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Hiatal Hernia
Diaphragmatic Hernia

Presentation

Examination is usually normal unless an underlying risk factor is present, or presentation is with complications of a para-oesophageal hernia such as obstruction. [patient.info]

Type II herniation presents with the GEJ in normal anatomic position, but with a gastric fundus herniation [2]. [pulsus.com]

Patients with PEH or mixed hiatal hernias typically present with intermittent dysphagia, substernal discomfort, or abdominal pain, and in rare cases present acutely with gastric volvulus and strangulation. [amboss.com]

Patients present with epigastric abdominal pain, hematemesis, retching, and inability to pass a nasogastric tube and need to be surgically treated. [kenhub.com]

Snapshot A 55-year-old man presents to the emergency room for palpitations and shortness of breath. He never had this problem before but notes that this has been progressive since he started heavy weight lifting training. [step2.medbullets.com]

Entire Body System

  • Anemia

    The acid may also cause ulcers within the stomach that can bleed and lead to acute or chronic anemia (low blood counts). There are a few different kinds of hiatal hernias. [uofmhealth.org]

    Anemia: Anemia is the most common laboratory finding in patients with paraesophageal (type II) hiatal hernia, and results from damage and ulceration to the lining of the stomach due to compression of the stomach at the level of esophageal hiatus (see [memorialhermann.org]

    Complications may include pulmonary (lung) aspiration, slow bleeding and iron deficiency anemia (for large hernias), and strangulation (closing off) of the hernia. [northwell.edu]

    If conservative measures fail to control the symptoms or if complications such as pulmonary (lung) aspiration, iron deficiency anemia (slow bleeding due to a large hernia), or strangulation of the hernia occur, surgical repair is indicated. [surgery.ucla.edu]

    Anemia, or low red blood cell count, can result herunterladen. Further, chronic inflammation of the lower esophagus may produce scarring and narrowing in this area. [ecaware.org]

Gastrointestinal

  • Dysphagia

    This indentation is called a Schatzki's ring (or "B ring") although that term is reserved by some only for such rings that produce dysphagia. [learningradiology.com]

    Paraesophageal hernias can become strangulated, resulting in dysphagia or chest pain, and require surgical correction. [pathwaymedicine.org]

    Difficulty swallowing (dysphagia) is another side effect that tends to improve in most patients with time – provided food is chewed thoroughly. [mcw.edu]

    Dysphagia (difficulty swallowing): Hiatal hernias can cause obstruction and delay in emptying of the lower part of the esophagus and the stomach, resulting in dysphagia. [memorialhermann.org]

    Dysphagia following Nissen fundoplication is due to the fundoplication being too tightly wrapped around the oesophagus leading to narrowing and patients unable to swallow solids. [kenhub.com]

  • Waterbrash

    The symptoms of gastroesophageal reflux disease (GERD) include heartburn, chest pain or burning, nausea, vomiting or retching (dry heaves) burping waterbrash, the rapid appearance of a large amount of saliva in the mouth that is stimulated by the refluxing [medicinenet.com]

  • Pyrosis

    A patient may exhibit such symptoms such as pyrosis (heartburn), occurring 1 to 4 hours after eating and aggravated by increased intra-abdominal pressure, accompanied by regurgitation or vomiting or retrosternal (behind the sternum, the bone lying mid [rn-journal.com]

Cardiovascular

  • Chest Pain

    Common symptoms from a paraesophageal hernia include: Chest pain—there are many causes for chest pain. [mcw.edu]

    Another symptom of a hiatal hernia is chest pain. Since chest pain can also be a symptom of a heart attack, it’s important to contact your healthcare provider or go to the emergency room if you experience any chest pain. [my.clevelandclinic.org]

    A hiatal hernia or GERD can cause chest pain with heartburn. The pain may feel dull and heavy in your chest. Heartburn does not involve your heart in any way. [colonialhealthcare.com]

    Chest pain: The chest pain commonly occurs postprandially (after eating) and is substernal (behind the breast bone) in location, giving rise to concern that the chest pain is cardiac in origin. [memorialhermann.org]

    Symptoms of strangulation may include: Chest pain Bloating Burping Problems swallowing If you have symptoms of strangulation, you should see a doctor right away. Doctors can often see a large hiatus hernia on a basic chest x-ray. [merckmanuals.com]

Workup

X-Ray

  • Esophageal Motility Disorder

    Esophageal manometry and 24 hour pH monitoring play important roles in assessment of esophageal motility disorders and reflux. For reflux, medical management with proton pump inhibitors constitutes the initial treatment of choice. [scielo.org.co]

Treatment

Outlook (Prognosis) Treatment can relieve most symptoms of hiatal hernia. [pennmedicine.org]

