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Updated: Oct 18 2018

Hiatal Hernias

  • 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 II: Paraesophageal 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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