Hiatal hernia(HH)

The diaphragm is a large and wide muscle that separates the pectoralis
cavity from the abdominal cavity. She’s kind of “stretched” between the sternum,
ribs and lumbar vertebrae, to which
attached. The formation of a hernia of the food hole occurs
because of its weakening, in which part
lower organs penetrate the upper (thoracic)
cavity.

In most cases, small hernia hiatus
diaphragms do not cause problems. If the hernia is large, gastric
the contents are thrown back into the esophagus, which leads to
heartburn, belching, as well as dysphagia and chest pain.

The reasons

О грыжи пищеводного отверстия диафрагмы

Hiatal hernia (сокращенно ГПОД)
diagnosed in about 5% of adults. More than half the cases
fall into old age – older than 55 years, due to
age-related changes — in particular, the natural process
loosening of the ligament apparatus.

Most often, diaphragmatic hernia develops due to the fact that
tissues whose task is to limit the esophageal opening of the diaphragm,
become much more resilient than necessary.
 Many do not even know that such a hernia is possible. BUT
Meanwhile, this is quite a serious problem requiring
квалифицированной medical care.

The reasons возникновения:

  • Injuries to the abdomen and chest;
  • Increased abdominal pressure;
  • Bouts of prolonged cough (asthma, chronic bronchitis);
  • Connective tissue diseases: Marfan syndrome, systemic
    scleroderma, systemic lupus erythematosus, dermatomyositis;
  • BUTстеническое телосложение;

Paraesophageal hernia may be congenital or
acquired character. Hiatal hernia у
children are usually associated with fetal disease – shortening
esophagus and requires surgery already in early
age

At risk are those who have the following diseases:

  • Phlebeurysm
  • Flat feet
  • Hemorrhoids
  • Obesity.

Also to the development of hiatal hernia
predisposes a violation of motility of the digestive tract when
hypermotor dyskinesia of the esophagus associated with peptic ulcer
duodenum and stomach, chronic gastroduodenitis,
chronic pancreatitis, calculous cholecystitis.

Симптомы грыжи пищеводного отверстия диафрагмы

HHP is a chronic disease affecting the digestive
system that is in 3rd place among other diseases such
как язва желудка и двенадцатиперстной кишки, хронического
cholecystitis. Hiatal hernia — это патология,
in which the stomach slides up to the esophagus.

Признаки грыжи пищеводного отверстия диафрагмы

Symptoms of HH:

  1. a sign of diaphragmatic hernia is a pain syndrome that
    usually localized in the epigastrium, spreads along the esophagus
    or radiating to the interscapular area and back
  2. chest pain may lead to a diagnosis by mistake
    patient to a cardiologist;
  3. pain may occur after a meal or physical
    напряжения, при кишечном метеоризме и после глубокого
    inhale;
  4. heartburn, burning in the throat, hiccups, nausea, urge to
    vomiting, hoarseness;
  5. cyanosis, vomiting with blood speak about the infringement of a hernia;
  6. in some cases, it may increase arterial
    pressure.
  7. at night there are strong bouts of cough, accompanied by
    suffocation, increased salivation.

Causes of pain with hernia of the diaphragm are
squeezing of the nerves and vessels of the stomach at the exit of his cardiac
parts in the chest cavity, exposure to acidic contents
intestines and stomach to the esophageal mucosa and stretching it
walls.

Pain with hernia esophageal can
differentiate based on the following features:

  • pains occur mostly after eating, physical
    load, in a horizontal position, with increased
    gassing;
  • they soften or disappear after a deep breath, belching,
    taking water, changing poses;
  • pain intensifies as a result of leaning forward.
  • Sometimes the pain may be shingles, reminding
    pancreatitis.

Typical symptoms of hernia of the esophageal diaphragm are
also:

  • hiccups;
  • heartburn;
  • pain in the tongue, burning sensation;
  • the appearance of hoarseness.

Immediately contact an ambulance if:

  • you feel nauseous
  • you had vomiting
  • you cannot empty your bowels or release gases.

Types of HH

There are such main types of hernia: sliding food hernia
(axinal) and fixed (paraesophageal) hernia.

