Was ist ein Hiatushernie

Die Speiseröhre schließt sich den Mund und Rachen in den Magen. Er bewegt sich in der Brusthöhle und beginnt an der Bauchhöhle durch ein Loch in der Membran als Hiatus bekannt. The term Hiatal hernia defines a condition where a portion of the stomach that ordinarily is located in the abdominal cavity swells or protrudes through the esophageal hiatus to sit within the chest cavity.

What causes a hiatal hernia?

Normalerweise, the place where the esophagus passes through the diaphragm is sealed by the phren oesophageal membrane, eine dünne Membran aus Gewebe der Speiseröhre mit der Membran angebracht, wo die Speiseröhre durch die Membran durchquert, so dass der Brusthöhle und der Bauchhöhle voneinander getrennt sind. Da die Speiseröhre verkürzt und verlängert mit jedem Schluck, im wesentlichen Quetschen Nahrung in den Magen, diese Membran erfordert Elastizität der Speiseröhre zu ermöglichen, nach oben und unten normaler Physiologie Magen zu bewegen, und diese Membran muss elastisch in die Speiseröhre zu ermöglichen, nach oben und unten zu bewegen,. Normale Physiologie unterstützt die gastroösophageale (GEBEN)Kreuzung, wo der Speiseröhre und des Magens kommen hin und her von knapp unterhalb knapp über der Membran zu bewegen. aber, im Ruhezustand, der GE-Übergang sollte unterhalb der Membran und in der Bauchhöhle befindet. Es ist wichtig, sich daran zu erinnern, dass diese Abstände sehr kurz sind.

Im Laufe der Zeit, die pharyngoesophageal Membran kann schwächer, ein Teil des Magens in die Membran Hernien kann und bleiben über der Membran dauerhaft.

Decreased abdominal muscle tone and increased pressure within the abdominal city may start to the growth of a Hiatal hernia. Deswegen, people who are overweight and women who are pregnant are at an elevated risk for developing a hiatal hernia.

People who have a repetitive vomiting or those who have constipation and strain to have bowel models increase the intra-abdominal pressure when they strain, and this may weaken the pharyngoesophageal membrane.

The membrane also may soften and lose its elasticity as a part of aging.
Ascites an abnormal accumulation of fluid in the abdominal cavity often observed in people with liver failure also, associated with the growth of a hiatal hernia.

Are there multiple types of a Hiatal Hernia?
The most common type of a hiatal hernia is a sliding hiatal hernia. This account for 95% of all hiatal hernias and, because a hiatus hernia by itself causes no symptoms, it is unknown how frequently his condition exists in the general population. With a sliding hernia, the GE junction and a portion of the stomach slide higher into the mediastinum, the area in the chest between the lungs where the esophagus advances and where the heart is located. Eine Hernie ist besonders spürbar während des Ansaugens, wenn das Zwerchfell kontrahiert und fällt in Richtung der Bauchhöhle, und wenn der Speiseröhre verringert sich während des Schluckens.
In einer para-Ösophagus-Hernien, der Spalt in der Membran groß pharyngoesophageal, und ein größerer Teil des Magens herniates in die Brust neben der Speiseröhre und bleibt dort, aber der Anschlussstelle GE bleibt unterhalb des Zwerchfells. Dies ist auf Bänder, die sich auf andere Organe im Bauchraum verbundenen Abschnitte des Magen halten, wenn ein para-esophageal Hernie geschieht, Teile des Magens drehen nach oben übernehmen die diese Position oberhalb des Zwerchfells.
In einer Kombination von Ereignissen, sollte er in der Membran werden Defekt groß, the GE junction and addition regions of the stomach can herniate and become dislodged into the chest causing both a para esophageal and a sliding hiatus hernia.

What are the signs and symptoms of a hiatus hernia?

By itself, a hiatus hernia causes no symptoms, and most are found unexpectedly when a person has a chest X-ray or abdominal X ray or abdominal Xray including upper GI series, and CT scans, (where the patient swallows barium or different contrast material). It also is found incidentally during gastrointestinal endoscopy of the esophagus stomach and duodenum (ECD)

Most often if symptoms transpire, they are due to gastroesophageal reflux disease (GERD) where the digestive juices containing acid from the stomach moves up into the esophagus.

The stomach is like a mixing bowl that allows food and digestive juices to mix to begin the digestive process. The stomach has a protective lining that inhibits acid from eating away at the stomach muscle and producing inflammation. Unglücklicherweise, the esophagus does not have a comparable protective lining. Stattdessen, it relies on the lower esophageal sphincter (DAS) located at the GE junction and the muscle of the diaphragm encircling the esophagus to function as a lid or plug to block acid from refluxing from the abdomen into the esophagus. In addition to the LES, the normal location of the GE junction within the abdominal cavity is important to keep the acid where it belongs. There is additional pressure in the chest cavity compared to the abdominal cavity, particularly during aspiration. This blend of pressure exerted within the lowermost esophagus from the LES, the diaphragm, and the abdominal cavity produces a zone of higher pressure that keeps stomach acid in place.

