Categories
Ailmemts & Remedies

Pilonidal sinus

Alternative Names:pilonidal cyst, pilonidal abscess or sacrococcygeal fistula

Definition:
A pilonidal sinus is a dimple in the skin in the crease of your child’s buttocks.

This may be noted at birth as a depression or hairy dimple and be present for many years without any symptoms.
Pilonidal sinus affect men more often and most commonly occur in young adults.


You may click to see picture

Two pilonidal cysts in the natal cleft
A pilonidal sinus may also occur due to a blockage in the hair follicles, often associated with an ingrown hair.
In both situations, hair acts as a foreign body, which may produce an infection. The infection may spread into the tissues of your child’s buttocks and produce an abscess (collection of pus under the skin) at a site several inches away from the sinus.

Pilonidal means “nest of hair”, and is derived from the Latin words for hair (“pilus”) and nest (“nidus”).The term was used by Herbert Mayo as early as 1830. R.M. Hodges was the first to use the phrase “pilonidal cyst” to describe the condition in 1880.

Symptoms:
A pilonidal sinus may cause no noticeable symptoms (asymptomatic). The only sign of its presence may be a small pit on the surface of the skin.

When it’s infected, a pilonidal sinus becomes a swollen mass (abscess). Signs and symptoms of an infected pilonidal cyst include:

*Pain
*Localized swelling
*Reddening of the skin
*Drainage of pus or blood from an opening in the skin (pilonidal sinus)
*Foul smell from draining pus

Hair protruding from a passage (tract) below the surface of the skin that connects the infected pilonidal cyst to the opening on the skin’s surface (a pilonidal sinus) — more than one sinus tract may form
Fever (uncommon)

Causes:
Quite why it happens isn’t entirely clear. When they occur in the cleft between the buttocks, one popular explanation is that there’s a developmental defect in the direction that the hair grows – that is, the hair grows inwards rather than outwards.

One proposed cause of pilonidal cysts is ingrown hair. Excessive sitting is thought to predispose people to the condition because they increase pressure on the coccyx region. Trauma is not believed to cause a pilonidal cyst; however, such an event may result in inflammation of an existing cyst. However there are cases where this can occur months after a localized injury to the area. Some researchers have proposed that pilonidal cysts may be the result of a congenital pilonidal dimple. Excessive sweating can also contribute to the cause of a pilonidal cyst.

The condition was widespread in the United States Army during World War II. More than eighty thousand soldiers having the condition required hospitalization.  It was termed “jeep seat or “Jeep riders’ disease”, because a large portion of people who were being hospitalized for it rode in jeeps, and prolonged rides in the bumpy vehicles were believed to have caused the condition due to irritation and pressure on the coccyx.

Risk Factors:
Certain factors can make you more susceptible to developing pilonidal cysts. These include:

*Obesity
*Inactive lifestyle
*Occupation or sports requiring prolonged sitting
*Excess body hair
*Stiff or coarse hair
*Poor hygiene
*Excess sweating

Complications:
If a chronically infected pilonidal cyst isn’t treated properly, there may be an increased risk of developing a type of skin cancer called squamous cell carcinoma.

Differential diagnosis
A pilonidal sinus can resemble a dermoid cyst, a kind of teratoma (germ cell tumor). In particular, a pilonidal cyst in the gluteal cleft can resemble a sacrococcygeal teratoma. Correct diagnosis is important because all teratomas require complete surgical excision, if possible without any spillage, and consultation with an oncologist.

Treatment :
Treatment may include antibiotic therapy, hot compresses and application of depilatory creams.

In more severe cases, the cyst may need to be lanced or surgically excised (along with pilonidal sinus tracts). Post-surgical wound packing may be necessary, and packing typically must be replaced twice daily for 4 to 8 weeks. In some cases, one year may be required for complete granulation to occur. Sometimes the cyst is resolved via surgical marsupialization.

Surgeons can also excise the sinus and repair with a reconstructive flap technique, which is done under general anesthetic. This approach is mainly used for complicated or recurring pilonidal disease, leaves little scar tissue and flattens the region between the buttocks, reducing the risk of recurrence.

Picture of Pilonidal cyst two days after surgery.

A novel and less destructive treatment is scraping the tract out and filling it with fibrin glue. This has the advantage of causing much less pain than traditional surgical treatments and allowing return to normal activities after 1–2 days in most cases.

