Synonyms in the broadest sense
Medical: Hiatus hernia
Definition diaphragmatic hernia
A diaphragmatic hernia is a disease of the diaphragm in which the opening in the diaphragm (hiatus esophageus) through which the esophagus passes is widened. As a result, there is a risk that parts of the stomach will move out of the abdominal cavity and into the chest cavity, causing health problems. The abdominal cavity and the chest cavity are separated from each other by the diaphragm.
The esophagus runs from the pharynx through the chest cavity and enters the abdominal cavity through a slit-like opening in the diaphragm (hiatus esophageus), only to open into the stomach shortly afterwards. This is also where the so-called lower esophageal sphincter (ring-shaped muscle fibers of the esophagus) is located, which prevents acidic stomach contents from flowing back into the esophagus. Through the slit-like opening of the diaphragm, parts of the stomach can be pressed out of the abdominal cavity into the thoracic cavity located above the diaphragm, which is called a “diaphragmatic hernia” or hiatal hernia.
Cause of a diaphragmatic hernia
Several factors can be assumed to contribute to the development of a diaphragmatic hernia. Factors like: increase the pressure in the abdominal cavity. With age, the elasticity of the connective tissue anchoring of the esophagus in its diaphragmatic passage (hiatus esophageus) decreases, so that if the pressure in the abdominal cavity is increased by the factors described above, it may no longer be possible to prevent parts of the stomach from passing through into the chest cavity.
- Adiposity (obesity)
- A pregnancy
- Constipation (constipation)
- Heavy lifting
- Cough or
- Vomiting
Forms of biliary hernia
There are different forms of diaphragmatic hernia
- Cardiofundal malposition
- Axial diaphragmatic hernia = sliding herniaSliding hernia(approx. 90%)
- Paraesophageal diaphragmatic hernia
- Mixed hernia (mixed hernia)
In cardiofundal malformation, the esophagus opens into the stomach at a more obtuse angle (His angle, esophagogastral angle) because the ligamentous apparatus securing the stomach to the diaphragm is loosened. Since this form is rarely associated with clinical symptoms, the cardiofundal malformation is more likely to be a chance finding during gastroscopy (gastroscopy).
Sliding hernia (axial diaphragmatic hernia) is the most common form of diaphragmatic hernia with about 90% of cases. In this form, the stomach entrance area (cardia) enters the chest cavity through the diaphragmatic opening of the esophagus (hiatus esophageus). In this case, the function of the lower esophageal sphincter (esophageal sphincter muscle) is no longer guaranteed and reflux of acid stomach contents (reflux) may occur.
The typical symptom is heartburn. Sliding hernia occurs more frequently with increasing age, so that 50% of people over 50 years of age already have a hiatus sliding hernia. The paraesophageal hiatus hernia (diaphragmatic hernia) is characterized by the fact that the entrance area of the stomach (cardia) is in its anatomically correct position, i.e. below the diaphragm within the abdominal cavity.
The lower esophageal sphincter (esophageal sphincter) is also intact. Another part of the stomach, however, protrudes into the chest cavity next to the esophagus. This can clinically cause a feeling of pressure in the heart area (especially after eating), difficulty swallowing, belching of undigested food and shortness of breath due to displacement of the lungs.
Complications can include constriction of the blood vessels supplying the lungs, stomach ulcers, tissue loss and potentially life-threatening bleeding. Mixed hernias (mixed hernias) are combinations of axial and paraesophageal diaphragmatic hernia and are more common than pure paraesophageal hiatal hernia. A rare extreme variant is the thoracic or upside-down stomach. In this case the complete stomach is located in the thoracic cavity.
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