Hiatus Hernia
HIATUS hernia occurs at the point where the oesophagus passes the through the diaphagm.

CAUSES
Congenitally short oesophagus.
Raised intra abdominal pressures. Eg. Obesity, pregnancy, ascites kyphosis.
Weakness of the oesophageal sphincter with reflux oesophagitis, s in old age.

TYPES
There are three types.
Sliding type
Rolling type
Combined.

SYMPTOMS
It is common in middle aged people, especially females.
Symptoms may be absent and the disease may be accidentally discovered. Due to regurgiation of aid, heartburn or acid regurgitation may be present. This is particularly felt after a heavy meal or after stopping forward or lying down. After taking hot drinks the condition can be aggravated. Sometimes the oesophagus may be inflamed or ulcerated, which may give rise to pain similar to heart pain. The pain may be produced when the oesophagus is perfused with hydrochloric acid and can be reduced by taking alkalis.

Nocturnal regurgitation of acid may cause respiratory distress. In the long run it may lead to narrowing of the oesophagus stenosis resulting in difficulty in swallowing and pseudo vomiting.

Due to pressure on the gastric pouch there may be cough, precordial distress, palpitation, heart pain and hiccups. Due to slow bleeding from the oesophageal ulcer, the patient may suffer from iron deficiency anaemia.


COMPLICATIONS
Oesophageal ulcer
Gastric ulceration
Perforation
Severe bleeding
Aspiration pneumonia

TREATMENT
Reduction of body weight, maintenance of propped-up position after food and small frequent meals.

MEDICATION
Nuxvom, Amonmur, Belladona, Asafoetida and Natrumphos are good medicines. Several others have to be tried according to the symptoms.