Herniated hernia

No diagnosis of "hiatal hernia" is made by any competent doctor. Because there is no such disease in the International Classification. To find out where this hernia is impossible. The correct name for the pathology is a hernia of the esophageal aperture of the diaphragm( abbreviated as GPOD).So the diagnosis sounds, and the disease is called medical workers.

Those who are far from medicine and have forgotten the anatomy do not go into details. The main thing - the disease is accompanied by signs of lesion of the esophagus. Therefore, we will not constantly correct "people's terminology".It is much more important to pay attention to the symptoms of the lesion, to prevent complications and to find out the possibilities of treatment without surgery and with the help of surgery.

Statistical analysis shows that "hernia of the esophagus" is most common in women in the age category of 60 years and older. In humans, up to 50 occurs with a frequency of 0.7%, in the period from 51 to 59 years increases in prevalence to 1.2%.The maximum is 4.7%.

Let's remember the anatomy of the "way" from the esophagus to the stomach

After swallowing the food lump is sent to the stomach along the muscular tube( esophagus).In an adult, it has an average length of 25 cm. Its task is to deliver the crushed and processed saliva food to begin digestion. The organ has longitudinal muscles, pushing the contents towards the stomach, and powerful circular - preventing return.

Esophagus in the upper part surrounding large vessels and bronchial tree

Seven anatomical segments are distinguished in the structure. We will only be interested in the 3 lower sections of the esophagus:

• Supidiaphragm - located 3-4 cm up from the diaphragm. Diverticulum, varicose veins are more often detected here, ulcers and inflammation, and hernias are formed.
• Intradiofragmal ( epicardial) - no more than 2 cm, passes through the thickness of the diaphragm muscle, through a special hole called "esophageal".In addition to the above pathology, plays an important role in functional disorders, participates in the mechanism of regulation of cardia opening, has a powerful fibrous-muscular ring, ensures closure of the lumen and complete tightness between the esophagus and stomach at rest. Surrounded by fatty tissue, mobile.
• Abdominal or subdiaphragmatic - 3-4 cm in size, also called the "vestibule" of the cardiac part of the stomach, functionally integrated with the diaphragmatic, forms at the age of the year an angle( Gisa) with a large curvature when it enters the stomach. Inside the corner is a fold that serves as a valve. It is closed by pressure inside the stomach and does not allow the reverse movement of food( regurgitation, eructation).

The diaphragm is formed by a dense muscle layer. It separates the thoracic cavity from the abdominal cavity. Has through-through diaphragmatic openings for passage of the esophagus, abdominal artery, sympathetic nerve and inferior vena cava. It braids them with tendons to ensure the fluctuation of pressure and creates the necessary conditions in the work of respiratory organs, heart and large vessels, digestion.

Why does a hernia occur?

Distinguish the causes of herniation of the esophagus of an innate and acquired character. Such an anomaly of development, like a short esophagus, "pulls" the upper part of the stomach into the chest cavity. The lack of collagen in the structure of the muscle fibers of the diaphragm weakens the tension of the muscles, contributes to the sagging and stretching of the tissue surrounding the esophagus.

To the elderly, a person acquires various disorders, which the body is no longer able to correct or compensate. These include:

• general changes in the structure of connective tissue( loss of collagen, elastin), which significantly weakens muscle ligament;
• heavy physical exertion, especially with a sharp rise or squat;
• a set of excess weight or sharp weight loss, the amount of abdominal fat affects the mobility of the diaphragm, intra-abdominal pressure, with a significant weight reduction biochemical processes in the muscle tissue change, its atrophy occurs;
• pregnancy in women with a large fetus or twin babies temporarily changes the location of the organs inside the abdomen;
• predisposition to constipation;
• the transferred operations on an esophagus do not do without infringement of function of body;
• chronic cough of smokers;
• abdominal enlargement due to ascites presses on the dome of the diaphragm from below;
• diseases of the esophagus associated with impaired motor function;
• trauma and esophagus burns( thermal and chemical);
• diseases of the stomach, small intestine, bile ducts, leading to disruption of food evacuation, secretion, changes in motor activity of the muscular layer( for example, reflex contraction of the longitudinal muscles of the esophagus with ulcer disease, cholecystitis);
• blunt abdominal trauma.

Mechanism of formation

Under the influence of one or several reasons an enlarged orifice of the esophageal canal is formed - the diaphragmatic hernia gates. They can get adjacent organs located below the dome: the upper part of the stomach, the omentum, the loop of the intestine. These hernias are called hiatal. Among all the hernias of the diaphragm they are 90%.

There are different types of hernia of the esophagus, they differ in localization and mobility:

• axial, refers to the sliding hernia - is more common( 95% of cases), the cardia of the stomach and the lower part of the esophagus move freely axially from the bottom up and back(such a hernia is also called "floating"), as a result, the stomach can lie over the diaphragm, the process of passage of the food lump is broken;
• fixed near-esophageal( parasophageal) - rarely( 5%), does not move, one of the stomach sections or the whole organ, epiploon, small intestine loop, part of the spleen leaves into the hole.

An important difference in the diagnosis and course of the disease is the ability of fixed hernias to be impaired

Slip hernias differ in degrees in 3 versions:

• 1 degree - is the initial stage, it is possible to penetrate the thoracic cavity only sub-diaphragmatic part of the esophagus, it is asymptomatic, treatment of esophageal hernia does not require surgery, it is usually sufficient to follow a diet;
• 2 degree - in addition to the lower parts of the esophagus, the upper part of the stomach leaves the hernial opening, the symptoms of the disease are expressed, the creation of a combined scheme is necessary to treat the hernia of the esophagus, if not take measures, complications occur;
• 3 degree - the most severe manifestation, the bulk of the stomach moves to the space above the diaphragm, perhaps the entire organ, the intestinal loops, to cure such a form without surgical intervention is impossible.

Symptoms

Clinical manifestations of the disease patients feel only from the second stage of the disease. The main symptoms are as follows. Pain - localized in the epigastric region, more often on the left, there are sudden, rather intense, very similar to angina pectoris, also intensified with severe physical exertion, during movement.

Impaired swallowing is described by patients as "a feeling of a crushing lump in the throat".Belching - bitterness, eaten food, acidic contents, occurs after eating, does not last long. Hoarse voice - causes the casting of acidic gastric juice in the larynx and the ligament apparatus, a chemical burn develops.

Heartburn - it happens both after eating and on an empty stomach, it increases in the prone position, when tilted forward. Persistent hiccups - the cause is the redistribution of the branches of the vagus nerve, why there is a convulsive contraction of the diaphragm. Patients with hiccough experience painful discomfort. At night, salivation increases, falling into the larynx promotes coughing attacks, insomnia.

In the painful syndrome it is important to notice signs of complications:

• the pain becomes almost constant, dull, aching;
• changes localization( "leaves" under the left scapula, in the abdomen);
• is manifested by an attack with a "cutting" character;
• increases with pressure in the epigastric region.

In the photo - with pain and swallowing difficulties, some patients experience a feeling of suffocation.

What are the possible complications?

Negative effects of untreated HFAP can lead to:

• to develop inflammation of the esophagus in a catarrhal, erosive form or in the form of reflux esophagitis;
• peptic ulcer in the lower parts with subsequent stenosis of the esophagus due to scar scarring or perforation;
• infringement of the fixed hernia;
• gastric or esophageal bleeding from varicose veins;
• attacks of reflex angina.

What are the signs of infringement?

Infringement of diaphragmatic hernia occurs due to sudden spasm of the enlarged esophageal ring. Sometimes it is the first symptom of the disease. It often occurs in patients who know about their pathology, in violation of the doctor's recommendations, refusal or contraindications to the operation to remove the hernia.

Against the background of usual symptoms suddenly there is a sharp pain in the upper part of the epigastrium and in the chest. Irradiates to the clavicle, left scapula. At very high intensity accompanied by a shock state. Long-term vomiting, increasing at the height of pain, lasts almost a day.

The abdomen is swollen, the intestinal peristalsis is preserved, it provokes pain. If there are similar signs, then surgical treatment of hernia of the esophagus is necessary for life-threatening indications. The patient should not hesitate to call an ambulance.

Diagnosis

To diagnose a doctor, the doctor determines in detail the symptoms, the relationship with risk factors, the presence of diseases of the digestive system. Objective signs of expansion of the esophagus and dislocation of organs are obtained using the X-ray method and endoscopy. X-ray examination is performed with contrasting digestive organs with barium suspension.

With a hernia, it is possible to detect an enlarged ring of the esophageal opening, a cardiac section of the stomach above the diaphragm, the absence of a lower segment of the esophagus in the space beneath the dome, a highly located sphincter.

Fibrogastroscopy shows the transition of the esophageal-gastric junction into the supra-diaphragmatic space, signs of complications( inflammation on the esophagus mucosa, erosion, peptic ulcers, various forms of gastritis).Differential diagnostics with a tumor is necessarily carried out. For this, the biopsy material is taken.

During the X-ray examination, several images are taken to capture the moment of passage of the barium through the hernial canal zone

. How to treat the hernia of the esophagus

. The doctor should tell the patient about the treatment options when the diagnosis is confirmed by additional methods. Methods of treatment of the hernia of the esophagus( we mean the "esophageal orifice") are chosen depending on the stage of the process, the patient's condition, age and concomitant diseases.

In the first stage, in the absence of symptoms, treatment requires compliance with prophylaxis to prevent a worsening of the hernial process. The patient is recommended a diet, prescribed therapeutic exercise. Great importance is attached to the ban on lifting weights and normalizing weight.

In the second-third stage, it is impossible to treat a herniated hernia without surgery. Only conservative methods are needed for elderly people with decompensation of the cardiovascular system, expressed by cerebral insufficiency. For them, the main thing is, if possible, to eliminate the causes of increased pressure in the abdominal cavity, to treat chronic diseases that promote pathology.

What to add to daily gymnastics?

Exercise is available to patients of any age. They can support the muscles of the diaphragm and abdomen, prevent atrophic changes. Respiratory gymnastics should be done in the morning on an empty stomach.

It includes: in the prone position - protrusion of the abdomen on inhalation and retraction while standing, - inclines to the sides on inspiration, return to the initial position on exhalation. Among the common exercises for muscles: lifting legs, "bicycles", "scissors".

The role of the diet

Dietary dishes should help to eliminate constipation, bloating, weight normalization, prevent overeating. Patients are advised to eat at least six times a day, in small portions. It is forbidden to include in the ration:

• alcoholic drinks, carbonated water, coffee;
• spicy seasonings, garlic, onion;
• fatty and fried foods;Pickles
• ;
• sour juices, berries and fruits;
• whole milk;
• fresh pastry, rye bread.

Sweet fruit is better to pre-clean, grate. Allowed:

• dried fruits( especially prunes);
• skimmed milk products( kefir, cottage cheese, yoghurt);
• boiled dishes from low-fat meat, poultry and fish;
• soups are vegetarian;
• porridge to cook on diluted milk;
• eggs soft-boiled;
• dried white bread, sweet rusks for tea;
• you can add milk to tea.

After eating, it is forbidden to go to bed, it is necessary to be like. It is not recommended to eat before going to bed. Kefir is useful to drink 3 hours before bedtime.

The drug reduces belch and heartburn

The use of medicines

Drugs for the patient with HFAP are necessary to support digestion and prevent functional disruption of secretion, motility. If the patient shows increased acidity, then drugs with antacid properties are recommended( Almagel, Gastal), acid blockers( Ranitidine, Famotidine, Nizatidine, Omeprazole).Improve the motor skills of Cisapride, Metoclopramide, they prevent and eliminate manifestations of gastroesophageal reflux with heartburn, eructation.

Types of surgical treatment

The task of the operation is to restore the tightness of the esophageal opening in the diaphragm, return and fix the esophagus and stomach to the natural position. Surgical treatment is indicated for patients with a second to third degree of hernia, if:

• aperture forms a fairly wide hernial canal;
• the fallen organs are fixed in the hernia gates;
• there are complications;
• hernia was formed against the background of disrupted mucosal development( dysplasia) and is dangerous by degeneration into a malignant tumor;
• is supposed to infringe the sliding hernia.

The enveloping properties of decoction from flax seeds protects the esophagus and stomach from inflammation

Treating folk remedies

Folk remedies for hernia of the esophagus help the diet and medication to eliminate undesirable manifestations of impaired functions of the digestive system. To relieve bloating, advise to use broths of mint, fennel, valerian, flaxseed or dill. From pain and heartburn helps tea with ginger or a little grated root. For the healing of inflammatory phenomena, carrot juice is useful.

Hernias of the esophagus most violate the functions of the stomach and esophagus. From the work of the initial department of the digestive tract depends the total. Therefore, other organs suffer without treatment. Timely treatment of a doctor can help prevent the progression of pathology.