Hiatus Hernia

  • 90% of the sliding type, 10% rolling

Rolling Hiatus Hernia

  • aka para-oesophageal
  • part of the fundus passes through diaphragm in a peritoneal sac and presses on oesophagus
  • cardio-oesophageal junction remains below diaphragm
  • no reflux as cardio-oesophageal sphincter mechanism is not compromised

Symptoms

  • Intermittent dysphaga -full stomach presses on oesophagus
  • Pain due to distension
  • Palpitations due to pressure on heart
  • Hiccoughs
  • Respiratory embarrassment

Investigations

  • CXR
    • air-fluid level in mediastinum
  • Barium meal
  • CT scan

Complications

  • Incarceration
  • gangrene
  • gastric volvulus

Treatment

  • Nissen Fundoplication

Sliding Hernia

  • Stomach slides through hiatus
  • position of cardio-oesophageal junction changes, mechanism compromised, reflux occurs

Symptoms

  • Retrosternal burning pain
  • Worse on bending, stooping or lying down
  • Heartburn
  • Acid regurgitation into mouth
  • Pain relieved by antacids
  • May radiate into jaw or left arm - simulates angina

Complications

  • Large herniae may cause cough,
  • palpitations
  • or hiccoughs
  • Oesophagitis may lead to ulceration
  • bleeding leading to anaemia
  • Dysphagia

Investigations

  • Hb
  • FBC
  • ESR
  • U&Es
  • LFTS
  • Barium swallow
  • Oesophaogoscopy and biopsy

Treatment

 

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