Updated: 10/18/2018

Hiatal Hernias

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Overview
 
Introduction
  • Present in 80% of patients with reflux.
  • Type I: Sliding hiatal hernia
    • most common type
    • GE junction and stomach slide into mediastinum through diaphragmatic esophageal hiatus
    • loss of diaphragm reinforcement allows reflux of stomach acid
  • Type IIParaesophageal hiatal hernia
    • herniation of stomach fundus through diaphragm parallel to esophagus
      • GE junction remains at level of the esophageal hiatus
Presentation
  • Similar to GERD
  • Physical exam
    • bowel sounds ausculated over left lower lung
Treatment
  • Type I
    • medical therapy similar to GERD
  • Type II
    • mandatory surgical repair due to risk of strangulation

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