(GP)

Overview

• The protrusion of abdominal contents into the thorax, usually the stomach
  • Sliding Hiatal Hernia (most common type, 95% of cases) → GOJ moves above the diaphragm.
  • Rolling Hiatal Hernia → GOJ remains below the diaphragm but a separate part of the stomach (eg. Fundus) herniates through the oesophageal hiatus. Needs more urgent treatment as volvulus can result in ischemia and necrosis.
• Risk Factors → obesity, GORD, increased intra-abdominal pressure (pregnancy, ascites, chronic cough or constipation)

Making Diagnosis

Clinical Features:

• Heartburn, dysphagia, regurgitation, odynophagia, shortness of breath, chronic cough and chest pain.
• GORD Symptoms → may be only reveal. Worse when lying flat.
• May have hiccups

Investigations:

• Barium Swallow → assesses type & size of hernia. Most sensitive test.
• Upper GI Endoscopy → given nature of symptoms, most patients have this first line, with hiatus hernia being found incidentally.
• CXR → retrocardiac bubble

Management Plan