Abdomen | Emergency Medicine | Hiatal hernia (Disease)
A hernia occurs when tissue from the abdomen is exhibited through an orifice of the abdominal muscles. When the herniation is done to the chest, this is called hiatal hernia.
There are three types of hiatal hernia: sliding, paraesofagiana and mixed. Sliding hiatal hernia is the most common and usually not serious. Hernia paraesofagiana and the joint may develop complications such as severe.
Gastro-oesophageal reflux symptoms include: - Heartburn, accompanied by heat and pain. Occurs after eating, lying down or bending forward. In medical terms is called heartburn. - Sour or salty taste in mouth. Is also due to reflux of stomach acid into the esophagus. Usually accompanies heartburn, but can sometimes be the only symptom. Secondary symptoms: - Upper abdominal fullness after meals - Difficulties in food ingestion (dysphagia) and feeling of lump in throat - nausea - Hoarse voice. If symptoms are severe or continue, it could be gastroesophageal reflux disease (GERD), ie food and gastric reflux into the esophagus, increased duration and frequency than for heartburn. Hiatal hernia and GERD, are diseases that usually occur together.
Usually no symptoms when sliding hernia. If they do appear, they are caused by acid reflux (ie, gastric reflux from the stomach into the esophagus) due to weight loss esophageal sphincter.
Causes and Risk factors
It is thought that hiatal hernias are caused by a larger-than-normal esophageal hiatus, the opening in the diaphragm through which the esophagus passes from the chest into the abdomen; as a result of the large opening, part of the stomach slips into the chest.
Other potentially contributing factors include: a permanent shortening of the esophagus (perhaps caused by inflammation and scarring from the reflux or regurgitation of stomach acid) which pulls the stomach up; an abnormally loose attachment of the esophagus to the diaphragm which allows the esophagus and stomach to slip upwards.
Diagnosis and Treatment
Large sliding hernias can cause ulcers, gastric mucosal erosions which are located in the hiatus. These ulcers were found by endoscopy to 5% of patients with hiatal hernia.
Treatment of large para-esophageal hernias causing symptoms requires surgery. During surgery, the stomach is pulled down into the abdomen, the esophageal hiatus is made smaller, and the esophagus is attached firmly to the diaphragm. This procedure restores the normal anatomy.
Since sliding hiatal hernias rarely cause problems themselves but rather contribute to acid reflux, the treatment for patients with hiatal hernias is usually the same as for the associated GERD. ...