Hiatus hernia
Updates to Article Attributes
Hiatus hernias (HH) occur when there when there is herniation abdominal contents through the oesophageal hiatus of the diaphragm into the thoracic cavity.
Clinical presentation
Many patients with HH are asymptomatic and it is an incidental finding. However, symptoms may include epigastric/chest pain, post prandial fullness, nausea and vomiting 3.
Sometimes HH are considered synonymous with gastro-oesophageal reflux disease (GORD) but there is a poor correlation between the two conditions.
Pathology
The most common contents of a HH is the stomach. There are two main types of hiatus hernia, although (although they may co co-exist):
Subtypes
Sliding hiatus hernia
This is the most common type of hiatus hernia (95(~90%). The gastro-oesophageal junction (GOJ) is usually displaced by more than 2 cm>2 cm above the oesophageal hiatus. The oesophageal hiatus is often abnormally widened to 3-4 cm (the upper limit of normal is 15 mm1.5 cm).
The gastric fundus may also also be displaced above the diaphragm and present as a retrocardiac mass on a chest radiograph. The presence of an air-fluid level in the mass suggests the diagnosis.
Small, sliding hiatus hernias commonly reduce in the upright position. The mere presence of a sliding hiatus hernia is of limited clinical significance in most cases. The function of the lower oesophageal sphincter and the presence of pathologic gastro-oesophageal reflux are the crucial factors in producing symptoms and causing complications.
Rolling (para-oesophageal) hiatus hernia
The rolling rolling (para-oesophageal) hiatus hernia is much less common than the sliding type. The GOJ remains in its normal location while a portion of the stomach herniates above the diaphragm.
The mixed or compound hiatal hernia is the most commonestcommon type of para-oesophageal hernia. The GOJ is displaced into the thorax with a large portion of the stomach, which is usually abnormally rotated.
Complications
HH containing stomach may result in gastric volvulus, which in turn presents as intestinal obstruction and may result in ischaemia/infarction.
Radiographic features
Plain radiograph
- retrocardiac opacity with air-fluid level
Differential diagnosis
On a frontal chest radiograph consider:
- retrocardiac lung abscess
- retrocardiac empyema
- epiphrenic oesophageal diverticulum
See also
-<p><strong>Hiatus hernias</strong> (<strong>HH</strong>) occur when there is herniation abdominal contents through the <a href="/articles/oesophageal-hiatus">oesophageal hiatus</a> of the <a href="/articles/diaphragm">diaphragm</a> into the thoracic cavity.</p><h4>Clinical presentation</h4><p>Many patients with HH are asymptomatic and it is an incidental finding. However, symptoms may include epigastric/chest pain, post prandial fullness, nausea and vomiting <sup>3</sup>. </p><p>Sometimes HH are considered synonymous with <a href="/articles/gastro-oesophageal-reflux-disease">gastro-oesophageal reflux disease (GORD)</a> but there is a poor correlation between the two conditions.</p><h4>Pathology</h4><p>The most common contents of a HH is the <a href="/articles/stomach">stomach</a>. There are two main types of hiatus hernia, although they may co-exist:</p><ul>- +<p><strong>Hiatus hernias</strong> (<strong>HH</strong>) occur when there is herniation abdominal contents through the <a href="/articles/oesophageal-hiatus">oesophageal hiatus</a> of the <a href="/articles/diaphragm">diaphragm</a> into the thoracic cavity.</p><h4>Clinical presentation</h4><p>Many patients with HH are asymptomatic and it is an incidental finding. However, symptoms may include epigastric/chest pain, post prandial fullness, nausea and vomiting <sup>3</sup>. </p><p>Sometimes HH are considered synonymous with <a href="/articles/gastro-oesophageal-reflux-disease">gastro-oesophageal reflux disease (GORD)</a> but there is a poor correlation between the two conditions.</p><h4>Pathology</h4><p>The most common contents of a HH is the <a href="/articles/stomach">stomach</a>. There are two main types of hiatus hernia (although they may co-exist):</p><ul>
-</ul><h5>Subtypes</h5><h6>Sliding hiatus hernia</h6><p>This is the most common type of hiatus hernia (95%). The <a href="/articles/gastro-oesophageal-junction">gastro-oesophageal junction</a> (GOJ) is usually displaced by more than 2 cm above the hiatus. The oesophageal hiatus is often abnormally widened to 3-4 cm (the upper limit of normal is 15 mm).</p><p>The gastric fundus may also be displaced above the <a href="/articles/diaphragm">diaphragm</a> and present as a <a href="/articles/retrocardiac-mass">retrocardiac mass</a> on a chest radiograph. The presence of an air-fluid level in the mass suggests the diagnosis.</p><p>Small, sliding hiatus hernias commonly reduce in the upright position. The mere presence of a sliding hiatus hernia is of limited clinical significance in most cases. The function of the lower oesophageal sphincter and the presence of pathologic gastro-oesophageal reflux are the crucial factors in producing symptoms and causing complications.</p><h6>Rolling (para-oesophageal) hiatus hernia</h6><p>The rolling (para-oesophageal) hiatus hernia is much less common than the sliding type. The GOJ remains in its normal location while a portion of the stomach herniates above the diaphragm.</p><p>The mixed or compound hiatal hernia is the most commonest type of para-oesophageal hernia. The GOJ is displaced into the thorax with a large portion of the stomach, which is usually abnormally rotated.</p><h5>Complications</h5><p>HH containing stomach may result in <a href="/articles/gastric-volvulus">gastric volvulus</a>, which in turn presents as intestinal obstruction and may result in ischaemia/infarction. </p><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul><li>retrocardiac opacity with air-fluid level </li></ul><h4>Differential diagnosis</h4><p>On a frontal chest radiograph consider:</p><ul>- +</ul><h5>Subtypes</h5><h6>Sliding hiatus hernia</h6><p>This is the most common type of hiatus hernia (~90%). The <a href="/articles/gastro-oesophageal-junction">gastro-oesophageal junction</a> (GOJ) is usually displaced >2 cm above the oesophageal hiatus. The oesophageal hiatus is often abnormally widened to 3-4 cm (the upper limit of normal is 1.5 cm).</p><p>The gastric fundus may also be displaced above the <a href="/articles/diaphragm">diaphragm</a> and present as a <a href="/articles/retrocardiac-mass">retrocardiac mass</a> on a chest radiograph. The presence of an air-fluid level in the mass suggests the diagnosis.</p><p>Small, sliding hiatus hernias commonly reduce in the upright position. The mere presence of a sliding hiatus hernia is of limited clinical significance in most cases. The function of the lower oesophageal sphincter and the presence of pathologic <a href="/articles/gastro-oesophageal-reflux-disease">gastro-oesophageal reflux</a> are the crucial factors in producing symptoms and causing complications.</p><h6>Rolling (para-oesophageal) hiatus hernia</h6><p>The rolling (para-oesophageal) hiatus hernia is much less common than the sliding type. The GOJ remains in its normal location while a portion of the stomach herniates above the diaphragm.</p><p>The mixed or compound hiatal hernia is the most common type of para-oesophageal hernia. The GOJ is displaced into the thorax with a large portion of the stomach, which is usually abnormally rotated.</p><h5>Complications</h5><p>HH containing stomach may result in <a href="/articles/gastric-volvulus">gastric volvulus</a>, which in turn presents as intestinal obstruction and may result in ischaemia/infarction. </p><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul><li>retrocardiac opacity with air-fluid level </li></ul><h4>Differential diagnosis</h4><p>On a frontal chest radiograph consider:</p><ul>
Tags changed:
- general surgery
Unable to process the form. Check for errors and try again.