Hiatal hernia

Hiatus hernia or hiatal hernia is the protrusion (or herniated) from the top of the stomach into the thorax through a tear or weakness in the diaphragm.

There are two main types of hiatal hernia:

The most common (95%) is a sliding hiatus hernia, in which the gastroesophageal junction moves above the diaphragm together with some of the stomach.

The second kind is rolling (or paraesophageal) hiatus hernia, when part of the stomach herniates through the esophageal hiatus and is located next to the esophagus, gastroesophageal Junction without movement. Account for the remaining 5% of hiatus hernia.

The third type is also sometimes described, and the combination of first and second kind.

The signs and symptoms  hiatal hernia is often called the "mimic" because the symptoms can mimic many disorders. For example, a person with this problem  often  experienced chest pain, shortness of breath (due to the effect on diaphragmatic hernia), and heart palpitations (due to irritation of the vagus nerve).

In most cases, hiatal hernia causes no symptoms. Pain and lack of  comfort  , the patient experiences  the pain and discomfort  is due to reflux of stomach acid, air, or bile. While some causes of acid reflux, it occurs more often in the presence of hiatal hernia

Schematic diagram of different types of hiatus hernia. Green is the esophagus, the stomach is red, purple is the diaphragm, blue is the HIS-angle. A is the normal anatomy, B is a pre-stage, C is a sliding hiatal hernia, and D is a paraesophageal type

Diagnosis

Large hiatus hernia on X-rays are characterized by an open arrow in contrast to the liver border is marked by closed arrows

Upper GI Endoscopy describe hiatus hernia

Hiatus hernia, as seen in CTThe diagnosis of hiatus hernia is usually done through the upper GI series, endoscopy or high-resolution manometry.

Treatment

 most cases, patients  have  to be uncomfortable and did not  get  care  specifically . However, when a large hiatal hernia, or paraesophageal type, tends to cause esophageal stricture and discomfort. Patients  with  symptoms  that  should elevate the head of their beds and avoid lying down directly after meals until treatment  is completed . If conditions  make people  become stressed, reduction of  stress techniques  can be done , or  by lowering the  weight. Drugs that reduce lower esophageal sphincter (or LES) pressure should be avoided. Antisecretory drugs such as proton pump inhibitors and H2 receptor blockers can be used to reduce acid secretion.

If your symptoms are  severe and chronic hernia ,  acid reflux is involved, surgery is sometimes recommended, as chronic reflux can greatly injure the esophagus and even lead to esophageal cancer.

Surgical procedure used is called Nissen fundoplication. In fundoplication, the gastric fundus (upper part) the stomach is wrapped, or plicated, around the lower esophagus to prevent stomach herniated through the diaphragm and absent in gastric acid re-instability. The procedure is now commonly performed laparoscopically. With the choice of appropriate patients, fundoplication laparoscopy had low levels of complications and rapid recovery.

Complications include gas bloat syndrome, dysphagia (difficulty swallowing), dumping syndrome, excessive scarring  or rarely  ( achalasia ) . Procedures sometimes fail from time to time, require a second operation to make repairs

Prognosis  A hiatus hernia  is almost  not cause symptoms. The condition promotes reflux  of gastric contents (through direct and indirect action on anti-reflux mechanism) and thus associated with gastroesophageal reflux disease (GERD). In this way hiatal hernia associated with all the potential consequences of GERD, heartburn, esophagitis, Barrett's esophagus, esophageal cancer and tooth erosion. However, the risk associated with a hiatal hernia is difficult for  the count, and lowest  risk .

In addition to the discomfort of GERD and dysphagia, hiatal hernia can have severe consequences if not treated. While sliding hernias especially associated with acid gastroesophageal reflux, rolling hernias can strangle the stomach above the diaphragm. This strangulation can result in esophageal or GI tract obstruction and tissue ,  it can even  become ischemic and necrose.

Other serious complications, though rare, is a large herniated can restrict the inflation of the lungs, causing pain and trouble breathing.

Most cases are asymptomatic.

Hiatal hernia EpidemiologyIncidence increases with age: about 60% of people aged 50 or older , have  had  hiatal hernia . with g ejala, depending on the competence of lower esophageal sphincter (LES)  by 9% . 95% of the  LES is a   hiatal hernia, LES stands out above the diaphragm along with the stomach, and only 5% is a kind of "rolling" (paraesophageal), in which the LES remains ,  te but stomach protruding above the diaphragm. People of all ages can get this condition, but is more common in older people.

Efforts Penyambuhan

According to Dr. Denis Burkitt, Hiatus hernia has a maximum prevalence in the community that developed in North America and Western Europe Conversely rare disease that  often occurs in  African rural communities . D iet fiber and the use of unnatural positions  during  a bowel movement , quite fatigued patients, thus  increasing intraabdominal pressure and abdominal esophageal broke out in the diaphragm.