| Hiatus hernia Classification and external resources |
|
 |
|
|---|---|
| ICD-10 | K44., Q40.1 |
| ICD-9 | 553.3, 750.6 |
| OMIM | 142400 |
| DiseasesDB | 29116 |
| eMedicine | med/1012 radio/337 |
| MeSH | D006551 |
A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption Q00-Q89 - Congenital malformations and deformations (Q00-Q07 Nervous system ( Anencephaly and similar malformations The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books A hernia is a protrusion of a tissue, structure or part of an organ through the muscular tissue or the membrane by which it is normally contained In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following The thorax is a division of an Animal 's body that lies between the head and the Abdomen. For other types of diaphragm see Diaphragm. In the Anatomy of Mammals the thoracic diaphragm is a sheet of Muscle
Contents |
Symptoms
The symptoms include acid reflux, and pain, similar to heartburn, in the chest and upper stomach. Gastroesophageal reflux disease ( American English and Canadian English) or Gastro-oesophageal reflux disease ( British English, Hiberno-English
In most patients, hiatus hernias cause no symptoms. Sometimes patients experience heartburn and regurgitation, when stomach acid refluxes back into the esophagus. Heartburn or pyrosis is a painful or burning sensation in the Esophagus, just below the breastbone usually associated with regurgitation of gastric acid Regurgitation is the controlled flow of Stomach contents back into the Esophagus and Mouth. Gastric acid is one of the main Secretions of the Stomach, together with several Enzymes and Intrinsic factor. The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in
Risk factors
The following are risk factors for having a hiatus hernia.
- Increased pressure within the abdomen caused by:
- Heavy lifting or frequent bending over
- Frequent or hard coughing
- Hard sneezing
- Pregnancy and delivery
- Violent vomiting
- Straining with constipation
- Obesity (extra weight pushes down on the abdomen increasing the pressure)
- Use of the sitting position for defecation[1] (See epidemiology below)
- Heredity
- Smoking
- Drug use, such as cocaine. In Vertebrates such as Mammals the abdomen (belly constitutes the part of the body between the Thorax (chest and Pelvis. In Medicine, a cough ( Latin: tussis) is a sudden and often repetitively occurring defence Reflex which helps to clear the large breathing passages Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected Defecation is the final act of Digestion by which organisms eliminate solid semisolid or liquid Waste material ( Faeces) from the Digestive tract Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. Drugs can be used in many different ways as detailed below Medication See also Medication People can use drugs to relieve pain or discomfort or to cure
- Stress
Diagnosis
The diagnosis of a hiatus hernia is typically made through an upper GI series or endoscopy. Upper GI series, also upper gastrointestinal (GI tract radiography, is a radiologic examination of the Upper gastrointestinal tract.
Types
There are two major kinds of hiatus hernia:
- The most common (95%) is the sliding hiatus hernia, where the gastroesophageal junction moves above the diaphragm together with some of the stomach. The cardia (also known as Z-line or esophagogastric junction or gastroesophageal junction) is the anatomical term for the junction orifice of
- The second kind is rolling (or paraesophageal) hiatus hernia, when a part of the stomach herniates through the esophageal hiatus beside, and without movement of, the gastroesophageal junction. In human anatomy the esophageal hiatus is a hole in the diaphragm through which the Esophagus passes It is about 100 times less common than the first kind. [2]
A third kind is also sometimes described, and is a combination of the first and second kinds.
