesophageal reflux disease (GERD)) · Laryngopharyngeal reflux (LPR) · Esophageal stricture · Megaesophagus
Stomach
Gastritis (Atrophic, Ménétrier's disease, Gastroenteritis) · Peptic (gastric) ulcer (Cushing ulcer, Dieulafoy's lesion) · Dyspepsia · Pyloric stenosis · Achlorhydria · Gastroparesis · Gastroptosis · Portal hypertensive gastropathy · Gastric antral vascular ectasia · Gastric dumping syndrome · Gastric volvulus
Small intestine/(duodenum/jejunum/ileum)
Enteritis (Duodenitis, Jejunitis, Ileitis) — Peptic (duodenal) ulcer (Curling's
ulcer) — Malabsorption: Coeliac · Tropical sprue · Blind loop syndrome · Whipple's · Short bowel syndrome · Steatorrhea · Milroy disease
Large intestine(appendix/colon)
Appendicitis · Colitis (Pseudomembranous, Ulcerative, Ischemic, Microscopic, Collagenous, Lymphocytic) · Functional colonic disease (IBS, Intestinal pseudoobstruction/Ogilvie
syndrome) — Megacolon/Toxic megacolon · Diverticulitis/Diverticulosis
Large and/or small
Enterocolitis (Necrotizing) · IBD (Crohn's disease) — vascular: Abdominal angina · Mesenteric ischemia · Angiodysplasia — Bowel obstruction: Ileus · Intussusception · Volvulus · Fecal impaction — Constipation · Diarrhea (Infectious) · Intestinal adhesions
Rectum Proctitis (Radiation
proctitis) · Proctalgia fugax · Rectal prolapse · Anismus
Anal canal
Anal fissure/Anal fistula · Anal abscess · Anal dysplasia · Pruritus ani
Liver
Hepatitis (Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis) · Cirrhosis (PBC) · Fatty liver (NASH) · vascular (Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver) · Alcoholic liver disease · Liver failure (Hepatic encephalopathy, Acute liver failure) · Liver abscess (Pyogenic, Amoebic) · Hepatorenal syndrome · Peliosis hepatis
Gallbladder
Cholecystitis · Gallstones/Cholecystolithiasis · Cholesterolosis · Rokitansky-Aschoff sinuses · Postcholecystectomy syndrome · Porcelain gallbladder
Bile duct/other biliary tree
Cholangitis (PSC, Secondary sclerosing cholangitis, Ascending) · Cholestasis/Mirizzi's syndrome · Biliary fistula · Haemobilia · Gallstones/Cholelithiasis
common bile duct (Choledocholithiasis, Biliary dyskinesia) · Sphincter of Oddi dysfunction
Pancreatic Pancreatitis (Acute, Chronic, Hereditary, Pancreatic abscess) · Pancreatic pseudocyst ·
Exocrine pancreatic insufficiency · Pancreatic fistula
Hernia
Diaphragmatic (Congenital) · Hiatus
Inguinal (Indirect, Direct) · Umbilical · Femoral · Obturator · Spigelian
lumbar (Petit's, Grynfeltt-Lesshaft)
undefined location (Incisional · Internal hernia)
PeritonealPeritonitis (Spontaneous bacterial peritonitis) · Hemoperitoneum · Pneumoperitoneum
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v • d • eCongenital malformations and
deformations of digestive system (Q35-Q45, 749-751)
Tongue, mouth and pharynx
Cleft lip and palate · Van der Woude syndrome · tongue (Ankyloglossia, Macroglossia, Hypoglossia)
Esophagus
EA/TEF (Esophageal atresia: types A, B, C, and D, Tracheoesophageal fistula: types B, C, D and E)esophageal rings (Esophageal web · upper , Schatzki ring · lower)
Stomach Pyloric stenosis · Hiatus herniaIntestines Intestinal atresia (Duodenal
atresia) · Meckel's diverticulum · Hirschsprung's disease · Intestinal
malrotation · Dolichocolon · Enteric duplication cyst
Rectum/anal canal
Imperforate anus · Persistent cloaca
Pancreas
Annular pancreas · Accessory pancreas · Johanson–Blizzard syndrome
Pancreas divisumBile duct
Choledochal cysts (Caroli disease) · Biliary atresia
LiverAlagille syndrome · Polycystic liver disease
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GRetrieved from "http://en.wikipedia.org/wiki/Hiatus_hernia"Categories: Hernias | Congenital disorders of digestive systemHidden categories: All articles with unsourced statements | Articles with unsourced statements from September 2008 | Articles with unsourced statements from July 2009 | All pages needing cleanup
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