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Fundoplication
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Douglas C. Barnhart, Robert A. Cina
The majority of children with pathologic gastroesophageal reflux have normal foregut anatomy. Hiatal hernias are more common in children with a history of esophageal atresia and congenital diaphragmatic hernia. Hiatal hernias can occur in otherwise normal children with GERD but are uncommon. Two types of hiatus hernia are recognized: Sliding hiatus hernia is characterized by ascent of the cardia into the mediastinum (Figure 28.1).In paraesophageal or rolling hernia, the gastroesophageal junction remains in the abdomen while part of the gastric fundus prolapses through the esophageal hiatus into the mediastinum (Figure 28.2).
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.
The upper gastrointestinal tract, common conditions, and recommended treatments
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
Hiatus hernia refers to the situation in which the top of the stomach slides up through the diaphragm into the chest (Figure 2.1). This is believed to be due to laxity of the structures that hold the stomach in place in the abdomen. Hiatus hernia may be asymptomatic but is often associated with GORD (see later) and, if very large may be associated with mechanical symptoms such as vomiting or difficulty breathing. Unless symptomatic, the presence of a hiatus hernia does not necessitate treatment, which requires surgery, rather the associated condition (usually reflux) is managed and, if that requires surgery, the hiatus hernia is repaired as part of the operation. For more information about hiatus hernia see [6].
Clinical characteristics of reflux esophagitis among patients with liver cirrhosis: a case-control study
Published in Scandinavian Journal of Gastroenterology, 2022
Zijin Liu, Lin Wei, Huiguo Ding
Erosive esophagitis was diagnosed based on the Los Angeles (LA) classification [19]. Additionally, the presence of Barrett’s epithelium was defined as the macroscopic identification of abnormal columnar esophageal epithelium more than 1 cm in thickness, which is suggestive of a columnar-lined distal esophagus. Hiatus hernia was defined if the proximal dislocation of the gastroesophageal junction was >2 cm above the diaphragmatic indentation. Esophageal varices were graded as mild, medium or severe. Mild EVs were defined as varicose veins that were straight or mildly tortuous without a red color (RC) sign. Medium EVs were defined as varicose veins that were serpentine without an RC sign or varicose veins that were mildly tortuous with an RC sign. Severe EVs were defined as varicose veins that were serpentine with an RC sign or varicose veins that were toruliform. Portal hypertension gastropathy (PHG) was defined as snakeskin-like mucosa, flat or bulging red marks or red spots resembling vascular ectasias found in the stomach. Helicobacter pylori (HP) infection was evaluated by mucous biopsy or 13C-urea-breath tests.
Health-care providers’ views of menopause and its management: a qualitative study
Published in Climacteric, 2021
S. R. Davis, D. Herbert, M. Reading, R. J. Bell
Between 2001 and 2003 there was a dramatic decline in the prescribing of menopausal hormone therapy (MHT) globally following the first publication of findings from the Women’s Health Initiative (WHI) estrogen–progestin study linking MHT use to an increase in breast cancer risk [1]. The use of MHT fell by approximately 40% in Australia [2], with even greater declines in Canada [3] and the USA [4]. Concomitantly, a hiatus developed in training of medical trainees and clinicians, and allied health professionals, in the management of menopause. A 2017 survey of trainees in family medicine, internal medicine, and obstetrics and gynecology in the USA reported that 20% had not had lectures on menopause in their residency and only 6.8% felt ‘adequately prepared to manage women experiencing menopause’ [5,p.242].
Sabina Spielrein’s Death Drive, Queer Experience, and Psychoanalytic Twogetherness
Published in Studies in Gender and Sexuality, 2021
The Kleinian analyst Hanna Segal wrote about working clinically with the death drive, which she understood as self-destructiveness. In her clinical vignettes, she addressed helping patients overcome severe self-destructiveness by bringing it into their conscious awareness, at moments when they are ready and feel safe enough to be confronted with it. Segal’s clinical thinking about the workings of the death drive and ways of overcoming them is crystallized and profound. But what Segal, and other theorists who worked narrowly in the intrapsychic sphere and did not venture to think about the social, did not consider is that some people chronically and persistently find themselves on the receiving end of others’ homicidal fantasies (if not actual attempts) and are subjected to objectifying, mortifying glances (Segal, 1993). For subjects who are often looked upon or treated in these ways, becoming aware of the death drive and confronting it internally is not enough, because the death drive is continuously nourished by hatred from the outside. When that is the case, a single confrontation is not enough, whereas perpetual confrontation is too exhausting. One needs, rather, to continually receive infusions of loving energy. One also needs to know how to psychically die once in a while, to go into a hiatus, a restful depression. No one can live their entire lives on the battleground.