Sliding (axinal) hernia

BUTксиальной хиатальной грыжей называют выпячивание органов,
located below the diaphragm, through the natural opening. AT
the vast majority of cases (approximately 90%) of the hernia of the diaphragm
are axial or sliding.

With sliding (axial, axial) hernia, free
penetration of the abdominal esophagus, cardia and the bottom of the stomach
through the esophageal opening of the diaphragm into the chest cavity and
self-return (when changing the position of the body) back to
брюшную cavity.

BUTксиальная хиатальная грыжа начинает развиваться при пониженной
elasticity of muscular connective tissue loosening their ligaments.
Depending on the area being displaced, they may be cardiac,
cardiofundal, subtotal or total gastric.

Axial hernia under the esophagus is characterized by different
etiology. There are the following etiological factors:

  • Motility disorders of the digestive system
  • The weakness of the ligament apparatus and other connective tissue
    items
  • High abdominal pressure
  • The presence of chronic pathology of the stomach, liver disease
    respiratory tract, accompanied by intense cough.

Among all diseases of the digestive system, this pathology
is in third place, making a serious “competition”
pathological conditions, such as peptic ulcer and
cholecystitis.

Fixed hcp

Fixed (paraesophageal) hiatal hernia
diaphragm is not as common. In this case, part of the stomach
pushed out through the diaphragm and stays there. As a rule, similar
hernias are not considered a serious disease. However, there is a risk
the fact that blood flow to the stomach can be blocked, which can
cause serious damage and needs urgent
medical care.

In patients with a fixed hernia, this may occur.
symptom as belching. It appears as a result of air ingress.
in the esophagus. Sometimes he gets there with a mixture of bile or
gastric juice. In this case, the belching will have characteristic
smack and smell.

Quite often, patients with paraesophageal hernia complain of
intense pain in the heart. This is not surprising, because that
the pain in the thoracic region that they feel is really imitating
heartfelt.

Degree hod

It is important to remember that early diagnosis of the disease will help.
avoid complications, and treatment will be more effective. At first
Stages can be dispensed with without surgery.

  1. At the first, the easiest degree, in a chest cavity rises
    the esophagus, which is normally located in the abdominal cavity
    (abdominal). The size of the hole does not allow the stomach
    climb up, it stays in place;
  2. При второй степени в грудной полости располагается
    abdominal esophagus, and directly in the area
    the esophageal opening of the diaphragm is already part of the stomach;
  3. ГПОД 3 степени — значительная часть желудка, иногда вплоть
    to his gatekeeper, moving to the duodenum, moves
    into the chest cavity.

Complications

Complications, которые могут возникнуть при ГПОД:

  • Hiatal hernia may be complicated
    the development of gastrointestinal bleeding. The reason
    bleeding are peptic ulcers, erosion of the esophagus and
    stomach.
  • Another possible but rare complication of hiatus hernia
    является ее ущемление и перфорация стенки stomach.
  • Anemia is a frequent complication of hiatal hernia
    aperture.
  • Reflux esophagitis is a natural and frequent complication
    GOD.

The remaining complications of hernia hiatal –
retrograde prolapse of the gastric mucosa into the esophagus,
invagination of the esophagus into the hernial part is rarely observed and
diagnosed with fluoroscopy and endoscopy of the esophagus and
stomach.

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It is clear that in these situations of complications
hiatal hernia
treatment of the underlying disease.

Diagnostics

Diagnostics ГПОД

To make a diagnosis of hernia hiatus
diaphragm, you must describe in detail your complaints to the doctor, go through
a series of surveys. Since such a disease sometimes proceeds
asymptomatic, it is possible to detect a hernia with a random examination
about other complaints.

The diagnosis of hiatal hernia is put on
on the basis of specific complaints and data instrumental methods
research.

  1. These include x-ray examination with
    contrast enhancement, endoscopy and manometry,
    measuring pressure in different parts of the esophagus.
  2. Additionally prescribe a complete blood count to exclude
    potential complication of hernia – gastrointestinal
    bleeding.
  3. When in addition to the hernia of the diaphragm, the patient has
    gallstone disease, he needs to undergo ultrasound
    study of the abdominal cavity.
  4. Because diaphragmatic hernia is often accompanied by symptoms,
    similar to signs of heart disease, will additionally have
    make an electrocardiography.

In any case, studies are assigned individually, taking into account
features of the patient and the collected history.

