Hiatus herniae

Question 1

What are the types of Hiatus Herniae?

Answer 1

I. Sliding Hiatus Hernia

2. Paraoesophageal Hiatus Hernia
3. Mixed Hiatus Hernia
4. Other ado organ into thorax (spleen / bowel)

Question 2

What is a sliding hiatus hernia?

Answer 2

Herniation of both the stomach and gastrooesopageal junction into thorax. 90% of oesophageal hernias.

Question 3

RFx for sliding hiatus hernia?

Answer 3

• Age
• Increased intra-abdominal pressure (obesity, pregnancy, coughing, heavy lifting).
• Smoking

Question 4

Clinical features of sliding hiatus hernia?

Answer 4

-Mostly asymptomatic +/- GERD (decreased competence of GE junction)

Question 5

Complications of sliding hiatus hernia?

Answer 5

• GORD
• Other = rare and related to reflux (oesophagitis, stricture, BE, oesophageal carcinoma) + extra oesophageal reflux (pneumonia, aspiration pneumonitis, cough, laryngitis)

Question 6

Ix in hiatus hernia?

Answer 6

• Imaging: CXR, barium swallow, endoscopy or oesophageal manometry.
• Gastroscopy w/ biopsy: r/o oesophagitis, BE and carcinoma.

Question 7

Lifestyle Rx of hiatus hernia?

Answer 7

-Lifestyle: smoking, weight loss, elevate head of bed, no food >3h pre sleep. Avoid trigger foods

Question 8

Rx sliding hiatus hernia?

Answer 8

• Antacid
• H2 antagonist
• PPI
• Prokinetic agent

Question 9

Surgical Mx sliding hiatus hernia (+ when is it indicated)?

Answer 9

-Fundoplication (fundus of stomach wrapped around lower oesophagus and suture in place).
Indicated on failure of medical therapy, oesophageal stricter, severe nocturnal aspiration of BE.

Question 10

What is a paraoesophagheal hiatus hernia?

Answer 10

Herniation of all or part of the stomach through the oesophageal hiatus into the thorax with an undisplayed GE junction.

Question 11

Complications of paraoesophagheal hernia?

Answer 11

• Haemorrhage
• Incarceration/ strangulation/ obstruction
• Gastric stasis ulcer

Question 12

Treatment of paraoesophagheal hernia?

Answer 12

Surgical to prevent severe complications.

Reduce hernia and excise sac, repair defect at hiatus, anti-reflux fundoplication.