Hiatus hernia

Aperture in the diaphragm, through weakening of the diaphragm or widening of an existing aperture, by which means an abdominal organ (such as the stomach) protrudes upwards into the chest cavity. The reverse (displacement of lung or heart into the abdominal cavity) never occurs because pressure in the abdominal cavity is generally higher (there is low pressure in the lungs during respiration to draw in the air). The condition occurs in a congenital and an acquired form. In the congenital form the hernial aperture can occur in various places. It is often an enlargement of an existing aperture on the lower side of the diaphragm, but an aperture can occur in the upper dome of the diaphragm, which is normally closed. In this congenital form a great deal of the content of the abdominal cavity can protrude into the thorax, putting pressure on the lungs and causing post-natal respiratory difficulties. The acquired form is usually the result of an excessively wide oesophagal aperture in the diaphragm, which can allow a section of the stomach to protrude into the thorax. Discomfort is often caused by poor closure of the opening of the stomach, which means that some of the contents of the stomach can pass into the oesophagus, causing heartburn and belching up of parts of food, e.g. when bending and lying down. Young children are most affected by vomiting. The acid stomach contents can cause inflammation of the mucous membrane of the oesophagus or ulceration of the oesophagus itself, associated with severe pain behind the breast bone. The congenital form is detected though lack of respiratory noise in the part of the thorax into which abdominal content has intruded. A thoracic X-ray shows displaced lung tissue. Oesophagal hernia is diagnosed by barium meal contrast X-rays. Treatment of both forms is by surgery to close the aperture or reduce the natural aperture.

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