Changes

===Diagnostic Imaging===

===Diagnostic Imaging===

*'''Plain survey radiographs''' may show a gas-filled soft tissue opacity in the caudodorsal thorax, continuous with the diaphragmatic margin.  Secondary [[Megaoesophagus|megaoesophagus]] may develop in longstanding cases and an alveolar lung pattern may be apparent, especially cranio-ventrally, if the animal is developing aspiration pneumonia.

'''Plain survey radiographs''' may show a gas-filled soft tissue opacity in the caudodorsal thorax, continuous with the diaphragmatic margin.  Secondary [[Megaoesophagus|megaoesophagus]] may develop in longstanding cases and an alveolar lung pattern may be apparent, especially cranio-ventrally, if the animal is developing aspiration pneumonia. '''Barium contrast studies''' may be used to confirm a diagnosis. Intermittent hiatal hernias can be difficult to detect and therefore it is sometimes necessary to put pressure on the abdomen during radiography to induce displacement of the stomach.

*'''Barium contrast studies''' may be used to confirm a diagnosis.

Intermittent hiatal hernias can be difficult to detect and therefore it is sometimes necessary to put pressure on the abdomen during radiography to induce displacement of the stomach.

*'''Fluoroscopy''' can be used to identify cases of intermittent herniation if the condition is still suspected after plain radiography.

'''Fluoroscopy''' can be used to identify cases of intermittent herniation if the condition is still suspected after plain radiography.

*'''Endoscopy''' may demonstrate cranial displacement of the lower oesophageal sphincter and a large oesophageal hiatus.

 

'''Endoscopy''' may demonstrate cranial displacement of the lower oesophageal sphincter and a large oesophageal hiatus.

==Treatment==

==Treatment==

===Surgical Management===

===Surgical Management===

Surgical management can be used with congenital cases (after medical management has been attempted) and to treat the underlying cause in acquired cases.

Surgical management can be used with congenital cases (after medical management has been attempted) and to treat the underlying cause in acquired cases. '''Hernia repair''' is achieved via a cranial ventral coeliotomy.  The oesophageal hiatus is exposed by transection of left triangular ligament (between the liver and diaphragm) and retraction of the liver.  The phreno-oesophageal ligament is partially incised and the oesophagus is retracted into the abdomen until the lower oesopageal sphincter is identified.  Sutures are then placed to reduce the size of the oesophageal hiatus.   An '''oesophagopexy''' may also be performed (tacking the oesophagus to the left body wall) or a '''fundic gastropexy'''.  A tube gastropexy has the added advantage of allowing cases to be fed if they are suffering from severe [[Oesophagitis|oesophagitis]] or oesophageal ulceration. '''Laryngeal surgery or correction of BOAS''' may be performed if this has contributed to the hernia.

*'''Hernia repair''' is achieved via a cranial ventral coeliotomy.  The oesophageal hiatus is exposed by transection of left triangular ligament (between the liver and diaphragm) and retraction of the liver.  The phreno-oesophageal ligament is partially incised and the oesophagus is retracted into the abdomen until the lower oesopageal sphincter is identified.  Sutures are then placed to reduce the size of the oesophageal hiatus.  

*An '''oesophagopexy''' may also be performed (tacking the oesophagus to the left body wall) or a '''fundic gastropexy'''.  A tube gastropexy has the added advantage of allowing cases to be fed if they are suffering from severe [[Oesophagitis|oesophagitis]] or oesophageal ulceration.

*'''Laryngeal surgery or correction of BOAS''' may be performed if this has contributed to the hernia.

==Prognosis==

==Prognosis==

==References==

==References==

[[Category:Oesophagus_-_Pathology]]

[[Category:Oesophagus_-_Pathology]]

[[Category:To_Do_-_James]]

[[Category:To_Do_-_James]]

[[Category:Cat]][[Category:Dog]]

[[Category:Cat]][[Category:Dog]]

[[Category:Expert_Review]]

[[Category:Expert_Review]]