China
Africa
Explore chapters and articles related to this topic
The oesophagus.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Gastro-oesophageal reflux is extremely common. It may occur as a complication of a hiatal hernia, but in many it has no such relationship. The easiest method for its detection is to use the water-swallowing 'de Carvalho' test after swallowing the barium - the patient lies a few degrees head-down and a little turned to the right, whilst he drinks water via a straw from a cup, and it is a very easy matter to note reflux of barium back up the oesophagus. Clearance of refluxed fluid is probably of more importance than reflux itself, as it may indicate that gastric type fluid may lie in the oesophagus much of the night, and lead to ulceration and stricture formation. These may occur in any part of the oesophagus, but particularly where refluxed acid fluid tends to remain. It may be in the mid-oesophagus in those who are bed-bound and paralysed, in the lower oesophagus, above the cardia or a hiatus hernia, and the Schatzki ring (at or close to the oesophago-gastric mucosal junction) may be potentiated by reflux. Webs or strictures of the lower pharynx or upper oesophagus are probably also caused by reflux, passing up to these areas at night; they may be associated with iron deficiency anaemia, presumably due to bleeding from oesophagitis. Severe cases may mimic varices or neoplasm, but most benign strictures are smooth in outline.
Symptomatic Giant Hiatal Hernia with Intrathoracic Stomach
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
A hiatal hernia is an abnormal protrusion of some, or even all, of the stomach into the thoracic cavity via the esophageal hiatus. Hiatal herniae are subcategorized into four types. The overwhelming majority of hiatal herniae are type I (sliding), which involves displacement of the gastroesophageal junction above the esophageal hiatus but the fundus remaining in the abdomen. Type II (paraesophageal) involves herniation of the gastric fundus through the esophageal hiatus while the gastroesophageal junction remains at the level of the hiatus. Type III (mixed) is a combination of type I and type II herniae where both the gastroesophageal junction and the fundus have herniated into the chest. Type IV herniae can be any of the above but occur when other structures, such as colon or small bowel, are found in the hernia sac [1]. While generally presenting de novo, a proportion may be recurrent following previous attempted hiatal hernia repair or anti-reflux surgery.
Abdominal surgery
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
The management of hiatus hernia is usually medical initially. All patients are advised to lose weight and control the symptoms with antacids and a variety of other medical compounds. If patients fail to respond to medication then surgery can be carried out. A number of surgical procedures have been described to repair hiatus hernias. The most commonly practised surgical repair is the Nissen fundoplication. This operation involves mobilizing the upper portion of the stomach, having reduced it back into the abdominal cavity. The stomach is then wrapped around the lower end of the oesophagus creating a non-spill inkwell effect. This procedure, originally carried out via an open abdominal incision or occasionally via thoraco-abdominal incision, is now routinely carried out endoscopically using the laparoscope and instruments to mobilize and control the lower end of the oesophagus.
Endoscopic measurement of hiatal hernias: is it reliable and does it have a clinical impact? Results from a large prospective database
Published in Postgraduate Medicine, 2023
Charles Christian Adarkwah, Oliver Hirsch, Merlissa Menzel, Joachim Labenz
It is thus conceivable that gastroesophageal reflux disease (GERD) is often associated with the presence of a hiatal hernia, thereby the hernia can be the precipitating as well as the maintaining factor [4]. However, small hernias frequently remain asymptomatic, while larger hernias often cause a variety of symptoms [5]. According to the Montreal definition, typical reflux symptoms are troublesome heartburn and/or regurgitation [6]. Both GERD and hiatal hernias occur more frequently with increasing age and weight. The risk factors for a hiatal hernia are very similar to those of reflux disease, i.e. especially high intra-abdominal pressure, caused e.g. by obesity or pregnancy, and increasing age play a decisive role here. After the age of 50, about 55–60% of people have a hiatal hernia, but only 9% suffer from clinical symptoms [5,7].
Percutaneous endoscopic gastrostomy: a dislodgement complication due to a moving hiatal hernia
Published in Scandinavian Journal of Gastroenterology, 2021
Miia L. Lehtinen, Ilkka Ilonen, Juha Kauppi, Jari Räsänen
The EGD performed in a secondary care center revealed a large Zenker’s diverticulum (ZD) in the proximal esophagus. No passage was gained distal to ZD. A large concomitant hiatal hernia was also suspected in the chest x-ray. As the patient had malnourishment due to dysphagia, resulting in severe progressive weight loss, need for an enteral feeding route was urgent and the patient was referred to a tertiary center. Surgical treatment for ZD was discussed but to improve the nutritional status before definitive surgery, the patient was consented for PEG insertion under general anesthesia. Passage distal to ZD in the EGD was time-consuming. When finally entering the stomach, a type-III uncomplicated paraesophageal hernia was noted. After an endoscopic repositioning maneuver, passage to duodenum was gained. Cutaneous transillumination was visible in the abdominal wall and a 20-Fr MIC-PEG tube (Halyard, GA, USA) was inserted using the pull-technique. A repeat EGD was abandoned due to the complicated passage distal to the ZD. A computed tomography (CT) was performed after the insertion, confirming the suspected large hiatal hernia with 50% of the stomach detected above the diaphragm plane. The MIC-PEG location was satisfactory in the gastric body below the diaphragm (Figure 1(A and B)).
Palliative care, when should it be a physicians’ choice of treatment?
Published in Progress in Palliative Care, 2019
E. Ruivo, M. Buni, A. Buketov, A. Lares
On the pre-anesthetic visit, the anesthesiologist reported a dehydrated, lethargic and tachypneic patient, with diminished vesicular breath sounds in the lower pulmonary lobes. Initially, at the emergency room, her vitals showed a heart rate of 90–100 bpm, respiratory rate of more than 25 breaths per minute, peripheral oxygen saturation (SpO2) of 93% with an oxygen mask at 5 L/min, and she was afebrile. The assessment of the anesthesiologist at the time scored the patient at a physical status of IV (score of the American Society of Anesthesiologists (ASA)). This score allowed the patient to be a candidate for surgery. However, because the patient had a compromised respiratory system, it was recommended that the patient have an open surgery to repair the hiatal hernia. Despite the physical state of the patient at the pre-anesthetic evaluation, the anesthesiologist agreed with the surgeon to proceed with laparoscopic surgical repair of the hiatal hernia which included cruroraphy and fundic gastropexy.