Hiatal Hernia Pathophysiology Quiz

Hiatal Hernia Types

• The most common type of hiatal hernia is sliding hiatal hernia.

Paraesophageal Hernia

• A true peritoneal sac can protrude into the posterior mediastinum in paraesophageal hernia due to the phrenoesophageal ligament's weakness.
• Characterized by a hernia sac containing the stomach or other abdominal organs.

Sliding Hiatal Hernia

• The hernia is contributed to by the relaxation of the lower esophageal sphincter and the diaphragmatic crura.
• The visceral peritoneum plays a role in facilitating the hernia by allowing the stomach to slide into the thorax.
• Exacerbated by factors such as obesity, pregnancy, and coughing.

Type III Hiatal Hernia

• A combination of sliding and paraesophageal hernia, where the stomach and hernia sac protrude into the thorax.

Type II and IV Hiatal Hernia

• Type II hiatal hernia is characterized by a true peritoneal sac containing the stomach or other abdominal organs.
• Type IV hiatal hernia is defined by the herniation of other organs, such as the colon or small intestine, into the thorax.

Complications and Treatment

• The major complication associated with mechanical strangulation of a hiatal hernia is necrosis of the stomach.
• The recommended treatment for sliding hiatal hernia is laparoscopic repair.
• Diagnostic procedures such as barium swallow or upper GI series may show the protrusion of the stomach into the thorax, indicating paraesophageal hiatal hernia.

Gastroparesis

• The most common association of gastroparesis is diabetes.
• Symptoms of diabetic gastroparesis include nausea, vomiting, and bloating.
• The pathophysiology of diabetic gastroparesis involves the damage of the vagus nerve, leading to impaired gastric motility and emptying.
• A recommended treatment option for gastroparesis is medications such as metoclopramide to stimulate gastric motility.