Hiatus Hernia & GORD

Hiatus hernia - herniation of part of the stomach into the chest region, usually asymptomatic

Sliding hiatus hernia - gastro-0esophageal junction slides through hiatus and lies above diaphragm. no symptoms unless reflux

Para-oesophageal/rolling hernia - small part of fundus of stomach rolls up through the hernia along the oesophagus.. sphincter reamins below the diaphragm & remains competent. sometimes, however, this will produce severe pain & need surgial treatment.

Gastro-oesophageal reflux - reflux of gastric contents which can occur normally

Gastro-oesophageal reflux disease (GORD) - reflux with persistent symptoms
GORD occurs only when anit-reflux mechanism fail to allow gastric contents to make prolonged contact with lower oesophageal mucosa. (can occur without an hiatus hernia)

Lower oesophageal sphincter (LOS) is formed by distal 4cm of oesophageal smooth muscle. After relaxation to allow bolus to enter stomach, it rapidly regains its normal tone & prevents reflux. It is able to increase tone in response to increased pressures.

Pathogenosis:
- Transient LOS relaxations
- Low resting LOS tone which fails to increase when lying flat
- LOS tone fails to increase when pressure increased eg. pregnancy
- Increase oesophageal mucosal
- Large hiatus hernia impairs the mechanism of crural diaphragm.
- Reduced oesophageal clearance of acid due to poor peristalsis and made worse by trapping of acid in hernial sac due to hiatus hernia.

Clinical Features:
1) Heartburn
2) Regurgitation of food & 'acid'

Why I think I was made to research this.. haha..
The difference between GOR & myocardia ischaemia

Gastro-oesophagal reflux
1) Burning pain produced by bending, stooping or lying down
2) Pain seldom radiates to arms
3) Pain precipitated by drinking hot liquids or alcohol
4) Relieved by antacids

Myocardia ischaemia
1) Gripping/crushing pain
2) Pain radiating into neck, shoulders, both arms
3) Pain by exercise
4) Accompanied by dyspnoea

Source: kumar & clarke

Note: words like oesophageal, diaphragm are really hard to spell..