What is the most sensitive test?
Barium swallow: most sensitive test
Assesses type and size of a hernia (including location of the stomach and the GEJ)
Describe the endoscopy.
used to diagnose hiatal hernia and evaluate for possible complications (see “Complications” below)
Z-line: squamocolumnar junction, which represents the transition from the squamous epithelium-lined esophageal mucosa to the columnar epithelium-lined gastric mucosa; corresponds to the GEJ
Types I and III: Z-line lies above the diaphragmatic hiatus
Types II and IV: Z-line remains undisplaced (below the diaphragmatic hiatus)
List other tests that can detect hiatal hernias.
Chest x-ray
Usually incidental finding
Types I, II, III: retrocardiac soft tissue opacity with/without an air-fluid level
Type IV: retrocardiac visceral gas (small bowel/colon) or soft tissue shadows (spleen/omentum)
CT Thorax: recommended for urgent preoperative evaluation of complicated type II, III, and IV hernias
Esophageal manometry: helps calculate the size of a sliding hiatal hernia by accurately identifying the level of the diaphragmatic hiatus
Esophageal pH monitoring: not a diagnostic test; useful for determining the extent of gastroesophageal reflux
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