Pilonidal cysts recur and do so more frequently if the surgical wound is sutured in the midline, as opposed to away from the midline, which obliterates the natal cleft and removes the focus of shearing stress.

Prevention:
To prevent future pilonidal sinus from developing:

*Clean the area daily with glycerin soap, which tends to be less irritating. Rinse the area thoroughly to remove any soapy residue. Washing briskly with a washcloth helps keep the area free of hair accumulation.

*Keep the area clean and dry. Powders may help, but avoid using oils or herbal remedies.
Avoid sitting for long periods of time.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Pilonidal_sinus
http://www.mayoclinic.com/health/pilonidal-cyst/DS00747
http://www.bbc.co.uk/health/physical_health/conditions/pilonidalsinus.shtml
http://www.childrenshospital.org/az/Site923/mainpageS923P0.html

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Categories
Ailmemts & Remedies

Laryngomalacia

A labeled anatomical diagram of the vocal fold...
A labeled anatomical diagram of the vocal folds or cords. (Photo credit: Wikipedia)

Definition:
Laryngomalacia is a softening of the tissues of the larynx (voice box) above the vocal cords. This softening causes the tissues to become floppy, and they may fall over the airway opening and partially block it.

CLICK TO SEE THE PICTURES

Laryngomalacia (literally, “soft larynx”) is a very common condition of infancy, in which the soft, immature cartilage of the upper larynx collapses inward during inhalation, causing airway obstruction. It can also be seen in older patients, especially those with neuromuscular conditions resulting in weakness of the muscles of the throat. However, the infantile form is much more common.

There are several types – the mildest may cause no problems, while the most severe can be associated with other abnormalities of the respiratory tract, and with neuromuscular and gastroenterological problems.

Symptoms:
Until the larynx becomes stronger, problems can arise for several reasons:

•The soft limp tissues of the larynx can collapse as the baby breathes in. This interrupts the flow of air and causes noisy breathing, with a sound called stridor, which is a sign of obstructed air flow – in fact laryngomalacia is the commonest cause of stridor in babies. It may be worse if the baby has a respiratory infection.

•In some children, laryngomalacia can interfere with feeding. The effort required to draw air in through the obstructed airway can cause reflux of food from the stomach back up into the oesophagus or gullet.

•There may be other ear, nose and throat problems, and rarely problems with the lungs. Low oxygen levels may disrupt normal growth.

Common symptoms are :-
*Nosy breathing (stridor) – An audible wheeze when your baby breathes in. It is often worse when the baby is agitated, feeding, *crying or sleeping on the back
*High pitched sound
*Difficulty feeding
*Poor weight gain
*Choking while feeding
*Apnea — Breathing stoppage
*Pulling in neck and check with each breath
*Cyanosis — Turning blue
*Gastroesophageal reflux — Spitting, vomiting and regurgitation
*Aspiration – Inhalation of food into the lungs

Causes:
Laryngomalacia is thought to be the result of abnormally slow maturation of the tissues of the larynx, possibly because of genetic factors. This simply means that at birth the baby’s respiratory tract isn’t developed and string enough to cope with the mechanical demands of drawing breath.

Although doctors believe there’s a link between laryngomalacia and gastro-oesophageal reflu, there isn’t a single common mechanism to link these two problems, so several theories exist. In some patients with laryngomalacia, reflux may be the primary cause of their airway problems. In others, it’s an additional factor on top of neurological or anatomical abnormalities.

Reflux is common in babies less than one year old, because the muscular valve at the entrance to the stomach (which holds food in the stomach) may be weak in small infants.

Research suggests that a very large number, if not all, of babies with laryngomalacia also have reflux of gastric acid and digestive enzymes up to the pharynx (back of the throat). This may have detrimental effects on the larynx and tracheobronchial tree (air passages into the lungs). This may cause persistent swelling (oedema) of the larynx lining, which is common in children with laryngomalacia.

There’s no consensus yet about managing this link, but it makes sense to think simple treatments to control reflux could help resolve the laryngomalacia more quickly, too. More interventional treatments such as surgery, with all their inherent risks, are best avoided if possible.

Although laryngomalacia is not associated with a specific gene, there is evidence that some cases may be inherited.

Diagnosis:
Your doctor will ask you some questions about your baby’s health problems and may recommend a test called a flexible laryngoscopy (lar ring os co pee) to further evaluate your baby’s condition.

