Hiatal Hernias
BY- SHARMA PRANNAY RAI
GROUP 40
5TH YEAR 9TH SEMESTER
What is hiatal hernia?

A hiatal hernia is when your stomach bulges
up into your chest through an opening in your
diaphragm, the muscle that separates the two
areas. The opening is called the hiatus, so
this condition is also called a hiatus hernia.
OR
 A hiatal or paraoesophageal hernia occurs
when the GE junction, the stomach, or other
abdominal organs such as the small intestine,
colon, or spleen move up into the chest
where they do not belong.
Pathophysiology of Hiatal Hernia

Type 1 Hernia / Sliding HH / Hernia En Glissade
•
Characterized by upward displacement of the
gastroesophageal junction into the posterior
mediastinum
•
Stomach remains in usual longitudinal position
•
Higher incidence of HH in people with inguinal
hernias
•
Majority of the patients are asymptomatic
•
Prevalence and size of sliding HH corelates with
increasing severity of reflux disease

Type II – True paraoesophageal hernia
•
Defined by normally positioned intraabdominal GE junction with upward
herniation of the stomach alongside it
•
Develops when there is a defect possibly
congenital in the hiatus anterior to the
esophagus
What is the point of difference between Type 1 and type
2 hernia?
Persistent posterior fixation of the gastroesophageal junction is the
essential difference between Paraoesophageal Hernia and sliding
Hiatus Hernia.

Type III – Mixed paraoesophageal
hernia ( I & II)

Displacement of both the GE junction and
large portion of the stomach cephalad into
the posterior mediastinum

Starts as a sliding HH but over time as the
hiatus enlarges, more of the fundus and
body herniate into the chest

Type IV- Paraoesophageal hernia
containing other intra-abdominal
organs
•
Esophageal hiatus has dilated to an
extent that the hernial sac also contains
other organs like Spleen, colon, or small
bowel
•
Bowel obstruction and complications
due to altered anatomy may occur
Pathogenesis
Factors affecting LES pressure
Decreased by
Increased by
Prostaglandin E1 & E2, Progesterone
Bombesin, Angiotensin II
Morphine and Meperidine
PP, Substance P, Motilin
Theophylline
Gastrin
Barbiturates, Diazepam, Dopamin
Antacids
CCB, Atropine, Nitrates
Cholinergic
Chocolate, coffee
Domeperidone
Alcohol, peppermint,
smoking, fat
Metoclopramide
Prostaglandin F
Symptoms

Many people with hiatal hernia don’t notice any symptoms. Others may have:
•
Heartburn from gastroesophageal reflux disease (GERD) Triad of symptomsretrosternal burning pain, epigastric pain and regurgitation. Most common in sliding
HH.
•
Chest pain
•
Bloating
•
Burping
•
Trouble swallowing
•
Bad taste in your mouth
•
Upset stomach and vomiting
•
Backflow of food or liquid from your stomach into your mouth
•
Shortness of breath
Diagnosis

Chest X-ray
•
Patients with symptoms may
undergo barium swallow, in
which a contrast agent is
swallowed and a series of xrays reveal the anatomy of the
esophagus and stomach.
A Schatzki ring is a circular band of
mucosal tissue that can form at the end
of the food pipe closest to the stomach.
The ring of tissue causes the food pipe,
or esophagus, to narrow. When
a ring forms, a person may have no
symptoms. Or, they may have difficulty
swallowing, which the medical
community calls dysphagia.

Esophagogastroduodenoscop
yis a procedure done under sedation
in which the doctor visualizes the
anatomy of the esophagus and
stomach by inserting a thin camera
to look at the upper gastrointestinal
tract.

Manometry may be used to measure the severity of the disease and to establish treatments. This
is a study that allows the pressure inside the esophagus to be measured to determine if the
muscles are too loose or too tight
Treatment
•
Antacids that neutralize stomach acid. Antacids, such as Mylanta, Rolaids and
Tums, may provide quick relief. Overuse of some antacids can cause side effects,
such as diarrhea or sometimes kidney problems.
•
Medications to reduce acid production. These medications — known as H-2receptor blockers — include cimetidine (Tagamet HB), famotidine (Pepcid AC) and
nizatidine (Axid AR)
•
Medications that block acid production and heal the esophagus. These medications
— known as proton pump inhibitors — are stronger acid blockers than H-2-receptor
blockers and allow time for damaged esophageal tissue to heal. Over-the-counter
proton pump inhibitors include lansoprazole (Prevacid 24HR) and omeprazole
(Prilosec, Zegerid)
THANK YOU