7/10/15, 18:55Hiatus hernia - Wikipedia, the free encyclopedia

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Ventricular hernia

Classification and external resources

SpecialtyGastroenterology, general surgery

DiseasesDB = 29116

ICD-10 K44(http://apps.who.int/classifications/icd10/browse/2015/en#/K44),Q40.1(http://apps.who.int/classifications/icd10/browse/2015/en#/Q40.1)

ICD-9-CM 553.3 (http://www.icd9data.com/getICD9Code.ashx?icd9=553.3),750.6 (http://www.icd9data.com/getICD9Code.ashx?icd9=750.6)

OMIM 142400 (http://omim.org/entry/142400)

MedlinePlus 001137(http://www.nlm.nih.gov/medlineplus/ency/article/001137.htm)

eMedicine med/1012 (http://www.emedicine.com/med/topic1012.htm)radio/337 (http://www.emedicine.com/radio/topic337.htm#)

MeSH D006551 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?field=uid&term=D006551)

Hiatus herniaFrom Wikipedia, the free encyclopedia

A hiatus hernia or hiatal hernia isthe protrusion (or herniation) of theupper part of the stomach into thethorax through a tear or weakness inthe diaphragm. Hiatus hernias oftenresult in heartburn but may alsocause chest pain or pain witheating.[1]

The most common cause is obesity.The diagnosis is often by endoscopyor medical imaging.[1]

A hiatus hernia may be treated withlifestyle changes such as raising thehead of the bed, weight loss, andadjusting eating habits. Medicationssuch as H2 blockers or proton pumpinhibitors may help. If the symptomsdo not improve with medications thesurgery known as laparoscopicfundoplication may be an option.[1] Itis not known how commonly hiatushernias occur with estimates in NorthAmerica varying from 10 to 80%.[1]

Contents1 Signs and symptoms2 Risk factors3 Diagnosis

3.1 Classification4 Treatment5 Epidemiology6 References7 External links

Signs and symptoms

7/10/15, 18:55Hiatus hernia - Wikipedia, the free encyclopedia

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Hiatal hernia has often been called the "great mimic" because its symptoms can resemble many disorders. Forexample, a person with this problem can experience dull pains in the chest, shortness of breath (caused by thehernia's effect on the diaphragm), heart palpitations (due to irritation of the vagus nerve), and swallowed food"balling up" and causing discomfort in lower esophagus until it passes on to stomach.

In most cases however, a hiatal hernia does not cause any symptoms. The pain and discomfort that a patientexperiences is due to the reflux of gastric acid, air, or bile. While there are several causes of acid reflux, it doeshappen more frequently in the presence of hiatal hernia.

For newborn the presence of Bochdalek hernia can be recognised [2] from symptoms such as difficulty breathing[3] fast respiration, increased heart rate.[4]

Risk factorsThe following are risk factors that can result in a hiatus hernia.

Increased pressure within the abdomen caused by:Heavy lifting or bending overFrequent or hard coughingHard sneezingViolent vomitingStrainingStress

DiagnosisThe diagnosis of a hiatus hernia is typically made through an upper GI series, endoscopy or high resolutionmanometry.

A large hiatus hernia onX-ray marked by openarrows in contrast to theheart borders marked byclosed arrows

Upper GI endoscopydepicting hiatus hernia

A hiatus hernia as seenon CT

Classification

7/10/15, 18:55Hiatus hernia - Wikipedia, the free encyclopedia

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Schematic diagram of different typesof hiatus hernia. Green is theesophagus, red is the stomach, purpleis the diaphragm, blue is the HIS-angle. A is the normal anatomy, B is apre-stage, C is a sliding hiatal hernia,and D is a paraesophageal (rolling)type.

Three types of esophageal hiatal hernia are identified:

type I (sliding) hernia: characterized by an upward herniation of thecardia and GE junction in the posterior mediastinum. The most commontype of Hiatal hernias (C).[5]

type II (rolling or paraesophageal) hernia (PEH): characterized by anupward herniation of the gastric fundus alongside a normally positionedcardia. The GE junction is in its normal place (D).

type III (combined sliding-rolling or mixed) hernia: characterized byan upward herniation of both the cardia and the gastric fundus.

type IV hiatal hernia: is declared in some taxonomies, when anadditional organ, usually the colon, herniates as well.

The end stage of type I and type II hernias occurs when the wholestomach migrates up into the chest by rotating 180° around itslongitudinal axis, with the cardia and pylorus as fixed points. In thissituation the abnormality is usually referred to as an intrathoracicstomach.

TreatmentIn most cases, sufferers experience no discomfort and no treatment isrequired. If there is pain or discomfort, 3 or 4 sips of room temperature water will usually relieve the pain.However, when the hiatal hernia is large, or is of the paraesophageal type, it is likely to cause esophagealstricture and discomfort. Symptomatic patients should elevate the head of their beds and avoid lying downdirectly after meals. If the condition has been brought on by stress, stress reduction techniques may beprescribed, or if overweight, weight loss may be indicated. Medications that reduce the lower esophagealsphincter (LES) pressure should be avoided. Antisecretory drugs like proton pump inhibitors and H2 receptorblockers can be used to reduce acid secretion.