During this test, done in your doctor’s office, a tiny camera that looks like a strand of spaghetti with a light on the end is passed through your baby’s nostril and into the lower part of the throat where the larynx is. This allows your doctor to see your baby’s voicebox.

After the diagnosis — additional tests:
If laryngomalacia is diagnosed, the doctor may want to do other diagnostic tests to evaluate the extent of your child’s problems and to see whether the lower airway is affected. These tests may include:

X-ray of the neck;
A neck X-ray is done to make sure that your baby does not have other problems below the voice box (in the subglottis, trachea or chest). These are areas that the doctor cannot see during the flexible laryngoscopy.

Airway fluoroscopy;
The doctor may also order a motion picture X-ray of the trachea to make sure that there are no other problems.

Microlaryngoscopy (my crow lar ring os co pee)and bronchoscopy (brawn cos co pee), also known as MLB
This test is done when a neck X-ray shows additional problems in the lower airway. Your child is taken to the operating room and given anesthesia. Then the doctor passes a tiny camera through your child’s mouth and down past the vocal cords (larynx) to look at the area below the vocal folds that may be contributing to the stridor (noisy breathing). The surgeon will take some pictures and will review the results with you afterward.

EGD or esophagogastroduodenoscopy pH probe
This test will be done if your child’s doctor suspects that there may be a more severe problem.

Treatment :
In almost all cases (99 percent), laryngomalacia resolves without treatment by the time your child is 18 to 20 months of age. However, if the laryngomalacia is severe, your child’s treatment may include medication or surgery.

Medication:
Your child’s GI doctor may prescribe an anti-reflux medication to help manage the gastroesophageal reflux (GERD). This is important because your child’s chronic neck and chest retractions from the laryngomalacia can worsen GERD. Also, the acid reflux can cause swelling above the vocal cords and worsen the noisy breathing.

Surgery:
Surgery is the treatment of choice if your child’s condition is severe. Symptoms that signal the need for surgery include:

*Life-threatening apneas (stoppages of breathing)

*Significant blue spells

*Failure to gain weight with feeding

*Significant chest and neck retractions

*Need for extra oxygen to breathe

*Heart or lung issues related to your child’s inability to get enough oxygen

Supraglottoplasty:
In this surgery, extra tissue above the vocal cords is trimmed in the operating room. Your child will be under general anesthesia while the surgeon does a thorough evaluation of the airway and removes the tissue. After surgery, your child will be taken to the pediatric intensive care unit (PICU) and will spend one night with a breathing tube in the nose. If there is not much swelling in this area, and if the surgeon feels it will be safe, the breathing tube will be removed the next day in the PICU. Your child will then be observed for another day to ensure that the airway is safe, and that your child is getting enough oxygen and is drinking normally.

This surgery may not completely eliminate the noisy breathing but it should help to:

*Reduce the severity of the symptoms

*Lessen the apneas (breathing stoppages)

*Reduce the extra oxygen requirements

*Improve swallowing

*Help your child gain weight.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Laryngomalacia
http://www.chop.edu/service/airway-disorders/conditions-we-treat/laryngomalacia.html
http://www.bbc.co.uk/health/physical_health/conditions/laryngomalacia.shtml

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Ailmemts & Remedies

Indigestion and Heartburn

Definition:
Indigestion — also called dyspepsia or an upset stomach — is a general term that describes discomfort in your upper abdomen.
It is a term that people use to describe a range of different symptoms relating to the stomach and gastro-intestinal system.
Indigestion is not a disease, but rather a collection of symptoms you experience, including bloating, belching and nausea. Although indigestion is common, how you experience indigestion may differ from other people. Symptoms of indigestion might be felt occasionally or as often as daily.

click to see the pictures

Fortunately, you may be able to prevent or treat the symptoms of indigestion.

Symptoms:
Most people with indigestion have one or more of the following symptoms:

*Early fullness during a meal. You haven’t eaten much of your meal, but you already feel full and may not be able to finish eating.

*Uncomfortable fullness after a meal. Fullness lasts longer than it should.

*Pain in the upper abdomen. You feel a mild to severe pain in the area between the bottom of your breastbone (sternum) and your navel.

*Burning in the upper abdomen. You feel an uncomfortable heat or burning sensation between the bottom of the breastbone and navel.

Less frequent symptoms that may come along with indigestion include:

*Nausea. You feel like you are about to vomit.

*Bloating. Your stomach feels swollen, tight and uncomfortable.

