Hiatal Hernia – All 4 Types Explained!

Hey, what’s up, you guys?

My name is Buck Parker. I am a board certified general surgeon.

In this video, we’re gonna talk about hiatal hernia, or hiatus hernia, or hernia of the hiatus, or however you wanna call it. Anyway, we’re gonna talk about hiatal hernias. If you wanna know what a hernia is exactly, check out my other videos. I have a definition of hernia, video as well.

Basically, what the hiatus hernia, or hiatal hernia is is a dilation of the hole in the diaphragm. The diaphragm is a big tent muscle that separates the chest and the abdomen. When the diaphragm, it’s usually a dome-shaped structure, and when you breathe in, it flattens out. It expands the chest. It lets you bring in air into your lungs. There are a couple structures that need to pass through the diaphragm to get from the chest to the abdomen. One of ’em is the abdominal aorta and another one is the esophagus. The esophagus is the one we’re gonna talk about when we’re talking about hiatal hernias.

In that dome-shaped muscle, there’s a hole, there’s a big hole in it and the esophagus passes right through that. Obviously, when you eat something, put something in your mouth, you swallow it. It goes from your mouth to your esophagus, down the esophagus, into the stomach. Now just before the esophagus hits the stomach is where it passes through the diaphragm. In the diaphragm, there’s a little hole. And usually, that’s a nice little tight hole and it doesn’t let a lot of stuff from the abdomen go up into the chest.

In a hiatal hernia, that hole dilates up. And it gets really big, and it can allow things from the abdomen to go up into the chest. In a typical hiatal hernia, about 95% of them, the stomach sort of slides up into the chest just a little bit, maybe a couple of centimeters. What happens, then, is you have reflux symptoms, and this is why hiatal hernias are so important and we talk about them a lot, because people end up having reflux which reflux is this burning sensation below your breastbone when you have a lot of food or hot, spicy food or something like that. You have, basically, acid reflux.

Acid in the stomach goes back up into the esophagus because that hole’s not tight anymore and it can’t really hold that food and the acid in the stomach. It doesn’t hold it down. It allows it to come back up into the esophagus. The stomach has a different lining than the esophagus. The stomach is prepared for the acid, and it doesn’t burn the stomach, but the esophagus is a completely different lining. The acid from the stomach goes up into the esophagus, then the esophagus burns and you feel that burning sensation.

Now let’s talk about the types of hiatal hernias. There are four types of hiatal hernias. The first type is called a sliding hiatal hernia. It is where the stomach, the junction of the esophagus and the stomach, that junction – we call the GE junction or the gastroesophageal GO junction – slides up a little bit past where that hole is in the diaphragm. The hole is actually called the hitacus. That slides up a little bit and that allows that reflux to happen and you get those symptoms.

Type two is actually called paraesophageal. The other ones are called paraesophageal hernias or next to paras, kind of around. So the contents of the abdomen slide up around the esophagus and into the chest. This picture here, we can see that the stomach actually slides up into the chest next to the esophagus. The GE junction in type two does not go into the chest. The GE junction, the gastroesophageal GE junction, stays in the abdomen. That’s a type two and that’s a very common one as well.

A type three is when the stomach, the GE junction first of all, slides up into the chest but also a portion of the stomach – not just the portion of the stomach that’s attached to the esophagus but also the, what we call, the cardia or the fundus of the stomach slides up around or next to the esophagus through the hiatus.

The fourth type is a paraesophageal hernia as well but this is when other organs then the stomach slides up into the chest such as the colon or the small bowel or the spleen or something like that. I have actually seen a few of these that the entire stomach is flipped up into the chest and it’s actually upside down, and I don’t even know how these people get any food down because they’re walking around with this for a long time.

I’ve also taken care of patients just the last year where they had the portion of the colon up into the chest and it became obstructed. Now hernias typically, if you’ve seen anything about other hernias, one of the dangerous things about hernias is if you get an organ, especially a small bowel or the colon stuck in a hernia and it cuts its own blood supply off, that organ can die such as the small bowel or the colon. This colon had flipped up into the chest, through the hole, but the hole wasn’t big enough for the colon to come back down on its own and it got stuck up there and actually died. The guy got very sick. We took care of him. We took that portion of colon out, and he ended up actually being okay.

That is the quick and dirty on the hiatal hernias. I hope that clears some questions up for you. If you like these videos, awesome. Subscribe to my channel. Like the video if you like this one and maybe share with a friend. That’d be awesome too. I will see you in the next one. Take care.

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