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Hiatus Hernia types,clinical picture,investigations and treatment

Definition of Hiatus Hernia :

This describes the herniation of a part of the stomach into the chest.

I. Sliding Hiatus hernia 

There is herniation of the gastro-esophageal junction through the esophageal hiatus in the diaphragm into the thorax.
This will affect the valvular mechanism of the gastro-esophageal junction leading to reflux of gastric contents into the esophagus.

Clinical features :

Heart burn (Pyrosis): It is a burning retrosternal pain occurring in lying down Qr leaning forward, it is severe during sleep.
Dysphagia may occur due to esophageal stricture.
Bleeding e.g. haematemesis, melena or presented with iron deficiency anemia due to esophagitis.
It may be asymptomatic.

Investigations :

1-Barium swallow.            2-Upper endoscopy

Treatment 

A. Medical :
 Weight reduction, also meals should be small.
Sleeping in sersl-slttlnq position.
H2 blockers and proton. pump inhibitors.
Prokinetic drug: Domperidone (motilium) .
B. Surgical 
Indicated in resistant cases, (fundoplication) .

II. Para-oesophageal (Rolling) hernia

A small part of the fundus of the stomach rolls up alongside the esophagus through the hiatus.
The gastro-esophageal junction remains in normal position, so there is no reflux.
It may lead to mediastinal syndrome if severe.
Also gastric volvulous or strangulation may occur.
Surgery is indicated in severe cases.

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