Sometimes people with indigestion also experience heartburn, but heartburn and indigestion are two separate conditions. Heartburn is a pain or burning feeling in the center of your chest that may radiate into your neck or back after or during eating.

It’s not uncommon for people with severe indigestion to think they’re having a heart attack. The pain may be stabbing, or a generalised soreness.

Some people experience reflux – where acidic stomach contents are regurgitated up into the gullet causing a severe burning sensation. Other symptoms include bloating, wind, belching and nausea. Sometimes the pain of indigestion can be relieved by belching.

Risk Factors:
People of all ages and of both sexes are affected by indigestion. It’s extremely common. An individual’s risk increases with excess alcohol consumption, use of drugs that may irritate the stomach (such as aspirin), other conditions where there is an abnormality in the digestive tract such as an ulcer and emotional problems such as anxiety or depression.

Causes:-
Indigestion has many causes, including:

Diseases: 

*Ulcers
*GERD
*Stomach cancer (rare)
*Gastroparesis (a condition where the stomach doesn’t empty properly; this often occurs in diabetics)
*Stomach infections
*Irritable bowel syndrome
*Chronic pancreatitis
*Thyroid disease

Medications:
*Aspirin and many other painkillers
*Estrogen and oral contraceptives
*Steroid medications
*Certain antibiotics
*Thyroid medicines

Lifestyle:
*Eating too much, eating too fast, eating high-fat foods,eating fried and toomuch spicy food or eating during stressful situations
*Drinking too much alcohol
*Cigarette smoking
*Stress and fatigue
*Swallowing excessive air when eating may increase the symptoms of belching and bloating, which are often associated with indigestion.

Sometimes people have persistent indigestion that is not related to any of these factors. This type of indigestion is called functional, or non-ulcer dyspepsia.

During the middle and later parts of pregnancy, many women have indigestion. This is believed to be caused by a number of pregnancy-related factors including hormones, which relax the muscles of the digestive tract, and the pressure of the growing uterus on the stomach.

Complications:
Although indigestion doesn’t usually have serious complications, it can affect your quality of life by making you feel uncomfortable and causing you to eat less. When indigestion is caused by an underlying condition, that condition could come with complications of its own.

Diagnosis:
If you are experiencing symptoms of indigestion, make an appointment to see your doctor to rule out a more serious condition. Because indigestion is such a broad term, it is helpful to provide your doctor with a precise description of the discomfort you are experiencing. In describing your indigestion symptoms, try to define where in the abdomen the discomfort usually occurs. Simply reporting pain in the stomach is not detailed enough for your doctor to help identify and treat your problem.

First, your doctor must rule out any underlying conditions. Your doctor may perform several blood tests and you may have X-rays of the stomach or small intestine. Your doctor may also use an instrument to look closely at the inside of the stomach, a procedure called an upper endoscopy. An endoscope, a flexible tube that contains a light and a camera to produce images from inside the body, is used in this procedure.

Treatment:
Because indigestion is a symptom rather than a disease, treatment usually depends upon the underlying condition causing the indigestion.

Often, episodes of indigestion go away within hours without medical attention. However, if your indigestion symptoms become worse, you should consult a doctor. Here are some helpful tips to alleviate indigestion:

*Try not to chew with your mouth open, talk while chewing, or eat too fast. This causes you to swallow too much air, which can aggravate indigestion.

*Drink fluids after rather than during meals.

*Avoid late-night eating.

*Try to get little relaxation after meals.

*Avoid toomuch spicy  and fried foods.

*Stop smoking.

*Avoid alcoholic beverages.

*Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.Exercise regularly. With your doctor’s OK, aim for 30 to 60 minutes of physical activity on most days of the week. It can be as simple as a daily walk, though not just after you eat.

*Regular exercise(specially Yoga exercise ) helps you keep off extra weight and promotes better digestion.

*Manage stress. Create a calm environment at mealtime. Practice relaxation techniques, such as deep breathing, meditation or yoga. Spend time doing things you enjoy. Get plenty of sleep.

*Eat more fibourous food (vegetable,fruits & nuts) and less meat(specially redmeat)

*Reconsider your medications. With your doctor’s approval, stop or cut back on pain relieving drugs that may irritate your stomach lining. If that’s not an option, be sure to take these medications with food.

*Do not exercise with a full stomach. Rather, exercise before a meal or at least one hour after eating a meal.
Do not lie down right after eating.

