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DISORDERS OF THE ESOPHAGUS

DISORDERS OF THE ESOPHAGUS. HIATAL HERNIA. HIATAL HERNIA. Distal esophagus- held in position by the phrenoesophageal ligament Occurs most commonly in women Most hiatal hernias are asymptomatic 5-10% of pts. will develop GERD There is strong association with obesity

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DISORDERS OF THE ESOPHAGUS

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  1. DISORDERS OF THE ESOPHAGUS HIATAL HERNIA

  2. HIATAL HERNIA • Distal esophagus- held in position by the phrenoesophageal ligament • Occurs most commonly in women • Most hiatal hernias are asymptomatic • 5-10% of pts. will develop GERD • There is strong association with obesity • Saint’s triad= gall stones+colonic diverticular disease+hiatal hernia

  3. HIATAL HERNIA • Type I or sliding HH: ph.-esoph. lig.intact but lax- distal esoph. and cardia herniate through the hiatus. • Type II or paraesophageal HH- focal defect of the ph.-esoph. lig.- greater curvature herniates upward alongside the esoph. • Type III- a combination of type I and II

  4. Sliding hiatus herniaThe herniated portion of the stomach can slide back and forth into and out the chest

  5. Sliding HH

  6. HIATAL HERNIASYMPTOMS • Type I- sy. of associated GERD • Type II, III- postprandial pain, - bloating, - breathlessness with meals, - mild dysphagia The herniated gastric pouch is susceptible to volvulus, obstruction, infarction, ischemic ulcers, occult bleeding, perforation, gangrene.

  7. HIATAL HERNIADIAGNOSIS AND EVALUATION • CXR- air/fluid level in post. M. on lat.view • Barium swallow- the dg. study of choice • Esophagoscopy- for GERD and esophagitis • Manometry and pH testing for refux sy.

  8. Hiatus hernia seen from below with the endoscope in an inverted position inside the stomach

  9. HIATAL HERNIAMANAGEMENT • Asymptomatic HH- no treatment • HH+GERD- medical treatment • Indications for surgery: • Symptomatic HH (chest pain, dysphagia) • HH+ severe esophagitis • HH type II, III Oprative objectives: - reduction of hernia - closure of the hiatal defect - antireflux procedure

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