Transcript DISORDERS OF THE ESOPHAGUS

HIATAL HERNIA
HIATAL HERNIA
 Distal esophagus- held in position by the
phrenoesophageal ligament
 Occurs most commonly in women
 Most hiatal hernias are asymptomatic
 5-10% of pts. will develop GERD
 There is strong association with obesity
 Saint’s triad= gall stones+colonic diverticular
disease+hiatal hernia
HIATAL HERNIA
 Type I or sliding HH: ph.-esoph. lig.intact but lax-
distal esoph. and cardia herniate through the hiatus.
 Type II or paraesophageal HH- focal defect of the ph.-
esoph. lig.- greater curvature herniates upward
alongside the esoph.
 Type III- a combination of type I and II
Sliding hiatus hernia
The herniated portion of the stomach can
slide back and forth into and out the chest
Sliding HH
HIATAL HERNIA
SYMPTOMS
 Type I- sy. of associated GERD
 Type II, III- postprandial pain,
- bloating,
- breathlessness with meals,
- mild dysphagia
The herniated gastric pouch is susceptible to volvulus,
obstruction, infarction, ischemic ulcers, occult
bleeding, perforation, gangrene.
HIATAL HERNIA
DIAGNOSIS AND EVALUATION
 CXR- air/fluid level in post. M. on lat.view
 Barium swallow- the dg. study of choice
 Esophagoscopy- for GERD and esophagitis
 Manometry and pH testing for refux sy.
Hiatus hernia seen from below with the
endoscope in an inverted position inside the
stomach
HIATAL HERNIA
MANAGEMENT
 Asymptomatic HH- no treatment
 HH+GERD- medical treatment
 Indications for surgery:
 Symptomatic HH (chest pain, dysphagia)
 HH+ severe esophagitis
 HH type II, III
Oprative objectives:
- reduction of hernia
- closure of the hiatal defect
- antireflux procedure