Hiatal (axial) hernia
The content of the article:
- Form and degree of the disease
- The reasons
- How does the disease manifest
- Possible complications
- Diagnostics
-
Hiatal (axial) hernia treatment
- Conservative therapy
- Surgery
- Video
Hiatal (axial) hernia is a pathological condition in which there is a protrusion of the abdominal organs through the esophageal opening of the diaphragm. Another name for the disease is hiatal hernia.
Hiatal, or axial hernia - one of the most common diseases of the digestive tract
Most often, there is a displacement of the lower part of the esophagus, as well as the stomach into the chest, less often other organs are involved in the pathological process. The onset of the disease is most often due to several factors.
The answer to the question of how to treat a hiatal (axial) hernia primarily depends on the cause of the development of the pathological process and the existing clinical signs.
Form and degree of the disease
Pathology can be congenital and acquired. It is also subdivided into three forms, which are presented in the table.
| View | Characteristic |
| Hiatal (axial, sliding) | In this form of the disease, the lower esophagus and upper stomach move (slide) into the chest cavity and back |
| Paraesophageal | It occurs relatively rarely, while there is a displacement of the lower part of the stomach from the abdominal cavity to the chest cavity (that is, the organ changes its position, turning upside down) |
| Combined | It is characterized by a combination of both of these forms of the disease |
The hiatal form of the disease, in turn, has two degrees, depending on the size of the hernial sac and the level of its displacement into the chest cavity:
- Hiatal (axial) hernia of the 1st degree - there is a change in the location of only the esophagus, while the stomach moves slightly higher (closer to the diaphragm). In the elderly, this is considered a variant of the norm, since it may be due to age-related changes in the human body.
- Hiatal (axial) hernia of the 2nd degree - not only the esophagus, but also the stomach is involved in the pathological process.
The reasons
The congenital form of the disease occurs during the prenatal period. Anomalies in the development of the diaphragm can contribute to its appearance.
The reason for the appearance of the acquired form of pathology can be:
- chest trauma;
- a history of inflammatory diseases;
- increased intra-abdominal pressure - during pregnancy, in patients with obesity, persistent cough (for example, with chronic obstructive bronchitis), with constant overeating, in patients with ascites, with heavy lifting;
- age-related changes.
The development of the pathological process is facilitated by:
- weakening of the muscles in the area of / u200b / u200bthe esophageal opening of the diaphragm, which can be observed in untrained people and elderly patients;
- the presence of gastroduodenitis, gastric ulcer and duodenal ulcer, pancreatitis, cholecystitis.
How does the disease manifest
Clinical signs depend on the form and severity of the disease. At the initial stages of the development of pathology, a person often lacks any symptoms.
With a hernia of 1 degree, heartburn may occur after eating (especially when eating fatty, sour, heavy foods), abdominal pain that occurs and / or worsens with prolonged bent position of the body.
At grade 2, patients may complain of:
- frequent heartburn that is not associated with meals. Heartburn can occur with a sharp change in body position, at night;
- difficulty swallowing;
- nausea;
- belching with air and / or stomach contents;
- pain in the abdomen and chest, which may resemble an attack of angina pectoris, increases in the horizontal position of the body, as well as with bending of the trunk. Painful sensations can occur in stressful situations. The pain can last from a few minutes to several days.
With the paraesophageal form of the disease, patients may experience:
- pain in the abdomen after eating (especially when the body bends forward);
- heartburn;
- belching;
- nausea.
With the combined form, a combination of the listed clinical signs is noted.
Possible complications
Eructation of stomach contents at night can lead to the development of aspiration pneumonia.
When the hernial sac is infringed, patients may experience sharp pain, nausea and vomiting, pallor of the skin, impaired consciousness. In this case, urgent hospitalization is required.
Diagnostics
Pathology is often detected when determining the reasons for the throwing of gastric contents into the esophagus, pain in the chest and / or abdomen.
To establish a diagnosis, carry out:
- endoscopic examination - will exclude other diseases of the digestive tract, in which similar symptoms may be observed;
- feces analysis for occult blood - to exclude bleeding in the gastrointestinal tract;
- X-ray examination - may be required to exclude diseases of the respiratory system;
- ECG (electrocardiography) - for the purpose of differential diagnosis with diseases of the cardiovascular system.
Hiatal (axial) hernia treatment
Conservative therapy
The disease of mild degree usually responds well to conservative treatment, which consists in adherence to diet and drug therapy.
- Diet. Fractional nutrition is shown. It is recommended to grind the products to a puree state, food should be eaten warm, avoiding too hot and cold dishes (the principle of thermal and physical sparing). Products that can irritate the mucous membrane of the gastrointestinal tract should be excluded from the diet: salted, pickled, smoked, spicy, fatty foods, alcoholic and caffeinated drinks (the principle of chemical sparing).
- Medication therapy. According to the testimony of patients can be prescribed antacids, prokinetic drugs, antispasmodics, analgesic drugs, vitamin and mineral complexes.
Surgery
In case of hiatal (axial) hernia of the 2nd degree, which is accompanied by severe symptoms, conservative therapy may be ineffective, in this case the issue of surgical intervention is considered. However, most often the operation is necessary for paraesophageal or combined form of the disease, in which there is a high risk of entrapment of organs in the hernial sac, gastric bleeding and other complications.
The gold standard of the operation is the laparoscopic method, which is characterized by less trauma, a shorter recovery period, and a low risk of complications. If it is impossible to carry out the intervention in this way, they resort to laparotomy.
During the operation, the esophageal opening of the diaphragm is sutured to its normal size, a cuff with an artificial ligamentous apparatus is created from the walls of the stomach, which prevents relapse. After such an operation, the patient may need to stay in the hospital for 3 days. The recovery period usually does not exceed 2 weeks.
After the end of treatment, patients usually require dispensary observation by a gastroenterologist.
Video
We offer for viewing a video on the topic of the article.
Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
Found a mistake in the text? Select it and press Ctrl + Enter.