Treatment of hiatal hernia: drugs and
operation

Treatment of diaphragmatic hernia begin with conservative
events. Since the clinic hernia hiatus
diaphragm to the fore the symptoms of gastroesophageal
reflux, conservative treatment is aimed mainly at their
elimination.

Based on pathogenetic mechanisms and clinical symptoms
the esophageal opening of the diaphragm, can be formulated as follows
the main tasks of her conservative treatment:

  1. reduction of aggressive properties of gastric juice and, above all,
    the content of r iici hydrochloric acid:
  2. prevention and restriction gastroesophageal
    reflux;
  3. local medicinal effect on the inflamed mucosa
    the shell of the esophagus, the hernial part of the stomach,
  4. decrease or elimination of esophageal and gastric
    dyskinesia:
  5. warning and limiting trauma in the hernial ring
    абдоминального отрезка пищевода и пролабирующей части stomach.

Drugs for HH

The doctor may prescribe you the following medications:

  • antacids to neutralize gastric acid
  • H2-histamine receptor blockers that reduce the production of
    acids
  • proton pump inhibitors (PPIs) – antisecretory
    drugs for the treatment of acid-related diseases
    stomach.
  • Drugs – proton pump inhibitors and histamine blockers
    (omez, omeprazole, gastrazole, ranitidine, pantoprazole).
  • Prokinetics to improve the condition of the gastric mucosa,
    esophagus, optimizing their motility, getting rid of nausea, pain
    (motilak, motilium, metoclopramide, ganaton, itomed,
    trimebutin).
  • B vitamins to accelerate tissue regeneration
    stomach.

As a rule, treatment of hernia of the diaphragm is 99% identical to tactics.
treatment of reflux esophagitis. In fact, all actions are directed
solely on the elimination of symptoms. Patient can take
medications prescribed by a doctor, follow a special diet, and
to adhere to all prescriptions of the doctor.

Surgery for hernia of the esophageal orifice

AT настоящее время operation является единственным
radical and most effective way to treat esophageal hernia
отверстия aperture. It is shown and in the absence of a result from
conducted drug therapy.

Surgery on the diaphragm for hiatal hernia is usually
planned, carried out after a thorough examination and preparation.
Emergency operations are not very often performed with complicated
hernias (pinching, perforation, or bleeding from squeezed
body).

Operations at the HHC are carried out in different ways. Gain popularity
Nissen fundoplication. With such an operation from a part of the wall
a stomach cuff is made which is fixed around the hole where
произошло расширение aperture.

Doctors operate in two ways, such as:

  • removal of open, abdominal incision;
  • laparoscopy with several small cuts and application
    endoscope with camera and optics.

Contraindications for surgery:

  • Acute infectious diseases.
  • Exacerbations of chronic diseases.
  • Heart disease in the stage of decompensation.
  • Severe lung disease with respiratory failure.
  • Uncompensated diabetes.
  • Blood disorders with coagulation disorders.
  • Renal and hepatic failure.
  • Pregnancy.
  • Oncological diseases.
  • Recently transferred abdominal operations.

In the postoperative period, antibiotics are prescribed,
painkillers for motility disorders
gastrointestinal tract – prokinetics (calle, motilium). Stitches
removed on the 7th day, after which the patient is discharged from
Hospital under the supervision of a gastroenterologist.

In the first months it is necessary to significantly reduce physical
load associated with active movements of the body.

The most common complications after surgery
Removing the hernia of the esophageal opening are:

  • recurrence of the disease;
  • cuff slippage;
  • feeling of discomfort in the chest area;
  • pain;
  • difficulty swallowing;
  • inflammatory processes;
  • seam divergence.

Диета после операции должна быть жидкая —  потребуется
соблюдать  примерно от 3 до 5 дней. Clear liquids
consist of broth, water or juice. If after 3-5 days
liquids are well tolerated, the diet will go into a soft
diet

A bland diet consists of foods that are easy to chew and
swallow such as food softened cooking or
mashed potatoes, canned or cooked soft fruits and vegetables,
или  нежным мясом, рыбой и птицей. If a mild diet
it is transferred within three weeks, and then it is possible to pass to the usual
diet

Diet and nutrition

Eating should be in small portions. A day should be 4–5
meals. After eating it is undesirable to rest in a lying position.
It is better to sit or even walk. Movement will stimulate the speediest
passage of food from the stomach to other parts of the digestive system.

Диета и правильное питание

Diet for hernia of the esophagus and the menu suggest an introduction to
diet:

  • yesterday’s bakery products from wheat flour;
  • mucous cereal soups;
  • sour dairy cuisine;
  • porridge, pasta;
  • meat, fish, boiled, baked, steamed;
  • oils of plant and animal origin.

It is forbidden to use seasonings and sugar in dishes for patients.
diaphragmatic hernia since it provokes
increased acidity of gastric juice and creates risks for
trauma to the esophagus.

It is necessary to adhere to a dietary diet, and
exactly:

  • eat food 5-6 times a day in small portions;
  • after eating for 1 hour do not go to bed;
  • dinner should be 2-3 hours before bedtime;
  • can be eaten ground fruits and vegetables, boiled
    meat and fish, cereals, jelly, vegetable soups;
  • before meals drink 1 tablespoon of sunflower or
    olive oil;
  • forbidden to accept fried, fatty, salty foods;
  • Smoking is prohibited.

How to treat a hernia of the esophageal orifice folk
by means

With diaphragmatic hernia, herbal therapy with traditional background
therapy allows you to improve the patient’s condition as a whole and remove
symptomatology. The following recipes speed up the secretion
gastric juice, make food move faster on
the esophagus, as well as eliminate the causes of constipation.

A simple remedy is goat’s milk, which should be drunk warm.
twice a day after meals. One-time amount is
0,5 стакана.

  1. Лечение проводят, применяя отвар коры осины – берут
    большую ложку сырья и заваривают 200 мл кипящей воды,
    insist and filter. ATыпивают по 2 большие ложки до
    5 раз в сутки перед едой.
  2. You can also use the branches of young aspen and cherry. They need
    pour a liter of boiling water and cook over low heat for
    half an hour. Next, allow to cool and take half a glass.
  3. No less effective, according to traditional healers, is
    the most common mint tea. To make it just add to
    boiling water several dried leaves of the plant, you can add
    sugar to taste (although it is better to abstain if possible). Drink in
    during the day in small sips and soon you will forget that you
    tormented by pain and heartburn.
  4. Можно смешать в равных долях семя льна, анисовые плоды,
    Althea and gentian roots, fenugreek. The components are ground,
    смешивают, трижды в сутки принимают по маленькой ложке
    powder. It is permissible to mix with honey.
  5. Chamomile decoction – a good tool for any manifestations
    diaphragmatic hernia. It does not just soothe the stomach, but also
    helps improve digestion. Excellent tool that boldly
    can be called a panacea for all ills.
  6. Calendula tea is also effective. It can be brewed together.
    with chamomile. This tea should be drunk no more than four times a day,
    certainly not earlier than one hour after meals.

Recommendations to people with HH

People who have this disease, it is recommended
observe the following guidelines:

  1. Больным нужно в обязательно порядке соблюдать специальную
    a diet that excludes products that cause irritation
    intestines;
  2. Food taken in fractional portions every few hours;
  3. Avoid torso forward, sudden changes of position
    body – it can cause pain in the sternum and heartburn;
  4. Patients should not lift weights more than 5 — b kg
  5. It is impossible to tighten the belt tightly, wear clothing going through the stomach –
    this creates additional pressure in the abdominal cavity;
  6. Avoid heavy physical exertion, but regularly
    perform exercises physical therapy, strengthening muscular
    corset and diaphragm restoring tone;
  7. Recommended last time there is no later than 2.5—3 h before
    bedtime;
  8. Normalize stools – constipation and diarrhea increase intra-abdominal
    pressure and promote the formation of esophageal hernia
    holes.
  9. It is recommended to drink a teaspoon before and after meals.
    unrefined vegetable oil;

Prevention

In addition to the basic measures for the prevention of gastroenterological
diseases (healthy lifestyle, elimination of stress, correct
nutrition) it is necessary to strengthen the muscular wall of the peritoneum – to engage
sports, therapeutic exercises, swing press. Patients with
a diagnosed hiatal hernia is subject to
dispensary observation by a gastroenterologist.

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