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hiatal hernia
Herniation of part of the stomach through the esophageal hiatus of the diaphragm.
Pathology:
- gastoesophageal reflux disease (GERD)
Genetics:
- see congenital diaphragmatic hernia
Clinical manifestations:
1) pain in the epigastric region or lower thorax
a) worse when reclining
b) relieved on standing
c) pain may be retrosternal with radiation to the left arm mimicking angina pectoris
2) hematemesis
3) large herniations
a) dullness on percussion in left lung base
b) absent breath sounds in left lung base
c) peristaltic sounds in left lung base
4) gastric reflux, nausea, bloating, chest discomfort, epigastric discomfort pharyngeal expulsion, esophageal expulsion, dysphagia [2]
5) severe symptoms include weight loss, colorectal bleeding
Special laboratory:
- upper GI endoscopy identifies untreatable gastric reflux
- manometry measures esophageal peristalsis [2]
Radiology:
- chest X-ray can show hiatal hernia
- barium swallow demonstrates the stomach above the diaphragm
Complications:
- incarceration of hiatal hernia
- nausea/vomiting changing to inability to vomit or retain oral intake
- no fever, leukocytosis
Management:
- treatment of GERD
- minimally invasive laparoscopic surgical correction [2]
General
diaphragmatic hernia
chronic gastrointestinal disease
References
- DeGowin & DeGowin's Diagnostic Examination, 6th edition,
RL DeGowin (ed), McGraw Hill, NY 1994, pg 879
- Yu HX, Han CS, Xue JR, Han ZF, Xin H.
Esophageal hiatal hernia: risk, diagnosis and management.
Expert Rev Gastroenterol Hepatol. 2018 Apr;12(4):319-329.
PMID: 29451037 Review.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Acid Reflux (GER & GERD) in Adults
https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults