Can a Car Accident Cause a Hiatal Hernia
Hiatal hernia
A hiatal hernia is a protrusion of the abdominal contents into the thorax through an enlarged esophageal hiatus caused by a weakness or opening in the diaphragm.
The upper part of the stomach normally protrudes upwards but information technology can also exist the small-scale intestine, transverse colon or omentum. The two types of hiatal hernias are Sliding and Paraesophageal. In sliding hernias the gastro-oesophageal junction slides upward into the thorax and this is the more than common out of the 2 types, finding it to be more than lxxx% of the cases.
Paraesophageal hernias are where the gastro-oesophageal junction stays in place however the top part of the stomach protrudes up next to the oesophagus into the thorax. Paraesophageal hiatus hernias comprise for almost xx% of the cases. Hiatal hernias are results in gastro-oesophageal reflux disease and contribute to cell changes and further complications.
Contents
- Hiatal hernia nomenclature
- Signs and symptoms
- Risk factors
- Investigations
- Direction
- Complications
- Highlights
- Sources
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Hiatal hernia nomenclature
Hiatal hernia can exist classified into four different types:
Type I – The well-nigh common blazon is the sliding hiatal hernia that occurs when the gastro-oesophageal junction or cardia protrudes into the hiatus of the diaphragm. The acute bending between the esophagus and stomach disappears. Increased abdominal pressure level plays a significant role in its aetiology. Other factors include relaxed muscles of the lower part of the esophagus and whatever pathology associated with phrenico-esophageal ligament. The phrenoesophageal ligament may have an absent inferior attachment or can becomes disrupted due to age effect and the muscular hiatal tunnel widens which results in type i hiatal hernias. The stomach stays in a longitudinal plane with the fundus below the gastro-oesophageal junction every bit normal. This type is most commonly associated with gastro-oesophageal reflux disease due to an insufficiency of the lower esophageal sphincter.
Type II – Pure para-oesophageal junction hernia likewise known as rolling hernia occurs with the gastro-oesophageal junction staying in its normal anatomical position, all the same, the fundus of the breadbasket protrudes upwardly through the diaphragm next to the oesophagus. It unremarkably occurs in individuals above 40 years of historic period. Factors contribute in the aetiology of this hernia are history of previous gastroesophageal surgery, thoracoabdominal trauma, skeletal deformity and congenital malformations. There can be localised defect in the phrenoesophageal membrane however the gastro-oesophageal junction is fixed to the preaortic fascia and the median arcuate ligament and then the fundus of the breadbasket protrudes upward. This type is as well associated with reflux disease.
Type III – Both the gastro-oesophageal junction and fundus protrude through the hiatus with the fundus lying superior to the gastro-oesophageal junction. This is a combination type of I and Ii too known every bit mixed type. The gastro-oesophageal junction is displaced above the diaphragm and therefore the hernia slides upwards in this blazon.
Type Four – A giant hiatal hernia, this is a classification if there is more than one third or one half of the stomach or any other abdominal organ or structure herniate through the diaphragm, for example, small intestine, transverse colon, omentum, liver or even spleen. This blazon is due to a large defect in the phrenoesophageal membrane causing it to stretch a lot more and leads to organs herniating upwardly. Gastroesophageal reflux is common in this type, and iron deficiency anaemia is another important symptom.
Signs and symptoms
In nigh cases hiatal hernias can remain asymptomatic or for some tin present with signs and symptoms such as:
- Heartburn
- Gastro-oesophageal reflux
- Flatulence
- Belching
- Abdominal epigastric pain
- Nausea
- Non ailing airsickness
- Haematemesis
- Coughing
- Wheezing
- Fever
- Chest pain
- Shortness of breath
- Rarely dysphagia
- Bowel sounds nowadays in breast
Some symptoms tin be mistaken for other diseases and therefore need to be investigated thoroughly to dominion out whatsoever possible medical emergencies.
Risk factors
Increased intra-abdominal pressure can pb to hiatal hernias. Certain take a chance factors tin can atomic number 82 to this for case:
- Obesity
- Heavy lifting
- Cough
- Sneezing
- Straining during bowel movements
- Airsickness
- Stress
- Crumbling
- Smoking
- Previous gastro-oesophageal surgical procedure
- Male person
- History of hernias
- Collagen disorder
Investigations
Investigations to help diagnose hiatal hernias are breast x-rays which shows retrocardiac opacity with air fluid level or can exist normal.
In improver Barium consume studies can be used and this test is the simply accurate method of measuring the size of a hiatus hernia. This examination can prove the stomach to exist partially or completely intrathoracic.
Hiatus hernia tin exist diagnosed by endoscopy. It is used to view the breadbasket and oesophagus and volition be able to gain visibility of the hernia protruding into the diaphragm. Information technology will also to show signs of strangulation or obstruction, or inflammation of the oesophagus.
An abdominal CT scan or abdominal MRI are imaging scan options that are carried out in some cases if at that place are concerns of other diseases.
Oesophageal manometry has been used for additional help in the diagnosis of hiatus hernia by testing for an abnormal pH level or showing a double hump configuration notwithstanding it is mostly used for the diagnosis of oesophageal movement disorders.
Management
Fugitive risk factors and preventing increased intra-abdominal pressure is advised. Lying elevated at nighttime tin can preclude nocturnal symptoms. Lifestyle advice for patients with obesity-related hiatal hernias, weight loss is advised and avoiding large meals, nicotine, caffeine and alcohol.
Medications such equally proton pump inhibitors such every bit Omeprazole or H2 receptor antagonists such equally Ranitidine are advised for symptomatic relief of reflux.
Surgical procedure called a Nissen Fundoplication is used for sliding hernia repair. This tin can exist done laparoscopically by the fundus of the stomach existence placed around the inferior office of the oesophagus. This prevents the breadbasket from herniating into the diaphragm and stops reflux symptoms and disease.
Para-oesophageal hiatus hernia repair is also done through minimally invasive laparoscopic technique. If in that location are signs of volvulus, haemorrhage or obstacle urgent surgical treatment is required.
Complications
Hiatal hernias can pb to gastric volvulus this is rare just life threatening. Information technology means that the stomach rotates on its mesentery and can lead to bowel obstruction and necrosis. Type II and III are more normally associated with gastric volvulus. Patients nowadays with epigastric abdominal pain, hematemesis, retching, and inability to pass a nasogastric tube and need to be surgically treated.
Recurrence of hernia can ordinarily occur later on the breakdown of a hiatal hernia repair due to damage to sutures and increased intra-abdominal pressure. A mesh repair is advised to care for in cases of recurrence.
Barrett's oesophagus is associated with chronic gastro-oesophageal reflux disease and is most ordinarily seen with sliding hernias.
Gastrointestinal haemorrhage may occur equally a result of gastro-oesophageal reflux disease leading to oesophagitis.
Dysphagia following Nissen fundoplication is due to the fundoplication being besides tightly wrapped around the oesophagus leading to narrowing and patients unable to swallow solids.
Highlights
- A hiatal hernia is a protrusion of the abdominal contents into the thorax through an enlarged oesophageal hiatus caused by a weakness or opening in the diaphragm.
- The four types of hiatal hernias are sliding, paraesophageal, mixed and giant hiatal hernia.
- Signs and symptoms: heartburn, gastro-oesophageal reflux, flatulence, belching, intestinal epigastric pain, nausea, non bilious vomiting, haematemesis, breast pain, shortness of jiff and bowel sounds present in breast.
- Risk factors: Increased intra-abdominal pressure for example heavy lifting, cough, sneezing, straining during bowel movements, vomiting and obesity, stress, crumbling, and previous gastro-oesophageal surgical procedures.
- Diagnostic investigations: Breast x-ray, endoscopy, barium studies, oesophageal manometry, CT and MRI.
- Complications: gastric volvulus, obstruction, Barrett'southward oesophagus, GI bleeding.
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