Medical Questions & Answers

Question: What is a hiatus hernia?
The chest cavity is separated from the abdominal cavity by a sheet of muscle (called the diaphragm) that runs across the body from front to back. Your stomach is immediately below the diaphragm, and is connected to the mouth by the gullet (oesophagus), which has to pass through a hole in the diaphragm.
Under certain circumstances, a small part of the stomach may slide through the hole in the diaphragm from the abdominal cavity into the chest cavity. This is a hiatus hernia. The stomach may slide backwards and forwards, or may be stuck in the diaphragmatic hole.
The hernia will allow the acid in the stomach to flow up into the oesophagus, where the cells are not protected from the stomach acid. This causes heartburn, an acid taste in the mouth, burping and in severe cases, ulcers. The factors that lead to the development of a hiatus hernia are obesity, stress, smoking, rapid eating, large meals, alcohol, heavy lifting and straining, repeated or constant bending and vomiting.
Treatment will involve avoiding these factors, antacids, medications to empty the stomach, drugs to reduce acid and spasm, and in very severe cases surgery may be tried.

Question: My baby has an umbilical hernia. It looks funny, but does not seem to worry him. I have heard conflicting advice on treatment for this problem. What do you think should be done for this?
Umbilical hernias occur when there is a weakness in the wall of the abdomen where the umbilical cord goes through the muscle layers into the baby’s body. Crying and straining force a piece of gut or fat through this weakened area leading to a lump under the belly button. This lump should go down when the child is lying at rest. The vast majorities of these require no treatment and close over spontaneously by the time the child is two or three years old. Only if it lasts beyond this time is corrective surgery necessary.
If the infant starts screaming, and the hernia is found to be hard, red and tender, an urgent operation will be required to reduce the trapped piece of gut. This problem is unusual.

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