hiatal hernia. distal esophagus- held in position by the phrenoesophageal ligament occurs most...
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HIATAL HERNIA
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HIATAL HERNIADistal esophagus- held in position by the
phrenoesophageal ligamentOccurs most commonly in womenMost hiatal hernias are asymptomatic5-10% of pts. will develop GERDThere is strong association with obesitySaint’s triad= gall stones+colonic
diverticular disease+hiatal hernia
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HIATAL HERNIAType I or sliding HH: ph.-esoph. lig.intact but
lax- distal esoph. and cardia herniate through the hiatus.
Type II or paraesophageal HH- focal defect of the ph.-esoph. lig.- greater curvature herniates upward alongside the esoph.
Type III- a combination of type I and II
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Sliding HH
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HIATAL HERNIASYMPTOMSType I- sy. of associated GERDType II, III- postprandial pain,
- bloating,- breathlessness with meals,- mild dysphagia
The herniated gastric pouch is susceptible to volvulus, obstruction, infarction, ischemic ulcers, occult bleeding, perforation, gangrene.
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HIATAL HERNIADIAGNOSIS AND EVALUATION
CXR- air/fluid level in post. M. on lat.view
Barium swallow- the dg. study of choice
Esophagoscopy- for GERD and esophagitis
Manometry and pH testing for refux sy.
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Hiatus hernia seen from below with the endoscope in an inverted position inside the stomach
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HIATAL HERNIAMANAGEMENT
Asymptomatic HH- no treatmentHH+GERD- medical treatmentIndications for surgery:
Symptomatic HH (chest pain, dysphagia)HH+ severe esophagitisHH type II, IIIOprative objectives: - reduction of hernia
- closure of the hiatal defect
- antireflux procedure