*Wait at least three hours after your last meal of the day before going to bed.

*Raise the head of your bed so that your head and chest are higher than your feet. You can do this by placing 6-inch blocks under the bedposts at the head of the bed. Don’t use piles of pillows to achieve the same goal. You will only put your head at an angle that can increase pressure on your stomach and make heartburn worse.

*Go to bed early and  get up early. Try to have atleast 6 hours sound sleep at night.

If indigestion is not relieved after making these changes, your doctor may prescribe medications to alleviate your symptoms.

Alternative  Therapy:
Some people may find relief from indigestion through the following methods, although more research is needed to determine their effectiveness:

*Drinking herbal tea with peppermint.

*Psychological methods, including relaxation techniques, cognitive therapy and hypnotherapy.

*Regular Yoga exercise under a trained Yoga instructor

*You may see herbal products that promise relief from indigestion. But remember, these products often haven’t been proven effective and there’s a risk that comes with taking herbs because they’re not regulated.

*Sometimes proper Homeopathic treatment works very  well.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.webmd.com/heartburn-gerd/guide/indigestion
http://www.bbc.co.uk/health/physical_health/conditions/indigestion1.shtml
http://www.mayoclinic.com/health/indigestion/DS01141
http://www.webmd.com/heartburn-gerd/guide/indigestion?page=2
http://heartburnadvice.info/result.php?y=46046424&r=c%3EbHWidoSjeYKvZXS3bXOmMnmv%5Bn9%3E%27f%3Evt%3Cvt%3C61%3C2%3C2%3C57157535%3Ctuzmf2%6061%2Fdtt%3C3%3Cjoufsdptnpt%60bggjmjbuf%604%60e3s%60efsq%3Ccsjehf91%3A%3Ccsjehf91%3A%3C22%3A8816%3C%3A%3A276%3Cdmfbo%3C%3Czbipp%3C%27jqvb%60je%3E3g%3Ag5g%3A62dce451g479c511988e4e7c2%27enybsht%3E53%3Ag54ddg93c6bgcg%3A533f1d723717%3Ad&Keywords=Severe Heartburn&rd=3
http://www.askdrthomas.com/ailments-heartburn-indigestion.html

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Health Problems & Solutions

Some Health Quaries & Answers

Stop the bottle, spare the teeth  :

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Q: My three and a half-year-old daughter has a poor appetite. She is only 10 kg while the expected weight is 15 kg (as per the pediatrician’s calculation). The doctor prescribed de-worming medication several times as well as tonics. I give her milk with Pediasure in a bottle at night. She has several decayed teeth and frequently complains of toothache.

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A: Your daughter probably has caries. The bottle will worsen her cavities because the milk will stick to the teeth which will allow bacteria to thrive in her mouth. These milk teeth will eventually fall off and you may feel they do not require any treatment. But food will get stuck there and cause discomfort. This will make her reluctant to eat, resulting in inadequate weight gain. Also, she is old enough to discard the bottle. You are probably giving it to her in the hope that she receives some calories. Stop the bottle and take her to a dentist. He might be able to fill the cavities.

Hiatus hernia
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Q: I have heart burn all the time. After some tests the doctor found that I have hiatus hernia. What should I do?
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A: The esophagus runs through the diaphragm to the stomach. It functions to carry food from the mouth to the stomach.The esophagus passes through the diaphragm just before it meets the stomach, through an opening called the esophageal hiatus.

 

A hiatal hernia occurs when part of the stomach protrudes up into the chest through the sheet of muscle called the diaphragm. This may result from a weakening of the surrounding tissues and may be aggravated by obesity and/or smoking.


Hiatus hernia is a condition where part of the stomach slides into the chest cavity. Many hiatus hernias are asymptomatic. Pain occurs because of acid reflux from the stomach into the esophagus.

You can get relief by losing weight, not lying down for an hour after food, and using medications like omeprazole and pantoprazole. If the hiatus hernia is long-standing with severe symptoms, surgery may be required.

Sugar free
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Q: I am diabetic and have been taking Sugar Free in my coffee, tea and curd. Is it safe?
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A:
There are many natural and synthetic sugar substitutes available. In India, the ones commonly used are saccharin and aspartame. Both have been certified as safe although initially saccharin was found to cause bladder cancer in mice. Aspartame consumption should not be more than 40 mg a day. In these circumstances, perhaps it is better for you to get used to tea and coffee without sugar.