Treatments Hiatal hernias don’t always require treatment beyond regular monitoring and medications. Under certain conditions, however, treatment will be necessary. [uofmhealth.org]

You work with a team that gives you individual attention and treatment that offers you the best possible results. Leaders in robotic surgery treatment. We have some of the world’s most experienced robotic surgeons for minimally invasive procedures. [umiamihealth.org]

Treatment The goals of treatment of hiatal hernias are to relieve symptoms and prevent complications. [surgery.ucla.edu]

Treatment Treatment options depend on the type of hernia you have and the severity of your condition. [dignityhealth.org]

Prognosis

> 95%) gastroesophageal junction (GEJ) herniating through diaphragm paraesophageal (type II, III, and IV; < 10%) gastric fundus herniating through the diaphragm with the GEJ remaining below the diaphragm Associated conditions gastroesophageal reflux Prognosis [step2.medbullets.com]

[…] size, orientation of herniated stomach within the lower thorax herniated contents lie adjacent to the esophagus widening of esophageal hiatus dehiscence of diaphragmatic crura (>15 mm): increased distance between crura and esophageal wall Treatment and prognosis [radiopaedia.org]

Outlook (Prognosis) Treatment can relieve most symptoms of hiatal hernia. [pennmedicine.org]

What Is the Prognosis of a Hiatal Hernia? If treated appropriately and lifestyle changes are made, you can minimize the effects of a hiatal hernia. If left untreated, complications can arise such as a strangulated hiatal hernia. [emedicinehealth.com]

Etiology

Etiology The etiology is multifactorial. [amboss.com]

Etiology of hiatus hernia is usually unknown, but a hiatus hernia is thought to be acquired through stretching of the fascial attachments between the esophagus and diaphragm at the hiatus (the opening through which the esophagus traverses the diaphragm [merckmanuals.com]

The multifactorial etiology and broad spectrum of presentation of recurrent hiatal hernias impede diagnosis and study and require extensive diagnostic suspicion and one or more complementary studies depending on the presentation. [scielo.org.co]

Definitions and etiology Attempts began early in the last century to classify hiatal hernia into subtypes5. The current anatomic classification has evolved to include a categorization of hiatal hernias into Types I – IV. [sages.org]

Epidemiology

Epidemiology Incidence increases with: Prevalence References:[1][2] Epidemiological data refers to the US, unless otherwise specified. Etiology The etiology is multifactorial. [amboss.com]

Introduction Overview a hernia through the esophageal hiatus of the diaphragm such that abdominal contents enter the chest treatment is usually lifestyle modifications and antacids, but surgery may be required Epidemiology incidence under detected due [step2.medbullets.com]

Epidemiology[1] The precise incidence of hiatus hernia is not known, as most studies have looked only at individuals who presented with symptoms of dyspepsia. [patient.info]

With proper patient selection, laparoscopic fundoplication recent studies have indicated relatively low complication rates, quick recovery, and relatively good long term results.[14][15][16][17][18] Epidemiology[edit] Incidence of hiatal hernias increases [en.wikipedia.org]

EPIDEMIOLOGY More than 95% of primary hiatal hernias are Type I sliding hernias. Types II, III and IV are grouped as para-esophageal hernias. Of these, over 90% are type III. Type II is the least common (Figure 1) (12). [scielo.org.co]

Pathophysiology

Type III: mixed hiatal hernia Type IV: complex hiatal hernia References:[3][5] Pathophysiology Changes in the presence of a hiatal hernia Predisposing factors lead to laxity of the esophageal hiatus, e.g.: Advanced age → phrenoesophageal ligament weakens [amboss.com]

ETIOPATHOGENESIS The pathophysiologies of primary hiatal hernias and recurrent hiatal hernias are not entirely clear. [scielo.org.co]

To facilitate review by multiple reviewers, these articles were divided into the following topics: Definitions, classification and pathophysiology Diagnosis Natural history and indications for surgery Preoperative assessment Technical considerations Transthoracic [sages.org]

Prevention

Normally, there are several mechanisms to prevent acid from flowing backwards (refluxing) up into the esophagus. [wakegastro.com]

Prevention Controlling risk factors such as obesity may help prevent hiatal hernia. References Brady MF. Hiatal hernia. In: Ferri FF, ed. Ferri's Clinical Advisor 2019. Philadelphia, PA: Elsevier; 2019:663.e2-663.e5. Falk GW, Katzka DA. [pennmedicine.org]

Folding the stomach around the lower esophagus to create a bumped, which prevents the stomach from riding back up into the chest again. [tampabayrefluxcenter.com]

To prevent the stomach from migrating upwards during healing, the surgeon may also suture the stomach to connective tissue in the abdomen, or place into the stomach a feeding tube that exits through the skin of the abdomen. [utmbhealth.com]

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