-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