Condition known as hiatus (hiatal) Hernia, the opening in the diaphragm through w/c the esophagus passes becomes

enlarged, & part of the upper stomach tends to move up into the lower portion of the thorax. Often occurs in women than in men.

2 types of hernias: 1. Sliding 2. paraesophageal

Sliding or type 1, hiatal hernia occurs in the upper stomach & gastroesophageal junction are displaced upward & slide in & out of the thorax. 90 % of patient w/ esophageal hiatal hernia have sliding hernia.

Paraesophageal hernia occurs when all or part of the stomach pushes through the diaphragm beside the esophagus. Paraesophageal hernias are further classified as types II, III, or IV, depending on the extent of herniation, with type IV having the greatest herniation.

Although abdominal hernias can be present at birth, others develop later in life. Some involve pathways formed during fetal development, existing openings in the abdominal cavity, or areas of abdominal-wall weakness. Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. Examples include: obesity, heavy lifting, coughing, straining during a bowel movement or urination, chronic lung disease, and fluid in the abdominal cavity. A family history of hernias can make you more likely to develop a hernia.

The signs and symptoms of a hernia can range from noticing a painless lump to the severely painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen (an incarcerated strangulated hernia).

Reducible hernia:

It may appear as a new lump in the groin or other abdominal area. It may ache but is not tender when touched. Sometimes pain precedes the discovery of the lump. The lump increases in size when standing or when abdominal pressure is increased (such as coughing). It may be reduced (pushed back into the abdomen) unless very large

Irreducible hernia:

It may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it. Some may be chronic (occur over a long term) without pain. An irreducible hernia is also known as an incarcerated hernia. It can lead to strangulation (blood supply being cut off to tissue in the hernia) Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.

Strangulated hernia

This is an irreducible hernia in which the entrapped intestine has its blood supply cut off. Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting). The affected person may appear ill with or without fever. This condition is a surgical emergency.

Medical :

Treatment of a hernia depends on whether it is reducible or irreducible and possibly strangulated. Reducible hernia- these kinds of hernias may be treated without surgery, perhaps using abdominal binders. Irreducible hernia- An attempt to reduce (push back) the hernia will generally be made, often after giving medicine for pain and muscle relaxation. If the intestinal contents of the hernia had the blood supply cut off, the development of dead (gangrenous) bowel is possible in as little as six hours. In cases in which the hernia has been strangulated for an extended time, surgery is performed to check whether the intestinal tissue has died and to repair the hernia. In cases in which the length of time that the hernia was irreducible was short and gangrenous bowel is not suspected, you may be discharged from the hospital.

The prognosis for hernia repairs is generally good with timely diagnosis and repair. The prognosis depends on the type and size of hernia as well as on the ability to reduce risk factors associated with the development of hernias. Older age, longer duration of hernia, and longer duration of irreducibility are thought to be risk factors for acute complications such as Strangulation and Intestinal obstruction. About 5% of primary inguinal hernia repairs are undertaken as emergencies. Abdominal hernias usually do not recur in children. They do reappear, however, in about 10 percent of adults. Surgery is considered the only cure. Surgery for recurrance of hernia is less successful than the first surgery. If diagnosed early in childhood, the prognosis for children who have had a surgically repaired inguinal hernia is excellent. Occasionally there are complications associated with inguinal hernias including death, but these are rare, occurring most often in children who were diagnosed later in childhood or whose hernias were strangulated.