hiatal hernia

Introduction

Herniation of part of the stomach through the esophageal hiatus of the diaphragm.

Pathology

• gastoesophageal reflux disease (GERD)

Genetics

• see congenital diaphragmatic hernia

Clinical manifestations

• pain in the epigastric region or lower thorax
  • worse when reclining
  • relieved on standing
  • pain may be retrosternal with radiation to the left arm mimicking angina pectoris
• hematemesis
• large herniations
  • dullness on percussion in left lung base
  • absent breath sounds in left lung base
  • peristaltic sounds in left lung base
• gastric reflux, nausea, bloating, chest discomfort, epigastric discomfort pharyngeal expulsion, esophageal expulsion, dysphagia
• severe symptoms include weight loss, colorectal bleeding

Diagnostic procedures

• upper GI endoscopy identifies untreatable gastric reflux
• manometry measures esophageal peristalsis

Radiology

• chest X-ray can show hiatal hernia
• barium swallow demonstrates the stomach above the diaphragm

Complications

• incarceration of hiatal hernia
  • nausea/vomiting changing to inability to vomit or retain oral intake
  • no fever, leukocytosis

Management

• treatment of GERD
• minimally invasive laparoscopic surgical correction

More general terms

• diaphragmatic hernia
• chronic gastrointestinal disease

Patient information

hiatal patient information