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Terms in this set (252)

- TYPE I
- Herniation of both the stomach and the GE junction into thorax
- 90% of esophageal hernias
- RISK:
o Age
o Increased intra-abdominal pressure (obesity, pregnancy, coughing, heavy lifting, straining with constipation
o Smoking
- CLINICAL FEATURES:
o Majority are asymptomatic
o Larger hernias frequently associated with GERD due to disruption of competence of GE junction and prevention of acid clearance once reflux has occurred
- COMPLICATIONS:
o Most common complication is GERD
o Other complications are rare and are related to reflux: esophagitis (dysphagia, heartburn), consequences of esophagitis (peptic stricture, Barrett's esophagus, esophageal carcinoma)
o Extra-esophageal complications (aspiration pneumonia, asthma, cough, laryngitis)
- INVESTIGATIONS:
o Barium swallow, endoscopy, or esophageal manometry
o 24-hr esophageal pH monitoring quantifies reflux
o Gastroscopy with biopsy to document type and extent of tissue damage and to rile out Barrett's and cancer
o CXR: globular shadow with air-fluid level visible over cardiac shadow
- TREATMENT:
o Treat symtoms of GERD
• LIFESTYLE: stop smoking, weight loss, elevate head of bed, no meals < 3hrs prior to sleeping, smaller and more frequent meals, avoid alcohol, coffee, mint and fat
• MEDICAL: antacid, H2-antagonist, PPI, adjuvant prokinetic agent
• SURGICAL (<15%): if sever complications or if refractory. NISSEN FUNDOPLICATION (laparoscopic)- fundus of stomach is wrapped around the lower esophagus and sutured in place (90% success rate)