일반적으로, the place where the esophagus passes through the diaphragm is sealed by the phren oesophageal membrane, a thin membrane of tissue attaching the esophagus with the diaphragm where the esophagus crosses through the diaphragm so that the chest cavity and abdominal cavity are divided from each other. Since the esophagus shortens and lengthens with each swallow, essentially squeezing food into the stomach, this membrane requires elasticity to allow the esophagus to move up and down Normal physiology stomach, and this membrane needs to be elastic to enable the esophagus to move up and down. Normal physiology supports the gastroesophageal (GE)junction, where the esophagus and stomach join to move back and forth from just underneath to just above the diaphragm. However, at rest, the GE junction should be located below the diaphragm and in the abdominal cavity. It is essential to remember that these distances are very short.
시간이 지남에, the pharyngoesophageal membrane may become weaker, 위의 부분은 막에 헤르니아 영구적 진동판 위에 유지할 수있다.
복부 도시 내 복부 근육과 증가 된 압력의 감소는 열공 탈장의 성장을 시작할 수 있습니다. 따라서, 임신 과체중 인 사람과 여성은 열공 탈장을 개발하기위한 높은 위험.
그들은 변형 할 때 반복적 인 구토를하거나 변비 및 변형이있는 사람들은 장 모델을 가지고 사람들은 복강 내 압력을 증가, 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. A hernia is extra noticeable during aspiration when the diaphragm contracts and falls in the direction of the abdominal cavity and when the esophagus decreases during swallowing.
In a para esophageal hernia, pharyngoesophageal 막에 갭이 크고, 그리고 위의 더 큰 부분은 인접한 가슴으로 식도 herniates 거기 유지, 그러나 GE 접합 다이어프램 이하 유지. 이 파라 식도 탈장이 발생하는 경우 복부 내부에 다른 기관에 연결 위의 부분을 유지 인대 때문이다, 위의 부분 횡격막 위의 그 위치를 추정 상향 회전.
이벤트의 조합에서, 그 커질 다이어프램에 결함해야, 위의 GE 접합하고 또한 영역 헤르니아 및 파라 식도 및 활주 열공 헤르니아 모두 유발 가슴에 빠질 될 수.
틈새 탈장의 징후와 증상은 무엇입니까?
스스로, 틈새 탈장은 증상 발생하지 않습니다, 사람이 상부 위장관 시리즈를 포함 흉부 X- 선 또는 복부 X 선 또는 복부 X- 선이있는 경우 대부분이 예기치 않게 발견된다, 및 CT 스캔, (환자는 바륨 또는 다른 조영제를 삼킨 곳). 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 (위식도 역류) 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. 운수 나쁘게, 식도는 비교 보호 안감이없는. 대신, it relies on the lower esophageal sphincter (LES) 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
- 가슴 앓이; chest pain or burning
- 구역질, 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. 역류 산 물방울이있을 수 있습니다 일부 환자들은 목의 뒤쪽에 표시. 이 산에서 불어 나 폐렴과 기관지염을 포함한 폐의 감염을 천식 경련 기침이나 재발생 생산 폐에 흡입 될 수있다. 이 노인까지 유아부터 모든 연령대의 개인에 발생할 수 있습니다.
GE의 접합이 다이어프램 아래에 존재하기 때문에 대부분의 파라 식도 중요한 탈장은 역류의 증상이 없습니다, 하지만 방식 때문에 위장 가슴으로 설정되어있다, there is the likelihood of a gastric volvulus where the stomach twist upon itself. Emergency and causes difficult, painful swallowing, 가슴 통증, 구토.
How is a hiatal hernia diagnosed?
가장 자주, a hiatal hernia is found unexpectedly with gastronitiesnial X-rays, EGD and sometimes CT scan, since, 스스로, 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.
가장 자주, 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.
Endoscopy is a medical operation performed under sedation by a gastroenterologist to look at the lining of the esophagus, 위, and duodenum. A hiatus hernia may be diagnosed easily in this manner, and more importantly, the physician may be able to see complications of GEr from the reflux of acid. Endoscopy is to diagnose scarring with structure (narrowing of the esophagus and precancerous ailments like Barrett’s esophagus. Biopsies or small tissue specimens may be taken and examine under a microscope.
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), 에 소메 프라 졸 (넥시움), lansoprazole (Prevacid), 오메프라졸 (프리로 섹),
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, however, 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. While this is more regularly seen in older people, para esophageal hernias also may occur as a congenital condition in neonates and infants.
Quite often, the surgery is performed as a minimally invasive operation utilizing a laparoscope. Although there are different methods, the results are comparable, and the best choice is usually the one the surgeon feels most relaxed performing in a specific circumstance.