5.3
A hiatal hernia is an abnormal protrusion of the stomach or other abdominal structures through the esophageal hiatus into the thoracic cavity.
Under normal physiological conditions, the gastroesophageal junction or GEJ is securely positioned below the diaphragm, anchored by the phrenoesophageal membrane, diaphragmatic crura, and surrounding connective tissues.
These structures can weaken with age or with sustained increases in intra-abdominal pressure, as seen during pregnancy or with activities like heavy lifting.
This weakening may enlarge the esophageal hiatus, allowing the GEJ and parts of the stomach to herniate upward into the thoracic cavity.
Hiatal hernias are classified into four types. Type I, or sliding hernia, involves the upward movement of the GEJ into the thoracic cavity.
Type II, or paraesophageal hernia, occurs when the gastric fundus herniates beside the esophagus.
Type III combines both, with displacement of the GEJ and the fundus.
Type IV involves herniation of the stomach along with other abdominal organs, such as the small intestine.
A hiatal hernia is the abnormal protrusion of the stomach or other abdominal organs through the esophageal hiatus of the diaphragm into the thoracic cavity.
Normally, the gastroesophageal junction (GEJ) lies below the diaphragm and is supported by the phrenoesophageal membrane, the diaphragmatic crura, and connective tissues. Weakening of these structures—due to aging, congenital defects like a short esophagus, or increased intra-abdominal pressure from coughing, obesity, pregnancy, or heavy lifting—enlarges the hiatus, allowing herniation of the GEJ and stomach into the chest.
Hiatal hernias are classified into four types.
All types disrupt the anti-reflux barrier, which includes the LES, crural diaphragm, intra-abdominal esophagus, and angle of His. Herniation lowers LES pressure, shortens the intra-abdominal esophagus, and flattens the angle of His, promoting reflux. Increased transient LES relaxations and reduced acid clearance further elevate esophageal acid exposure, leading to GERD and complications such as esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma.
A hiatal hernia is an abnormal protrusion of the stomach or other abdominal structures through the esophageal hiatus into the thoracic cavity.
Under normal physiological conditions, the gastroesophageal junction or GEJ is securely positioned below the diaphragm, anchored by the phrenoesophageal membrane, diaphragmatic crura, and surrounding connective tissues.
These structures can weaken with age or with sustained increases in intra-abdominal pressure, as seen during pregnancy or with activities like heavy lifting.
This weakening may enlarge the esophageal hiatus, allowing the GEJ and parts of the stomach to herniate upward into the thoracic cavity.
Hiatal hernias are classified into four types. Type I, or sliding hernia, involves the upward movement of the GEJ into the thoracic cavity.
Type II, or paraesophageal hernia, occurs when the gastric fundus herniates beside the esophagus.
Type III combines both, with displacement of the GEJ and the fundus.
Type IV involves herniation of the stomach along with other abdominal organs, such as the small intestine.
From Chapter 5:
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