Hiatal Hernia Midterm Notes PDF

5 1 GASTROINTESTINAL – Hiatal Hernia A hiatal hernia is a condi+on where part of the stomach protrudes through the esophageal hiatus (an opening in the diaphragm) into the thoracic cavity. 1. Most Likely...

5 1 GASTROINTESTINAL – Hiatal Hernia A hiatal hernia is a condi+on where part of the stomach protrudes through the esophageal hiatus (an opening in the diaphragm) into the thoracic cavity. 1. Most Likely Cause Cause: o Weakening of the diaphragm muscle at the site of the esophageal hiatus is the primary cause. o The esophageal hiatus is a natural opening in the diaphragm for the esophagus and vagus nerve. When the muscle surrounding this opening weakens, abdominal organs (like the stomach) may herniate into the chest cavity. o Factors that increase abdominal pressure (like pregnancy, obesity, chronic coughing, or heavy liCing) can force the stomach through the weakened area. 2. Pathophysiology The pathophysiology of a hiatal hernia depends on the type of hernia present. 1. Sliding Hiatal Hernia (Type 1) o Most common type of hiatal hernia. o The gastroesophageal junc+on and a por+on of the stomach "slide" up into the thoracic cavity. o This movement occurs due to an increase in abdominal pressure (as seen with obesity or chronic coughing) and a weakening of the esophageal hiatus. o When the gastroesophageal junc+on moves above the diaphragm, the lower esophageal sphincter (LES) loses its ability to close properly, which may lead to gastroesophageal reflux disease (GERD). 2. Paraesophageal Hiatal Hernia (Type 2) o Less common but more serious. o Involves the hernia+on of part of the greater curvature of the stomach through a secondary opening in the diaphragm, while the gastroesophageal junc+on remains in its normal posi+on. o This can lead to gastric strangulaKon if the blood supply to the stomach is cut off, which is a medical emergency. 3. Mixed Hiatal Hernia (Type 3) o A combinaKon of sliding (Type 1) and paraesophageal (Type 2) hiatal hernias. o Part of the stomach herniates next to the esophagus, while the gastroesophageal junc+on also moves above the diaphragm. 3. Disease Transmission Transmission: o Hiatal hernia is a non-communicable condiKon. o It is caused by anatomical or structural changes in the body, specifically at the diaphragm. o While not transmissible, it can be congenital (present at birth) in some cases.  2 4. Risk Factors Certain modifiable and non-modifiable risk factors contribute to the development of a hiatal hernia. Modifiable Risk Factors Obesity: Excess abdominal fat increases intra-abdominal pressure, pushing the stomach upward through the hiatus. Heavy LiRing/Straining: Ac+vi+es that increase abdominal pressure, such as liCing heavy objects, increase the likelihood of hernia forma+on. Chronic Coughing: Condi+ons like chronic obstruc+ve pulmonary disease (COPD) or chronic bronchi+s can raise abdominal pressure over +me, leading to hernia forma+on. Smoking: Smoking weakens the diaphragm and affects connec+ve +ssue integrity, increasing the risk of hernia+on. Pregnancy: Increased intra-abdominal pressure from the growing uterus may force the stomach through the esophageal hiatus. Non-Modifiable Risk Factors Age: Risk increases with age, as the diaphragm muscle weakens over +me. Congenital Defects: Some individuals are born with a larger-than-normal esophageal hiatus, which predisposes them to hiatal hernia. GeneKcs: Family history of hiatal hernia increases the likelihood of developing the condi+on, though it is not directly inherited. Summary Table Criteria Hiatal Hernia Weakening of the diaphragm at the esophageal hiatus. Increased abdominal Most Likely pressure from obesity, pregnancy, heavy liCing, and chronic coughing may Cause contribute to the development of hiatal hernia. Sliding hernia (Type 1): The gastroesophageal junc+on and part of the stomach move into the thoracic cavity. Paraesophageal hernia (Type 2): The Pathophysiology greater curvature of the stomach herniates into the thoracic cavity without movement of the gastroesophageal junc+on. Mixed hernia (Type 3): A combina+on of Type 1 and Type 2. Not transmissible. Caused by anatomical or structural changes in the Transmission diaphragm. Modifiable: Obesity, heavy liCing, smoking, chronic coughing, and pregnancy. Risk Factors Non-Modifiable: Age, congenital diaphragm defects, family history of hiatal hernia.