-IBIS-1.5.0-
tx
digestive system
hiatal hernia
diagnoses

definition and etiology

definition:
A herniation of a portion of the stomach into the thoracic cavity through an enlarged esophageal hiatus in the diaphragm.

etiology:
There is no clear cause, but trauma or congenital abnormality may be involved. In a sliding hiatal hernia the gastroesphageal junction and the fundus of the stomach both slide upwards; in paraesophageal hiatus hernia, the gastroesophageal junction remains in its anatomically correct position while just a pouch of the stomach slides up through the esophageal hiatus to sit next to the gastroesophageal junction. Hiatal hernias are common; they may be seen in up to 60% of the population over 50 years old.

signs and symptoms

signs and symptoms: often asymptomatic
• heartburn with esophageal reflux, aggravated by alcohol, smoking, coffee etc.
• chest pain: worse laying down down after eating
• feeling of fullness in the chest or neck
• sensation of restricted inhalation, sometimes
• dysphagia, sometimes

lab findings:
• (+) barium x-ray (presence of hiatal hernia does not rule out other causes of symptoms)
• endoscopy

course and prognosis

This is most commonly a chronic condition which may be asymptomatic or symptomatic or both at different times. Visceral manipulation and other therapies are often successful in treating it. Pharmacologic agents may ameliorate symptoms.

A paraesophageal hernia may incarcerate, strangulate, perforate or cause respiratory distress, creating a medical emergency. Either type of hernia may cause bleeding.

differential diagnosis

• peptic ulcer disease
• gastroesophageal reflux
• esophagitis
• gastritis
• angina pectoris


footnotes