Treatment
In most cases, sufferers experience no discomfort and no treatment is required. However, when the hiatal hernia is large, or is of the paraesophageal type, it is likely to cause esophageal stricture and discomfort. Benign esophageal stricture is a narrowing of the Esophagus that causes swallowing difficulties Symptomatic patients should elevate the head of their beds and avoid lying down directly after meals until treatment is rendered. If the condition has been brought on by stress, stress reduction techniques may be prescribed, or if overweight, weight loss may be indicated. Stress management encompasses techniques intended to equip a person with effective coping mechanisms for dealing with psychological stress, with stress defined as a person's Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid Medications that lower the lower esophageal sphincter (or LES) pressure should be avoided. The cardia (also known as Z-line or esophagogastric junction or gastroesophageal junction) is the anatomical term for the junction orifice of The cardia (also known as Z-line or esophagogastric junction or gastroesophageal junction) is the anatomical term for the junction orifice of Antisecretory drugs like proton pump inhibitors and H2 receptor blockers can be used to reduce acid secretion. Proton pump inhibitors (or "PPI"s are a group of drugs whose main action is pronounced and long-lasting reduction of Gastric acid production H2 receptors positively coupled to Adenylate cyclase via Gs. It is a potent stimulant of cAMP production
Where hernia symptoms are severe and chronic acid reflux is involved, surgery is sometimes recommended, as chronic reflux can severely injure the esophagus and even lead to esophageal cancer. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in Esophageal cancer is malignancy of the Esophagus. There are various subtypes
The surgical procedure used is called Nissen fundoplication. Nissen fundoplication is a Surgical procedure to treat Gastroesophageal reflux disease (GERD and Hiatus hernia. In fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the inferior part of the esophagus, preventing herniation of the stomach through the hiatus in the diaphragm and the reflux of gastric acid. Gastric acid is one of the main Secretions of the Stomach, together with several Enzymes and Intrinsic factor. The procedure is now commonly performed laparoscopically. Laparoscopic surgery, also called Minimally invasive surgery (MIS, bandaid surgery, Keyhole surgery, or pinhole surgery With proper patient selection, laparoscopic fundoplication has low complication rates and a quick recovery. [3]
Complications include gas bloat syndrome, dysphagia (trouble swallowing), dumping syndrome, excessive scarring, and rarely, achalasia. Nissen fundoplication is a Surgical procedure to treat Gastroesophageal reflux disease (GERD and Hiatus hernia. Dysphagia should not be confused with the similarly pronounced Dysphasia, a language disorder Gastric dumping syndrome, or rapid gastric emptying, happens when the lower end of the small intestine the Jejunum, fills too quickly with undigested food from the Achalasia, also known as esophageal achalasia, achalasia cardiae, cardiospasm, dyssynergia esophagus, and esophageal aperistalsis The procedure sometimes fails over time, requiring a second surgery to make repairs.
Complications
A hiatus hernia per se does not cause any symptoms. The condition promotes reflux of gastric contents (via its direct and indirect actions on the anti-reflux mechanism) and thus is associated with gastroesophageal reflux disease (GERD). Gastroesophageal reflux disease ( American English and Canadian English) or Gastro-oesophageal reflux disease ( British English, Hiberno-English In this way a hiatus hernia is associated with all the potential consequences of GERD - heartburn, esophagitis, Barrett's esophagus and esophageal cancer. Heartburn or pyrosis is a painful or burning sensation in the Esophagus, just below the breastbone usually associated with regurgitation of gastric acid Esophagitis (or Oesophagitis) is Inflammation of the Esophagus. Barrett's esophagus (UK Oesophagus (sometimes called Barrett's syndrome, CELLO, columnar epithelium lined lower oesophagus or colloquially as Barrett's Esophageal cancer is malignancy of the Esophagus. There are various subtypes However the risk attributable to the hiatus hernia is difficult to quantify, and at most is low.
Besides discomfort from GERD and dysphagia, hiatal hernias can have severe consequences for patients if not treated. While sliding hernias are primarily associated with gastroesophageal acid reflux, rolling hernias can strangulate a portion of the stomach above the diaphragm. Strangulating is the process of constricting flow of Blood supply to a tissue. This strangulation can result in esophageal or GI tract obstruction and the tissue even become ischemic and necrose. In Medicine, ischemia ( Greek ισχαιμία, isch- is restriction hema or haema is Blood) is a restriction Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue.
Another severe complication, although very rare, is a large herniation that can restrict the inflation of a lung, causing pain and breathing problems. lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive
Epidemiology
Hiatus hernias affect anywhere from 1 to 20% of the population. Of these, 9% are symptomatic, depending on the competence of the lower esophageal sphincter (LES). The cardia (also known as Z-line or esophagogastric junction or gastroesophageal junction) is the anatomical term for the junction orifice of 95% of these are "sliding" hiatus hernias, in which the LES protrudes above the diaphragm along with the stomach, and only 5% are the "rolling" type (paraesophageal), in which the LES remains stationary but the stomach protrudes above the diaphragm. People of all ages can get this condition, but it is more common in older people.
According to Dr. Denis Burkitt, "Hiatus hernia has its maximum prevalence in economically developed communities in North America and Western Europe. Denis Parsons Burkitt ( 28 February, 1911 – 23 March 1993) Surgeon, was born in Enniskillen, County Fermanagh . . . In contrast the disease is rare in situations typified by rural African communities. "[1] Burkitt attributes the disease to insufficient dietary fiber and the use of the unnatural sitting position for defecation. Both factors create the need for straining at stool, increasing intraabdominal pressure and pushing the stomach through the esophageal hiatus in the diaphragm.
Notes and references
External links
The Collaborative Hypertext of Radiology (or "CHORUS" is a free medical reference databaseDapyx Software network: MP3 Explorer | Ebook Manager | Zenithic