In cases with sliding hit hernia, The GE junction flows above the diaphragm and into the chest, and the higher pressure zone is dissipated. Acid is allowed to reflux back into the esophagus creating inflammation of the lining of the esophagus and the symptoms of GERD.

These symptoms may include the following:

  • Buring in the esophagus region
  • Waterbrash, the rapid emergence of a considerable amount of saliva in the mouth that is stimulated by
  • the refluxing acid
  • Sodbrennen; chest pain or burning
  • Übelkeit, vomiting or retching (dry heaves)

Symptoms normally are worse after meals. These symptoms may be made worse when lying fast and may resolve with sitting up or walking.
In some subjects, reflux into the lower esophagus sets off nervous reflexes that can produce a cough or even spasm of the small airways within the lungs asthma. Some patients may have reflux acid droplets appear in the back of their throat. This acid can be breathed in or aspirated into the lung producing coughing spasms asthma or reoccurring infections of the lung including pneumonia and bronchitis. This may occur in an individual of all ages from infants to the elderly.

Most para esophageal vital hernias have no symptoms of reflux because the GE junction resides below the diaphragm, but because of the way the stomach has turned into the chest, there is the likelihood of a gastric volvulus where the stomach twist upon itself. Emergency and causes difficult, painful swallowing, Brustschmerzen, und Erbrechen.

How is a hiatal hernia diagnosed?
Meistens, a hiatal hernia is found unexpectedly with gastronitiesnial X-rays, EGD and sometimes CT scan, since, von selbst, it causes no symptoms. Only when there are linked, symptoms of GERD will the patient usually seek medical care. With symptoms of GERD, it is likely that a hiatal hernia exists in some form since most patients with GER have Hiatal hernias.

Meistens, the diagnosis is established by a barium swallow or upper GI series, where a radiologist uses fluoroscopy to examine in real time as the swallowed barium outlines the esophagus, stomach and upper section of the small intestine. In addition to seeing the anatomy, the radiologist also can note the movement of the muscles that work to propel that barium (and presumably) food through the esophagus into the stomach and beyond.

Die Endoskopie ist eine medizinische Operation unter Sedierung durch einen Gastroenterologen durchgeführt an der Auskleidung des Ösophagus zu sehen, Bauch, und Duodenum. Eine Hiatushernie auf diese Weise leicht sein kann diagnostiziert, und noch wichtiger, der Arzt in der Lage seiner Komplikationen von Dn aus dem Rückfluss von Säure zu sehen. Die Endoskopie ist Vernarbung mit Struktur zu diagnostizieren (Verengung der Speiseröhre und präkanzerösen Erkrankungen wie Barrett-Ösophagus. Biopsien oder kleine Gewebeproben können unter einem Mikroskop aufgenommen und untersuchen werden.

What is the treatment for a hiatal hernia?
The treatment for a hiatal hernia is a treatment for GERD and minimizing acid reflux. This includes decreasing acid secretion in the stomach, avoiding elements and substances that are vexatious to the stomach lining, and mechanical means to keep the residual acid in the stomach where it belongs.
Proton pump inhibitor medications are ordinarily used to decrease acid production. These include rabeprazole (Aciphex), pantoprazole (Protonix), Esomeprazol (Nexium), lansoprazole (Prevacid), Omeprazol (Prilosec),

Änderungen des Lebensstils
Lifestyle changes may include elevating your head while laying in bed, sleeping to allow gravity to limit acid from refluxing into the esophagus.
Small frequent meals may help rather than eating two or three large meals a day.
Some foods should be avoided including onions, citrus fruits, tomatoes, spicy food, aber, most individuals are aware of the foods that trigger heartburn symptoms and evade them.

Hiatal Hernia Surgery
With the addition of proton pump inhibitor medications, medica

l therapy ha decreased the need of surgery for sliding hiatal hernias, and it is often only advised for people who have failed aggressive drug treatment or who have advanced complications of GERD, like ulcers, strictures, and bleeding, or those with chronic pneumonia from aspiration.

Patients with para esophageal hernias often have no symptoms, and surgery is required only if the hernias become confined and become stuck in the diaphragmatic hiatus or rotate to cause a volvulus. Während dies regelmäßig bei älteren Menschen ist zu sehen, para-Ösophagus-Hernien kann auch als eine angeborene Krankheit bei Neugeborenen und Säuglingen auftreten.
Ziemlich oft, Die Operation wird als minimal invasive Operation durchgeführt unter Verwendung eines Laparoskops. Zwar gibt es verschiedene Methoden, die Ergebnisse sind vergleichbar, und die beste Wahl ist in der Regel derjenige der Chirurg fühlt sich am entspannt in einem bestimmten Umstand Durchführung.