Vital fluid
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Q: I am a 37-year-old woman. I am pale and the doctor said I am anaemic. My haemoglobin is 7gm. He gave me a capsule containing iron and zinc to be taken twice a day. After three months there has been no improvement. What should I do?

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A: Your anaemia needs to be investigated. You may be losing blood because of heavy periods, piles or a stomach ulcer. Or you may have intestinal parasites that are depleting you of blood. Rarely, cancer may present itself as anaemia. If there is no cause for the anaemia other than iron and zinc deficiency, it should respond to supplements. The binding sites on the intestines for iron and zinc absorption are identical. If you consume a tablet containing both these elements they compete for the binding site and block it. To be effective, iron and zinc have to be taken as separate tablets or capsules 12 hours apart (one in the morning and the other in the evening). Or, you take iron one day and zinc the next.

Health hour
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Q: My son is unable to run or jog owing to a tight work schedule. Can he follow some other form of exercise?

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A:
The requirements of exercise for the maintenance of health have increased from 30 minutes three times a week to an hour a day. If you son is unable to spare that kind of time, he can get more or less the same benefits by skipping or continuous stair climbing (up and down) for 20 minutes. Cross training and doing different activities probably deliver the best benefits as compared to repeating the same one. Different sets of muscles are used, producing all-round toning.

Source: The Telegraph ( Kolkata, India)

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Ailmemts & Remedies

Hiatal Hernia

Alternative Names:Hernia – hiatal,  Hiatus hernia.

Definition:
.Hiatal hernia is a condition in which a portion of the stomach protrudes upward into the chest, through an opening in the diaphragm. The diaphragm is the sheet of muscle that separates the chest from the abdomen. It is used in breathing.

click  see to picture

The  diaphragm normally has a small opening (hiatus) that allows your food tube (esophagus) to pass through on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.
click to see picture

The esophagus runs through the diaphragm to the stomach. It functions to carry food from the mouth to the stomach.The esophagus passes through the diaphragm just before it meets the stomach, through an opening called the esophageal hiatus.

click  to see picture

A hiatal hernia occurs when part of the stomach protrudes up into the chest through the sheet of muscle called the diaphragm. This may result from a weakening of the surrounding tissues and may be aggravated by obesity and/or smoking.

.CLICK & SEE THE PICTURES
In most cases, a small hiatal hernia doesn’t cause problems, and you may never know you have a hiatal hernia unless your doctor discovers it when checking for another condition. But a large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn and chest pain. Self-care measures or medications can usually relieve these symptoms, although a very large hiatal hernia sometimes requires surgery.

Classification:
There are two major kinds of hiatus hernia:
The most common (95%) is the sliding hiatus hernia, where the gastroesophageal junction moves above the diaphragm together with some of the stomach.

The second kind is rolling (or paraesophageal) hiatus hernia, when a part of the stomach herniates through the esophageal hiatus and lies beside the esophagus, without movement of the gastroesophageal junction. It accounts for the remaining 5% of hiatus hernias.

A third kind is also sometimes described, and is a combination of the first and second kinds.

Symptoms:
Small hiatal hernias
Most small hiatal hernias cause no signs or symptoms.

Large hiatal hernias
Larger hiatal hernias can cause signs and symptoms such as:

*Heartburn, worse when bending over or lying down
*Belching
*Chest pain
*Nausea
*Swallowing difficulty

A hiatal hernia by itself rarely causes symptoms — pain and discomfort are usually due to the reflux of gastric acid, air, or bile. Reflux happens more easily when there is a hiatal hernia, although a hiatal hernia is not the only cause of reflux.

Causes:

A hiatal hernia occurs when weakened muscle tissue allows your stomach to bulge up through your diaphragm. It’s not always clear why this happens, but pressure on your stomach may contribute to the formation of hiatal hernia.

How a hiatal hernia forms
Your diaphragm is a large dome-shaped muscle that separates your chest cavity from your abdomen. Normally, your esophagus passes into your stomach through an opening in the diaphragm called the hiatus. Hiatal hernias occur when the muscle tissue surrounding this opening becomes weak, and the upper part of your stomach bulges up through the diaphragm into your chest cavity.

Possible causes of hiatal hernia  are:
*Injury to the area
*An inherited weakness in the surrounding muscles
*Being born with an unusually large hiatus
*Persistent and intense pressure on the surrounding muscles, such as when coughing, vomiting, or straining during a bowel movement or while lifting heavy objects.

