hernia the opening in the diaphragm through which the esophagus passes becomes enlarged and part of the upper stomach tends to move up into the lower portion of the thorax Risk factor weakened ID: 1039260
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1. hiatal hernia
2. In the condition known as hiatus (or hiatal) hernia, the opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper stomach tends to move up into the lower portion of the thorax.
3. Risk factor weakened gastro-oesophageal diaphragmatic anchors, shortening of the oesophagus increased intra-abdominal pressure
4. types of hiatal herniassliding hernia Sliding, or type I, hiatal hernia occurs when the upperstomach and the gastroesophageal junction are displaced upward and slide in and out of the thoraxAbout 90% of patients with esophageal hiatal hernia have a sliding hernia.
5. EsophagusGastroesophageal junctionHerniated portionof stomachDiaphragm
6. paraesophageal hernia occurs when all or part of the stomach pushes through the diaphragm beside the esophagus A paraoesophageal hernia can become incarcerated (constricted) and strangulate, impairing blood flow to the herniated tissue. People with paraoesophageal hernia may develop gastritis or chronic or acute gastrointestinal bleeding.
7. GastroesophagealjunctionEsophagusHerniated portionof stomach
8. MANIFESTATIONS Hiatal hernia Reflux, heartburnFeeling of fullnessSubsternal chest painDysphagiaOccult bleedingBelching, indigestion
9. Assessment and Diagnostic FindingsDiagnosis is confirmed by x-ray studies, barium swallow, And fluoroscopy.
10. ManagementManagement for a hiatal hernia includes frequent, small feedings that can pass easily through the esophagus. The patient is advised not to recline for 1 hour after eating, to prevent reflux or movement of the hernia, and to elevate the head of the bed on 4- to 8-inch (10- to 20-cm) blocks to prevent the hernia from sliding upward.
11. If medical management is unsuccessful, surgical intervention may be necessary. Surgical management involves a Nissen fundoplication (wrapping of a portion of the gastric fundus around the sphincter area of the esophagus). A Nissenfundoplication can be performed by the open method or by laparoscopy