plate 391

A Hiatus is a gap or hole. In the context of the diaphragm, there are hiati (?) for a number of structures including the Vena Cava, the Aorta, and the Esophagus. These can be seen as the three openings in this image (plate 391) of Gray’s Anatomy. The smaller gap in the center is the esophageal hiatus (recall that the esophagus is a collapsed structure except in the case when a bolus of food is moving through it.

Hiatal Hernias occur when part (or all) of the stomach moves up through this opening and into the thoracic cavity. In general, these hernias are classified as either sliding or para-esophageal (see below). In general, a sliding hernia is one in which part of the stomach (including the gastroesophageal junction) moves up and down through the hiatus and the axis of the stomach is aligned with the axis of the esophagus (i.e. symmetrical). Para-esophageal hernias occur when the gastroesophageal junction remains in the abdomen, but part of the fundus of the stomach moves into the thoracic cavity.

As stated in wikipedia, “In most cases however, a hiatal hernia does not cause any symptoms. The pain and discomfort that a patient experiences is due to the reflux of gastric acid, air, or bile.” As such, they are often treated with lifestyle changes rather than more invasive procedures.

These hernias are most common among obese persons, women, and in those over 50 years old.

Of the two varieties of hiatal hernias, paraesophageal hernias are more often treated with surgery, which resolves symptoms in ~90% of patients. Outcomes are most favorable with laproscopic, rather than open, surgery.

I have a feeling I’ll ask something about this on tomorrow’s exam…