The following are risk factors that can result in a hiatus hernia.

*Increased pressure within the abdomen caused by:
*Heavy lifting or bending over
*Frequent or hard coughing
*Hard sneezing
*Pregnancy and delivery
*Violent vomiting
*Straining with constipation
*Obesity (extra weight pushes down on the abdomen increasing the pressure)
*Use of the sitting position for defecation
*Heredity
*Smoking
*Drug use, such as cocaine.[citation needed]
*Stress
*Diaphragm weakness

Diagnosis:
The diagnosis of a hiatus hernia is typically made through an upper GI series, endoscopy or High resolution manometry.

Treatment:
In most cases, sufferers experience no discomfort and no treatment is required. However, when the hiatal hernia is large, or is of the paraesophageal type, it is likely to cause esophageal stricture and discomfort. Symptomatic patients should elevate the head of their beds and avoid lying down directly after meals until treatment is rendered. If the condition has been brought on by stress, stress reduction techniques may be prescribed, or if overweight, weight loss may be indicated. Medications that reduce the lower esophageal sphincter (or LES) pressure should be avoided. Antisecretory drugs like proton pump inhibitors and H2 receptor blockers can be used to reduce acid secretion.

Where hernia symptoms are severe and chronic acid reflux is involved, surgery is sometimes recommended, as chronic reflux can severely injure the esophagus and even lead to esophageal cancer.

The surgical procedure used is called Nissen fundoplication. In fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the inferior part of the esophagus, preventing herniation of the stomach through the hiatus in the diaphragm and the reflux of gastric acid. The procedure is now commonly performed laparoscopically. With proper patient selection, laparoscopic fundoplication has low complication rates and a quick recovery.

Complications include gas bloat syndrome, dysphagia (trouble swallowing), dumping syndrome, excessive scarring, and rarely, achalasia. The procedure sometimes fails over time, requiring a second surgery to make repairs.

Lifestyle & Home Remedy:
Lifestyle changes may help control the signs and symptoms of acid reflux caused by a hiatal hernia. Consider trying to:

*Eat several smaller meals throughout the day rather than a few large meals.
*Avoid foods that trigger heartburn, such as chocolate, onions, spicy foods, citrus fruits and tomato-based foods.
*Avoid alcohol.
*Limit the amount of fatty foods you eat.
*Sit up after you eat, rather than taking a nap or lying down.
*Eat at least three hours before bedtime.
*Lose weight if you’re overweight or obese.
*Stop smoking.
*Elevate the head of your bed 6 inches (about 15 centimeters).
*Work to reduce the stress in your daily life.

Alternative Medication:
Some alternative medicine practitioners claim to have discovered a way to cure a hiatal hernia by pushing the stomach back to its normal position below the diaphragm. Practitioners may use their hands to apply pressure to the abdomen and manipulate the stomach.

There’s no evidence that such manipulation works to cure hiatal hernia. No clinical trials of the technique have been conducted.

But Practicing Regular Yoga Exercise & meditation has definitely got some better effect.

Prognosis:
A hiatus hernia  normally  does not cause any symptoms. The condition promotes reflux of gastric contents (via its direct and indirect actions on the anti-reflux mechanism) and thus is associated with gastroesophageal reflux disease (GERD). In this way a hiatus hernia is associated with all the potential consequences of GERD – heartburn, esophagitis, Barrett’s esophagus, esophageal cancer and dental erosion. However the risk attributable to the hiatus hernia is difficult to quantify, and at most is low.

Besides discomfort from GERD and dysphagia, hiatal hernias can have severe consequences if not treated. While sliding hernias are primarily associated with gastroesophageal acid reflux, rolling hernias can strangulate a portion of the stomach above the diaphragm. This strangulation can result in esophageal or GI tract obstruction and the tissue can even become ischemic and necrose.

Another severe complication, although very rare, is a large herniation that can restrict the inflation of a lung, causing pain and breathing problems.

Most cases are asymptomatic.

Prevention:
Controlling risk factors such as obesity may help prevent hiatal hernia.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Hiatus_hernia
http://www.nlm.nih.gov/medlineplus/ency/article/001137.htm
http://www.mayoclinic.com/health/hiatal-hernia/DS00099

http://www.nlm.nih.gov/medlineplus/ency/presentations/100028_1.htm

http://www.nlm.nih.gov/medlineplus/ency/imagepages/17070.htm

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