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Diaphragmatic Hernia
Aka: Diaphragmatic Hernia, Hiatal Hernia
- Pathophysiology
- StomachHerniation via esophageal hiatus of diaphragm
- Types
- Type I: Sliding Hiatal Hernia (accounts for 95% of cases)
- Type II: Paraesophageal Herniation
- Complication of Anti-Reflux Surgery
- Risk of Gastric Volvulus (surgical emergency)
- Surgical repair is indicated if symptoms occur
- Wiechman (2001) Ann Thorac Surg 71:1030-1037 [PubMed]
- Symptoms
- See Gastroesophageal Reflux
- Pain in epigastrium or lower chest
- Worse on reclining
- Relieved on standing
- Pain may be retrosternal with radiation down left arm
- Hematemesis
- Signs
- Normal exam unless large Hernia
- Left lung base
- Dullness to percussion
- Absent breath sounds
- Bowel sounds present
- Differential diagnosis
- Angina Pectoris
- Gastroesophageal Reflux
- Diagnostics
- Barium swallow (UGI)
- StomachHerniated above diaphragm
- Upper endoscopy
- Poor at identifying Hiatal Hernia
- Indicated to evaluate for esophageal or gastric malignancy or Eosinophilic Esophagitis