Section: Overview
A hiatal hernia is the protrusion of abdominal contents into the thoracic or chest cavity through the esophageal hiatus, which is the natural opening in the diaphragm that allows the passage of the esophagus. These hernias may be persistent or intermittent.
Hiatal hernias occur in both dogs and cats, and males seem to be predisposed.
Causes
Congenital (present since birth)
Traumatic
Gastroesophageal reflux, which is the backward flow of stomach contents up and into the esophagus. Reflux often accompanies hiatal hernias and results in subsequent esophagitis or inflammation of the esophagus.
What to Watch For
Vomiting
Excessive drooling
Vomiting blood
Difficulty breathing
Regurgitation, which is the effortless evacuation of fluid, mucus, and undigested food from the esophagus
Diagnosis
Baseline tests to include a complete blood count (CBC), biochemical profile, and urinalysis are recommended in all patients, and are often within normal limits.
More specific tests include:
Radiographs (x-rays) of the thorax (chest) and abdomen generally support a dilated esophagus, and may help rule out secondary aspiration pneumonia. Normal radiographs do not rule out a hiatal hernia.
Esophagram (barium swallow)
Fluoroscopy (a radiographic evaluation that assesses the esophagus in motion)
Endoscopy/esophagoscopy is a procedure that allows visual inspection of the esophagus
Treatment
It is most important to determine whether the patient's condition warrants admission to the hospital for treatment, or treatment at home as an outpatient. Treatment is important, as untreated animals are predisposed to developing chronic esophagitis with mucosal (lining of the esophagus) ulceration, aspiration pneumonia, stricture (narrowing), and strangulation of abdominal organs.
Treatment typically involves:
Fluid and electrolyte therapy, especially if they have concurrent aspiration pneumonia
Nutritional support
Antibiotic therapy in patients with concurrent pneumonia
Low fat diet with elevated, frequent, small feedings
Surgical intervention in some patients, especially in those that need to have their herniated abdominal organs replaced
The best initial approach is conservative medial treatment to control esophagitis and clinical signs. Drugs that decrease or inhibit acid production by the stomach such as Tagamet® (cimetidine), Pepcid® (famotidine), Zantac® (ranitidine), Cytotec® (misoprostol), and Prilosec® (omeprazole) encourage and expedite the resolution of gastroesophageal reflux and esophagitis.
Home Care
Administer all medication and diet as directed by your veterinarian. If any change is noted in your pet's condition, notify your veterinarian. In particular, if coughing or difficulty breathing is observed, contact your veterinarian at once, as this may signal aspiration pneumonia secondary to a malfunctioning esophagus.
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Reflux esophagitis is an inflammation of the esophagus caused by the backward flow of gastric or intestinal fluid into the esophagus. This fluid contains acids and other irritating substances that can...
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