Hiatal hernia
Alerts and Notices
Synopsis
Hiatal hernias are typically asymptomatic. On occasion, patients will complain of vague abdominal discomfort. However, in most instances, they are diagnosed incidentally on cross-sectional imaging or upper endoscopy.
Hiatal hernias are classified as sliding or paraesophageal:
- Type I: sliding hernia – Most common type, due to progressive weakening of the gastroesophageal junction allowing a portion of the gastric cardia to slide upward with increased abdominal pressure, swallowing, and respiration. Patients with type I hernias are more likely to have gastroesophageal reflux disease (GERD).
- Types II, III, IV: paraesophageal hernia – Herniation includes viscera other than the gastric cardia, including gastric fundus and the colon. In type II and III hernias, the stomach becomes "inverted," possibly leading to gastric volvulus.
Codes
ICD10CM:K44.9 – Diaphragmatic hernia without obstruction or gangrene
Q40.1 – Congenital hiatus hernia
SNOMEDCT:
84089009 – Hiatal Hernia
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Most hiatal hernias are asymptomatic and are anatomic diagnoses.For symptomatic hiatal hernias, consider the following:
- Peptic ulcer disease
- Gastritis
- Acute coronary syndrome
- Coronary artery disease
- Esophagitis
- Achalasia (see esophageal motility disorder)
- Esophageal web / esophageal ring
- Esophageal spasm (see esophageal motility disorder)
- Gastroparesis
- Gastroenteritis
- Mesenteric ischemia
- Malignancy (particularly esophageal, gastric, small bowel, pancreatic, liver)
- Biliary colic / cholelithiasis
- Zollinger-Ellison syndrome
- Chronic pancreatitis
- Drug side effects (NSAIDs, alcohol, caffeine, antibiotics, corticosteroids, opiates, digoxin)
- Inflammatory bowel disease (ulcerative colitis, Crohn disease)
- Irritable bowel syndrome
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:12/18/2016
Last Updated:09/16/2020
Last Updated:09/16/2020
Hiatal hernia