Hiatal hernia

Hiatal hernia

    * Introduction
    * Causes
    * Signs and symptoms
    * Diagnosis
    * Treatment
Hiatal hernia is defined as continuous or intermittent passage of a portion of the stomach through the diaphragmatic hiatus esophageal-gastric junction above the chest. Hiatal hernias are classified using anatomical criteria into two types: axial and paraesofagiene. The combination of the two types can be included in the third type, mixed. Axial hernia, sliding is the most common type of hiatal hernia, it is usually determined by the broadening of the esophageal hiatus cardiei slipping through the hole in the chest expanded. Characteristic symptoms are related to gastro-esophageal reflux. Paraesofagiene hernias, or rolling, are characterized through a gastro-esophageal junction normally located, but a large gastric tuberosity runs through the gap, the side of the esophagus in the chest. Factors favoring: wide gap esophageal, esophagus short, old age. Trigger factor is increased pressure secondary abdominal obesity, pregnancy, abdominal tumors, voluminous ascites. Characteristic symptoms are gastro-esophageal reflux include nausea, vomiting, acid regurgitation, epigastric heartburn, cough, regurgitation and aspiration pneumonia pain. Treatment of large hernias require surgery, you push the hernia back into the abdomen through the hiatus, and it is sutured narrows. For patients with sliding hernias with symptoms of gastro-esophageal reflux is the treatment of gastro-esophageal reflux disease.
Pathogenesis Esophagus through the diaphragmatic hiatus to make the junction with the stomach. Hiatus has a diameter of 2 cm and is a normal anatomic hole in the diaphragm muscle, particularly to allow the esophagus to descend into the abdomen. Lower esophageal sphincter is a circular smooth muscle, wide 2, 5-4, 5 cm, with an upper portion of the diaphragmatic hiatus and the lower right below it, in the abdomen. At this level, and visceral peritoneum covers the esophagus frenoesofagial ligament. Frenoesofagial ligament is a fibrous band conjunctiva, which maintains the lower esophageal sphincter into the abdominal cavity. Ring A is a conjunctive strengthening the ligament, seen once read barium examinations, and marks the upper part of the SEI. Right below it there is a dilated portion of the esophagus that forms the vestibule. A second ring B, can be seen just below the Z line approximates the vestibule and esophageal mucosa. This confirms the diagnosis of ring B hiatal hernia. Occasionally, this ring is called inelulSchatzki. Any sudden increase in intra-abdominal pressure SEI works by increasing pressure. His is also a wide angle between the cardia and distal esophagus, it loses its mechanical function to prevent gastro-esophageal reflux. Gastro-esophageal junction is a barrier to prevent regurgitation of food, other elements of this barrier are: diaphragm muscle, the pressure and angle of His SEI.