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

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Diaphragmatic Hernia (C0019284)

Definition (NCI) A congenital or acquired weakness or opening in the diaphragm which allows abdominal contents to protrude into the chest cavity; congenital diaphragmatic hernias are caused when the embryonic diaphragm fails to fuse.
Definition (MSH) Protrusion of abdominal structures into the THORAX as a result of congenital or traumatic defects in the respiratory DIAPHRAGM.
Concepts Anatomical Abnormality (T190)
MSH D006548
ICD10 K44 , K44.9
SnomedCT 155748004, 266511003, 196911004, 196912006, 266444006, 155750007, 196901006, 39839004
English Diaphragmatic Hernias, Hernia, Diaphragmatic, Hernias, Diaphragmatic, Diaphragmatic hernia NOS, Unspecif.diaphragmatic hernia, Unspecified diaphragmatic hernia, Diaphragmatic Hernia, diaphragmatic hernia, diaphragmatic hernia (diagnosis), Hernia, Diaphragmatic [Disease/Finding], hernia diaphragmatic, Hernia;diaphragmatic, diaphragmatic hernias, Diaphragmatic hernias, Hernia - diagphragmatic, Diaphragmatic hernia NOS (disorder), Unspecified diaphragmatic hernia (disorder), Diaphragmatic hernia, Diaphragmatic hernia (disorder), diaphragmatic; hernia, hernia; diaphragmatic, Diaphragmatic hernia, NOS
Italian Ernie diaframmatiche, Ernia diaframmatica NAS, Ernia diaframmatica
Dutch diafragmabreuk NAO, diaphragmatica; hernia, hernia; diaphragmatica, diafragmabreuk, middenrifbreuk, Hernia diaphragmatica
French Hernie diaphragmatique SAI, Diaphragmatocèle, Hernies diaphragmatiques, Hernie diaphragmatique, Hernie du diaphragme
German Diaphragmahernie NNB, Diaphragmahernie, Zwerchfellhernien, Hernia diaphragmatica, Hernie, Zwerchfell-, Zwerchfellhernie
Portuguese Hérnia diafragmática NE, Hérnia do diafragma, Hérnias diafragmáticas, Hérnia Diafragmática
Spanish Hernia diafragmática NEOM, hernia diafragmática, SAI (trastorno), hernia diafragmática no especificada (trastorno), hernia diafragmática, SAI, Diaphragmatic hernia NOS, hernia diafragmática no especificada, hernia diafragmática (trastorno), hernia diafragmática, Hernia diafragmática, Hernias diafragmáticas, Hernia Diafragmática
Japanese 横隔膜ヘルニアNOS, オウカクマクヘルニア, オウカクマクヘルニアNOS, 横隔膜ヘルニア, ヘルニア-横隔膜
Swedish Diafragmabråck
Czech hernie brániční, Diafragmatická hernie NOS, Brániční kýly, Diafragmatická hernie
Finnish Palleatyrä
Korean 가로막헤르니아
Polish Przepuklina przeponowa
Hungarian Rekesz sérv, Rekeszsérvek, Rekeszsérv k.m.n.
Norwegian Diafragmahernie, Hernia diaphragmatica, Mellomgulvsbrokk, Diafragmabrokk