Where hernia symptoms are severe and chronic acid reflux is involved, surgery is sometimes recommended, aschronic 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) ofthe stomach is wrapped, or plicated, around the inferior part of the esophagus, preventing herniation of thestomach through the hiatus in the diaphragm and the reflux of gastric acid. The procedure is now commonlyperformed laparoscopically. With proper patient selection, laparoscopic fundoplication recent studies haveindicated low complication rates, quick recovery, and relatively good long term results.[6][7][8][9][10]

Complications include gas bloat syndrome, dysphagia (trouble swallowing), dumping syndrome, excessivescarring, and rarely, achalasia. The procedure sometimes fails over time, requiring a second surgery to makerepairs.

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EpidemiologyIncidence of hiatal hernias increases with age; approximately 60% of individuals aged 50 or older have a hiatalhernia.[11] 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 withthe stomach, and only 5% are the "rolling" type (paraesophageal), in which the LES remains stationary but thestomach protrudes above the diaphragm. People of all ages can get this condition, but it is more common inolder people.

According to Dr. Denis Burkitt, "Hiatus hernia has its maximum prevalence in economically developedcommunities in North America and Western Europe ... In contrast the disease is rare in situations typified byrural African communities."[12] Burkitt attributes the disease to insufficient dietary fiber and the use of theunnatural sitting position for defecation. Both factors create the need for straining at stool, increasingintraabdominal pressure and pushing the stomach through the esophageal hiatus in the diaphragm.[13]

References1. Roman, S; Kahrilas, PJ (23 October 2014). "The diagnosis and management of hiatus hernia.". BMJ (Clinical research

ed.) 349: g6154. doi:10.1136/bmj.g6154 (https://dx.doi.org/10.1136%2Fbmj.g6154). PMID 25341679(https://www.ncbi.nlm.nih.gov/pubmed/25341679).

2. doi: 10.1016/s1875-9572(10)60006-x3. doi: :10.1016/j.athoracsur.20134. doi:10.1016/s0377-1237(05)80177-75. Brunicardi, F. Charles; Dane K. Andersen; Timothy R. Billiar (2010). "Chapter 25: Esophagus and Diaphragmatic

Hernia". Schwartz's Principles of Surgery (9th ed.). New York: McGraw-Hill, Medical Pub. Division. pp. 842–843.ISBN 978-0-07-1547703.

6. Migaczewski M et al. (January 2013). "Laparoscopic Nissen fundoplication in the treatment of Barrett's esophagus"(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3699774/). NCBI (PMC3699774). doi:10.5114/wiitm.2011.32941(https://dx.doi.org/10.5114%2Fwiitm.2011.32941).

7. Testoni PA et al. (May 2012). "Transoral incisionless fundoplication for treatment of gastroesophageal reflux disease inclinical practice" (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472060/). NCBI (PMC3472060).doi:10.1007/s00464-012-2324-2 (https://dx.doi.org/10.1007%2Fs00464-012-2324-2).

8. Ozmen V et al. (Dec 2005). "Histologic and clinical outcome after laparoscopic Nissen fundoplication forgastroesophageal reflux disease and Barrett's esophagus" (http://www.ncbi.nlm.nih.gov/pubmed/16362470). NCBI.PMID 16362470 (https://www.ncbi.nlm.nih.gov/pubmed/16362470).

9. Abbas AE et al. (Feb 2004). "Barrett's esophagus: the role of laparoscopic fundoplication"(http://www.ncbi.nlm.nih.gov/pubmed/14759403). NCBI. PMID 14759403(https://www.ncbi.nlm.nih.gov/pubmed/14759403).

10. "Journal Index PDF (fee for article)" (http://bu.edu.eg/portal/uploads/discussed_thesis/11311862/11311862_R.pdf) (PDF).Lange Current Medical Diagnosis & Treatment 2006.

11. Goyal Raj K, "Chapter 286. Diseases of the Esophagus". Harrison's Principles of Internal Medicine, 17e.12. Burkitt DP (1981). "Hiatus hernia: is it preventable?" (http://www.ajcn.org/cgi/reprint/34/3/428.pdf) (PDF). Am. J. Clin.

Nutr. 34 (3): 428–31. PMID 6259926 (https://www.ncbi.nlm.nih.gov/pubmed/6259926).13. Sontag S (1999). "Defining GERD" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579007). Yale J Biol Med 72 (2-

3): 69–80. PMC 2579007 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579007). PMID 10780568(https://www.ncbi.nlm.nih.gov/pubmed/10780568).

7/10/15, 18:55Hiatus hernia - Wikipedia, the free encyclopedia

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Wikimedia Commons hasmedia related to Hiatalhernia.

External links01011 (http://chorus.rad.mcw.edu/doc/01011.html) at CHORUS

Hiatal hernia CT Scans (http://www.ctcases.net/ct-cases-

database/4%20Abdomen%20And%20Pelvis/5%20Gastrointestinal%20Tract/4.5.13%20Hiatal%20hernia/) - CT CasesHiatus Hernia - Help and Advice (http://www.teammead.co.uk/hiatushernia) - Hiatus Hernia - Help andAdvice

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Categories: Diaphragmatic hernias Congenital disorders of digestive system

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