Contrast swallow or meal – can be used to diagnose a hiatus hernia and rule out other structural disorders such as strictures or motility disorders.Ambulatory 24-hour oesophageal pH monitoring – quantifies the level of reflux and assess the relationship between the reflux episodes and patient symptoms. Oesophageal manometry – measures the pressure within the oesophagus during swallowing, useful for assessment of oesophageal motility disorders, such as achalasia.However, if the hiatus hernia is asymptomatic with no significant features on imaging, then no further investigations are usually required.įor patients being considered for surgical management (discussed below), further investigations are often required: Many hiatus hernia are often diagnosed incidentally, typically on CT imaging. 4, also termed the ‘Z-line’), as well as any oesophagitis, gastritis, or Barrett’s oesophagus present (and exclude any malignancy). OGD can show an upward displacement of the GOJ (Fig. The majority of cases are diagnosed on upper GI endoscopy (OGD), as the most common symptom is reflux or epigastric pain. Types II-IV are all forms of paraoesophageal hernias, and have a higher risk of gastric ischaemia or volvulus. Sliding hernia are frequently associated with gastro-oesophageal reflux disease (GORD). Type IV, Other Structures – other structures apart from the stomach herniating through the oesophageal hiatus.Type III, Mixed Type – both the gastric fundus and the GOJ herniate above the hiatus, with the fundus lying above the GOJ.This is a true hernia with a peritoneal sac (Fig. Type II, Rolling Hernia (or para-oesophageal) – an upward movement of the gastric fundus occurs to lie alongside a normally positioned GOJ, which creates a ‘bubble’ of stomach in the thorax.Type I, Sliding Hernia (90%) – the gastro-oesophageal junction (GOJ), the abdominal part of the oesophagus, and frequently the cardia of the stomach move (or “slides”) upwards through the diaphragmatic hiatus into the thorax (Fig.The anatomical classification of hiatus hernia consists of: Figure 1 – The inferior surface of the diaphragm Classification
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |