What is a Herniated Stomach

There is no such pathology as a "hernia of the stomach" in the International Statistical Classification because the name of the hernia is associated with a tissue or organ that forms a hernia "gate" or an enlarged passage. The stomach does not miss anything, except the food mass.

The people have fixed the erroneous concept of "gastric hernia" because of the possibility of this organ to penetrate through the weak points of the diaphragm( especially the esophageal opening) into the chest cavity. Herniated gates can form in the zone of natural passage of vessels, nerves or have a pathological origin.

In ICD-10 under the code K44, the acquired hernia of the esophageal aperture of the diaphragm( GVPD) is listed, and under the heading "Developmental abnormality" this disease is coded as a congenital malformation of Q40.1.

Therefore, using an unknown terminology, we will still have in mind the diaphragmatic origin of the hernia.

How does a hernial opening form?

The diaphragm is a muscular formation that separates the thoracic cavity from the abdominal cavity. Tendons interweaving around the through passageways, it tightly compresses them, provides a sealed separation and optimal pressure for the work of the organs of the cardiovascular, respiratory and digestive systems.

Natural weak areas in the diaphragmatic muscle are created not only in the area of ​​passage of the esophagus, but also in the inferior vena cava, sympathetic nerve, abdominal aorta. Other varieties of hernias of natural openings in the diaphragm do not touch the stomach, are rare, have no practical significance.

Among the reasons for the formation of "hernia of the stomach" identify predisposing factors and directly realizing. Contribute to weakness of the muscle of the diaphragm:

• deficiency of connective tissue of a congenital or acquired character( absence of collagen providing elasticity, Marfan syndrome);
• diaphragm injury in wounds, bruises, as a result of surgery on the organs of the gastrointestinal tract( GIT), heart, lungs, liver;
• involutional( senile) changes in muscles and ligaments, some authors believe that 70% of people over 65 have conditions for a hernia.

The implementing factors include any conditions that cause an increase in intra-abdominal pressure:

• sharp lifting of gravity;
• straining with constipation;
• pregnancy;
• strong cough( in smokers);
• overeating, a significant expansion of the stomach;
• obesity with abdominal fat deposition;
• rapid weight loss;
• curvature of the spine;
• formation of ascites in cirrhosis of the liver, heart failure.

One of the important components of the "hernia of the stomach," which provides the emergence of 15-20% of patients with peptic ulcer and chronic cholecystitis, is a marked reflex reduction in the longitudinal muscles of the esophagus and esophagospasm. These causes create conditions for reducing muscle tone and weakness in the area of ​​natural openings.

Fixed paresophageal hernias are fixed in the lower part of the esophagus and do not change the localization of

. Thus, the passage between the esophagus and the stomach widens in diameter, and the peritoneal part of the esophagus and the upper part( cardia) of the stomach can enter it when the pressure in the abdominal cavity increases. The mechanism is characteristic for the formation of a hiatal hernia. Pathological holes in the diaphragm are formed with injuries, usually in combination with the organs of the thoracic and abdominal cavity( road, fall from height).

Localize in different places, but more often in the left dome, since the liver located under the right part of the diaphragm protects it from injury and hernias. The size of the hernial gates depends on the type of mechanical damage. The contents of the hernial protrusion include the intestinal loops, stomach, omentum.

Hernia variants

By origin, the hernia of the diaphragm is divided into traumatic and non-traumatic. In the absence of a formed hernial sac, the contents are referred to as false. Since we are interested only in those species that are connected anatomically with the stomach, let us dwell in more detail on the hernia of the esophageal aperture of the diaphragm or the hiatal one.

This variety accounts for more than 90% of all diaphragmatic hernias. According to statistics, they are on the third place in the group of diseases of the digestive system after peptic ulcer and gallstone. There are two main types of hernia of the esophageal opening: sliding( it is also axial), perepishchevodnaya( paraesophageal, fixed).

Some authors additionally take into account mixed( combined) and complicated, combining features of both species. Gliding accounts for up to 95% of all hiatal hernias. They are distinguished by the free movement of part of the stomach and esophagus in both directions. Since the direction of motion coincides with the axis of the esophagus, they are also called axial( axial).

Slip hernia

When forming an axial hernia it is necessary to take into account the anatomical and physiological features of the stomach and esophagus. Both organs are connected below the diaphragm( part of the esophagus is located sub-diaphragmatically) at an acute angle. In the region of the apex there is a fold of the mucous membrane, which serves as a valve.

It together with the cardiac sphincter does not allow the contents of the stomach to flow into the esophagus( regurgitation).During the formation of a sliding hernia, the angle at the joint site is smoothed, which leads to the termination of the role of the valve and its disappearance. The formation of gastroesophageal reflux becomes inevitable.

Slip hernias can be either fixed or non-fixed. During fixation, the esophagus is shortened( two degrees are distinguished).Non-fixed hernias are able to self-correct if the patient is in an upright position. This sign is important in planning surgical treatment.

In Russia, surgeons use the classification of academician B.V.Petrovsky. It takes into account part of the stomach involved in the formation of a sliding hiatal hernia. It is accepted to distinguish the hernia:

• cardiac - only the cardia falls into the hernial sac;
• cardiofundal - includes cardia and part of the body of the stomach;
• subtotal gastric - includes all departments to the pylorus;
• total gastric - the entire body, including the pyloric part, passes into the chest cavity.

Fixed

The parasophageal hernia is much less common than the sliding hernia. They account for only 5% of all cases of HVAC.Typical fixation of the cardia, access to the enlarged esophageal opening of the bottom of the stomach or the entire organ, with the loop of the intestine, omentum, sometimes part of the spleen.

The greater the volume of the stomach that has fallen into the hernial sac, the more pronounced the symptoms of

. This type of hernia may be impaired. The following types are distinguished:

• foundation;
• antral;
• intestinal;
• gastrointestinal;
• stuffing box.

Symptomatic in the case of stomach parts falling into the hernial sac

The clinical symptoms of a "hernia of the stomach" in a sliding type are explained by a disorder of the cardia valve and gastroesophageal reflux. Typical pain, heartburn, belching food and air, difficult swallowing. The pain syndrome is expressed with different intensity. Strengthens after eating, with physical work, lying down.

The pain is located behind the sternum, in the epigastric region and under the xiphoid process. They can irradiate into the left scapula, shoulder and arm. Very similar to angina. This can be the cause of an erroneous diagnosis. The eructation arises at the use of alcohol, overeating. The patients feel better when standing, after walking, drinking milk or soda.

Dysphagia( impaired swallowing) lasts for many years, increases with exacerbation of esophagitis, is characterized by a benign course. In addition to these signs, such manifestations are possible, as:

• nausea and vomiting;
• long hiccough;
• bitterness in the mouth;
• increased salivation;
• hoarseness of voice.

Heartburn accompanies pain, increases with changes in body position, the photo and this complaint can not distinguish between angina and signs of hernia

. The clinic and the course of paresisophageal hernia are associated with the nature of the contents of the hernial sac and the degree of displacement of the thoracic cavity organs. The stomach most often presses the pleural cavity. Symptomocomplex resembles signs of a sliding hernia( pain in the epigastrium and behind the sternum after eating, a violation of swallowing, eructation).But heartburn and vomiting are atypical, since there is no gastroesophageal reflux.

Traumatic hernias are characterized by a displacement of the heart to the right, dyspnea, rhythm disturbance, pain during breathing and after eating. A prolonged untreated process with chronic bleeding from the vessels of the stomach and esophagus leads to anemia. Patients pale, worried about frequent dizziness, weakness, but can not lie because of the pain in the epigastric pain.

Than the hernia of a diaphragm is dangerous?

The main danger of untimely detection is that the "hernia of the stomach" can become clogged by the muscles, with a high probability of squeezing, shortening the organ and significantly hindering the passage of food. This disrupts the functioning of the entire digestive tract.

Possible serious consequences include:

• formation of esophageal narrowing;
• gastroesophageal reflux disease;
• perforation of the esophagus;
• the formation of a stomach ulcer;
• bleeding from the vessels of the esophagus and stomach, contributing to anemia;
• reflex attacks of angina pectoris;
• high risk of malignant tissue degeneration( Barrett's esophagus).

Symptom of gastroesophageal reflux with prolonged course of hernia grows into

disease How is the diagnosis made?

Diagnosis of protrusion of the stomach into the hernial opening requires careful examination of the patient, clarification of the conditions under which symptoms arise, the nature of nutrition, the duration of manifestations, signs of other diseases of the stomach. On examination, you can identify the effects of chronic bleeding( pallor), the deviation of the relative dullness of the heart, tenderness in palpation in epigastrium.

The basic value is given to the x-ray and endoscopic method. For X-ray examination, an overview and contrast fluoroscopy( passage of contrast medium and filling of the esophagus and stomach sections in online mode) is used. Additionally, they take pictures( X-rays).The patient is seen in a vertical, horizontal position, lying on his side, in a Trendelenburg posture( knee-elbow).

To objective signs of a hernia of the esophagus of the diaphragm carry only clear evidence of a shift to the zone of the mediastinum of a part or the whole of the stomach. Indirect signs are:

• absence of a gas bubble of the stomach or a change in its shape, dimensions, supra-diaphragmatic location;
• smoothed esophagocardial angle in the picture of high confluence of the esophagus with a sliding hernia;
• gastroesophageal reflux with contrast casting;
• is a symptom of "pharyngeal dance", when a reverse peristalsis is observed when swallowing contrast.

On esophagogastroscopy, performed with the help of a fibrogastroscope, there are:

• a sign of "gaping of the cardia" or unconjugation of the esophagus at the level through the diaphragm;
• localization of the cardia of the stomach above the diaphragm with a shortening of the esophagus;
• manifestation of gastroesophageal reflux;
• foci of degeneration of the epithelium.

Radiographs are conducted as the contrast progresses

Endoscopic method allows you to assess the severity of lesions of the stomach and esophagus, exclude cancer degeneration and other pathologies. Sometimes it is required to find out the degree of decompensation of the esophagocardial sphincter, which indicates the manifestation of reflux casting. To do this, use the technique of esophagomanometry, intra-esophageal pH-metry, scintigraphy.

Electrocardiography makes it possible to exclude myocardial ischemia. Ultrasound of the abdominal cavity is performed to identify other diseases that may be the cause of a hernia. With the consequences of injuries, difficulties in diagnosis, laparoscopy is used, as an opportunity to examine the abdominal cavity and subdiaphragmatic space.

Differential diagnosis with diaphragmatic hernia involving the stomach is performed:

• with cicatrical narrowing of the esophagus;
• tumor of the esophagus;
• portal hypertension;
• angina pectoris;
• with ulcer and cholelithiasis;
• other types of diaphragmatic hernia.

How to treat gastric hernia protrusion?

Treatment of "gastric hernia" depends on the species. So, sliding hernia seldom need surgical intervention. They are not infringed and successfully treated by therapeutic methods. The main tasks of conservative therapy:

• to prevent gastroesophageal reflux;
• to eliminate the disturbed motility of the esophagus and stomach( using the prokinetics Cerucal, Motilium);
• suppress increased acidity of gastric juice( omeprazole) and protect the mucous membrane( Almagel);
• use all the possibilities of treating reflux esophagitis.

The obligatory conditions of treatment are the patient's compliance with recommendations on diet and regimen. Patients can not raise the severity, so any kind of work related to physical activity is contraindicated. It is not recommended to wear tight belts, they promote the growth of intra-abdominal pressure. You can not smoke, because nicotine promotes atony of the esophageal sphincter.

The place for sleeping should be arranged so that the head end has always been significantly elevated. Dinner costs not later than 18 hours. From the menu you will have to exclude all dishes that cause irritation of the stomach, the secretion of juice, increased formation of gases. Categorically contraindicated alcoholic drinks, carbonated water, strong coffee, heavy meat fried and smoked dishes, spicy seasonings, legumes, cabbage, freshly baked bread, milk.

Surgical treatment of a sliding hernia is performed:

• if the symptoms are severe and there is no effect of therapy;
• for severe reflux-esophagitis with frequent bleeding, ulcerative process, anemia;
• if esophageal narrowing is detected;
• when a hernia of the subtotal and total type is planned, the hernial sac is large;
• if the sliding hiatal hernia is combined with another pathology requiring surgical intervention( peptic ulcer, gallstones).

Laparoscopic intervention

is often used. Paraeophageal hernias tend to increase in size, creating a threat of infringement. Therefore, they always need an operation. The operation is more often in suturing the hernial gates. With hernias of large size and the signs of sphincter deficiency, the cardia is strengthened by Nissen plasty( fundoplication).

The operation after the formation of a traumatic hernia is made through access in the chest, the seventh intercostal space is opened on the left. The essence of the intervention is the restoration of the broken integrity of the diaphragm.

Is it possible to cure the disease with herbs?

Folk remedies can not fix a hernia or limit the mobility of the stomach. But unconventional prescription phytotherapy helps to eliminate painful symptoms. Recommended medicinal preparations used in decoctions:

• №1 - from leaves of mother-and-stepmother, gooseberry, mint, flaxseed, althea root;
• №2 - flowers of marigold, grass, cucumber, burdock, wormwood, dill seeds.

Before use, you can select the most suitable plant from the collection. It is better to consult a doctor. In the presence of symptoms similar to a hernial, you need to undergo a test and clarify the diagnosis. Similar signs accompany many diseases, so it is important to start treatment in time.