Pathophysiology
1. Stomach herniation via esophageal hiatus of diaphragm
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
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
Signs
1. Normal exam unless large hernia
2. Left lung base
  1. Dullness to percussion
  2. Absent breath sounds
  3. Bowel sounds present
Differential diagnosis
1. Angina Pectoris
2. Gastroesophageal Reflux
Radiology
1. Barium swallow (UGI)
  1. Stomach herniated above diaphragm

Navigation Tree

Please see the Terms and Conditions. Please also see the privacy statement regarding advertising on this page. Although access to this page is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians.

This page was written by Scott Moses, MD. This page was last revised on 4/26/2008 9:13:12 PM. This page was last published on 4/29/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.