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Hiatal Hernia

Hiatus Hernia


Presentation

  • Nissen fundoplication also reinforces the lower esophageal sphincter and alleviates reflux when it is present.[columbiasurgery.org]
  • "A twenty-year review of early and late-presenting congenital Bochdalek diaphragmatic hernia: are they different clinical spectra?". Pediatr Neonatol. 51 (1): 26–30. doi : 10.1016/S1875-9572(10)60006-X. PMID 20225535.[en.wikipedia.org]
  • For those without structural abnormalities of the antireflux barrier, inappropriate tLESR is the dominant and single most important mechanism, and these patients tend to present with milder disease severity compared to those with severe GERD whose predominant[ncbi.nlm.nih.gov]
Anemia
  • Giant hiatal hernias may cause symptoms including heartburn/regurgitation, anemia, aspiration, chest pain associated with eating, vomiting after meals, difficulty swallowing, fatigue, and shortness of breath.[columbiasurgery.org]
  • Hiatal hernia Other names Hiatus hernia A drawing of a hiatal hernia Specialty Gastroenterology, general surgery Symptoms Taste of acid in the back of the mouth, heartburn, trouble swallowing [1] Complications Iron deficiency anemia, volvulus, bowel obstruction[en.wikipedia.org]
Weight Loss
  • Symptomatic patients should elevate the head of their beds and avoid lying down directly after meals. [1] If the condition has been brought on by stress, stress reduction techniques may be prescribed, or if overweight, weight loss may be indicated.[en.wikipedia.org]
  • Since GERD is the most common clinical manifestation in patients with hiatal hernia, lifestyle modifications (weight loss, elevation of head of bed, etc.) should be encouraged and medications (antacids, prokinetics, H2-receptor antagonists and proton[ncbi.nlm.nih.gov]
Physician
  • In esophagoscopy/endoscopy of the esophagus, a thin, flexible tube with a camera is inserted through the mouth into the esophagus, allowing the physician to view the interior of the esophagus and obtain small tissue samples for biopsy, if necessary.[columbiasurgery.org]
Disability
  • However surgery has its own risks including death and disability, so that even for large or paraesophageal hernias, watchful waiting may on balance be safer and cause fewer problems than surgery. [10] Complications from surgical procedures to correct[en.wikipedia.org]
Fatigue
  • Giant hiatal hernias may cause symptoms including heartburn/regurgitation, anemia, aspiration, chest pain associated with eating, vomiting after meals, difficulty swallowing, fatigue, and shortness of breath.[columbiasurgery.org]
Cough
  • Gorenstein, MD » Risk Factors Hiatal hernia is initiated by pressure in the abdomen occurring through: Heavy lifting Hard coughing or sneezing Violent vomiting Pregnancy and delivery Obesity may also cause hiatal hernia because of pressure on the abdomen[columbiasurgery.org]
  • […] symptoms such as difficulty breathing [4] fast respiration, increased heart rate. [5] Causes [ edit ] The following are potential causes of a hiatal hernia. [6] Increased pressure within the abdomen caused by: Heavy lifting or bending over Frequent or hard coughing[en.wikipedia.org]
  • The role of crural diaphragm in increasing the LES pressure becomes particularly more pronounced during periods of elevated intra-abdominal pressures such as coughing, abdominal straining and abdominal compression. 68, 69 However in hiatal hernia, the[ncbi.nlm.nih.gov]
Sneezing
  • Gorenstein, MD » Risk Factors Hiatal hernia is initiated by pressure in the abdomen occurring through: Heavy lifting Hard coughing or sneezing Violent vomiting Pregnancy and delivery Obesity may also cause hiatal hernia because of pressure on the abdomen[columbiasurgery.org]
  • […] difficulty breathing [4] fast respiration, increased heart rate. [5] Causes [ edit ] The following are potential causes of a hiatal hernia. [6] Increased pressure within the abdomen caused by: Heavy lifting or bending over Frequent or hard coughing Hard sneezing[en.wikipedia.org]
Chest Pain
  • Giant hiatal hernias may cause symptoms including heartburn/regurgitation, anemia, aspiration, chest pain associated with eating, vomiting after meals, difficulty swallowing, fatigue, and shortness of breath.[columbiasurgery.org]
  • In addition, hiatal hernias often result in heartburn but may also cause chest pain or pain with eating. [1] In most cases however, a hiatal hernia does not cause any symptoms.[en.wikipedia.org]
Palpitations
  • Among them, a person with a hiatal hernia can experience dull pains in the chest, shortness of breath (caused by the hernia's effect on the diaphragm ), heart palpitations (due to irritation of the vagus nerve ), and swallowed food "balling up" and causing[en.wikipedia.org]
Ulcer
  • Surgery should be considered for those patients with refractory symptoms and for those who develop complications, such as recurrent bleeding, ulcerations or strictures.[ncbi.nlm.nih.gov]
Irritability
  • Among them, a person with a hiatal hernia can experience dull pains in the chest, shortness of breath (caused by the hernia's effect on the diaphragm ), heart palpitations (due to irritation of the vagus nerve ), and swallowed food "balling up" and causing[en.wikipedia.org]

Treatment

  • Treatment [ edit ] In the great majority of cases, sufferers experience no life-altering discomfort, and no treatment is required. If there is pain or discomfort, 3 or 4 sips of room temperature water will usually relieve the pain.[en.wikipedia.org]
  • Because reflux may damage the lining of the esophagus, treatment is essential. Symptoms can usually be managed with medications and behavior modification such as elevating the upper body on a pillow during sleep.[columbiasurgery.org]
  • Therefore, the standard treatments for GERD still apply.[med.unc.edu]
  • TREATMENT The presence of hiatal hernia per se is not an indication for treatment, and therapy should be given to those with symptoms attributable to this condition.[ncbi.nlm.nih.gov]

Etiology

  • […] these patients tend to present with milder disease severity compared to those with severe GERD whose predominant mechanism can be attributed more to the presence of hypotonic LES and/or anatomical defect such as hiatal hernia. 4, 11, 13, 14 ANATOMY AND ETIOLOGY[ncbi.nlm.nih.gov]

Epidemiology

  • With proper patient selection, laparoscopic fundoplication recent studies have indicated relatively low complication rates, quick recovery, and relatively good long term results. [11] [12] [13] [14] [15] Epidemiology [ edit ] Incidence of hiatal hernias[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology of gastroesophageal reflux: lower esophageal sphincter dysfunction in gastroesophageal reflux disease. Gastroenterol Clin North Am. 1990; 19 :517–535. [ PubMed ] [ Google Scholar ] 6. Sloan S, Rademaker AW, Kahrilas PJ.[ncbi.nlm.nih.gov]

Prevention

  • Nissen Fundoplication To repair and prevent a sliding hiatal hernia, Nissen fundoplication involves wrapping of the fundus (upper part) of the stomach around the bottom portion of the esophagus to create a bulge of tissue that holds the stomach in place[columbiasurgery.org]
  • 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.[en.wikipedia.org]
  • The phrenoesophageal ligament/membrane is inserted circumferentially into the esophageal musculature in the close vicinity of the squamocolumnar junction (SCJ). 16 This ligament/membrane is essential in maintaining the competence of GEJ and preventing[ncbi.nlm.nih.gov]

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