Hiatal hernia, or diaphragmatic hernia occurs when a esophageal aperture (opening through which the esophagus enters the chest cavity from the abdominal) ventral part of the esophagus, stomach or abdominal portion of the esophagus with the stomach moves into the chest cavity. Sometimes through the esophageal opening into the chest cavity can be displaced and other organs located in the abdomen.
The cause of diaphragmatic hernia is an increased tissue elasticity limit esophageal aperture, the ligaments between the diaphragm and the esophagus, one of the legs of the diaphragm. Increased elasticity of the aperture may be innate. Sometimes there is an anomaly of development - the so-called "short esophagus with thoracic stomach", but most of hernia occurs in the patient's life under the influence of an environment conducive to increased intra-abdominal pressure. It's hard physical labor, obesity, ascites (accumulation of fluid in the abdominal cavity), endocrine diseases. Sometimes, a hiatal hernia results in pregnancy. What matters is the weakening and thinning of the ligaments and connective tissue with age.
At the onset of displacement of the abdomen into the chest cavity occurs from time to time, under the influence of physical activity, coughing, vomiting, eating, etc. Then, this loss becomes more frequent or permanent.
The most common hernia or axial sliding. In the esophageal aperture falls ventral part of the esophagus or the final part of the esophagus with the stomach.
Sliding hiatal hernia may not appear complain if the lower esophageal sphincter is functioning normally. But, often, with the state function of the sphincter is disturbed and there is gastro-oesophageal reflux - reflux of stomach contents into the esophagus. Over time, under the influence of aggressive gastric inflammation occurs in the lower esophagus - esophagitis. The patient has there are complaints of heartburn after eating, growing in a horizontal position during physical effort. Having pain after edy.Boli may have a different character, to give to the sternum, in the heart area, shoulder, neck and jaw. Sometimes the pain can arise only in a certain position of the body.
If you go into the chest cavity of the stomach is called a hernia paraesophageal (periesophageal). At this hernia pain occur frequently, give the bottom of the sternum, shoulder, left arm, and sometimes reminiscent of pain arising from angina. These pains often start in the supine position. The patient may complain of stomach bloating, foreign body sensation in the upper abdomen.
Complication of hiatal hernia is most often of reflux oesophagitis, but may develop a peptic ulcer of the esophagus, in the long course of which, in turn, can occur cicatricial stenosis (narrowing) of the esophagus. There are acute and chronic bleeding from the esophagus, perforation of the esophagus or esophageal hernia incarceration in the aperture.
The diagnosis of hiatal hernia determine if the X-ray study. It is often quite ordinary X-ray of the esophagus and stomach using barium contrast study. To conduct further diagnosis esofagogasroskopy.
Treatment of hiatal hernia.
Assigned to a diet with a fractional power in small portions, the treatment of constipation. Be sure to use therapeutic exercise. Performing certain exercises to avoid displacement of the stomach. Drugs are used to reduce gastric acid secretion and reduce the aggressiveness of gastric contents, the normalization of dyskinesias of the gastrointestinal tract. Sometimes there is a need for surgical treatment. The emergence of complications of hiatal hernia is often the indication for surgical treatment.