II. Pathophysiology

  1. Stomach Herniation via esophageal hiatus of diaphragm

III. Types

  1. Type I: Sliding Hiatal Hernia (accounts for 95% of cases)
  2. Type II: Paraesophageal Herniation
    1. Complication of Anti-Reflux Surgery
    2. Risk of Gastric Volvulus (surgical emergency)
    3. Surgical repair is indicated if symptoms occur
      1. Wiechman (2001) Ann Thorac Surg 71:1030-1037 [PubMed]

IV. Symptoms

  1. See Gastroesophageal Reflux
  2. Pain in epigastrium or lower chest
    1. Worse on reclining
    2. Relieved on standing
    3. Pain may be retrosternal with radiation down left arm
  3. Hematemesis

V. Signs

  1. Normal exam unless large Hernia
  2. Left lung base
    1. Dullness to percussion
    2. Absent breath sounds
    3. Bowel sounds present

VI. Differential diagnosis

VII. Diagnostics

  1. Barium swallow (UGI)
    1. StomachHerniated above diaphragm
  2. Upper endoscopy
    1. Poor at identifying Hiatal Hernia
    2. Indicated to evaluate for esophageal or gastric malignancy or Eosinophilic Esophagitis

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