Hiatal hernia (mechanism of disease)

This is a flowchart on hiatal hernia, covering the etiology, pathophysiology, and manifestations.

ADDITIONAL TAGS:
Type II: paraesophageal hiatal hernia
Risk factors / SDOH
Cell / tissue damage
Structural factors
Hiatal hernia
Medicine / iatrogenic
Infectious / microbial
Biochem / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Environmental, toxin
Genetics / developmental
Pressure / flow physiology
Pathophysiology
Etiology
Manifestations
By Mysid - Self-made in Inkscape, based on File:Hiatus hernia.PNG., CC0, https://commons.wikimedia.org/w/index...
Protrusion of abdominal structure (usually portion of stomach [95%]) into the thorax through diaphragmatic esophageal hiatus
Lax diaphragmatic esophageal hiatus
Prolonged ↑ intra- abdominal pressure
+/- genetic predisposition
Chronic constipation
Chronic cough
Ascites
Pregnancy
Obesity
Loss of elastin fibres in the diaphragmatic crura
Phrenoesophageal ligament weakens with increasing age
COPD
Liver disease
Deposition of fat in and around the crura widens the hiatus
Crura of diaphragm are tendons that extend to vertebral column
Smoking
Age
Defects of the pleuro- peritoneal membrane
Congenital diaphragmatic hernia
Lost reflux barrier
Compromised fluid emptying of distal esophagus
esophagus
diaphragm
Normal anatomy
Pre-stage
Type I: sliding hiatal hernia
GEJ and the gastric cardia slide up into the posterior mediastinum
Gastric fundus remains below the diaphragm (hourglass stomach)
Part of the gastric fundus herniates into the thorax
GEJ remains in position below the diaphragm
GERD symptoms: heartburn, regurgitation, coughing, chest pain, difficulty swallowing (food stuck in throat), vomiting, sore throat / hoarseness
Epigastric / substernal pain
Early satiety
Retching
Identify type of hernia with barium swallow, endoscopy, CXR, CT
Complications:
Gastric ulcers
Gastric perforation
Upper GI bleed
Gastric volvulus
Fe def anemia
GEJ = gastro- esophageal junction