《sandhill文摘》word版

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1、IdentifyingtheLESwhenaHiatalHerniaisPresentusingHRiM OneofthemanyadvantagesofourHighResolutionEsophagealManometrySystem(probeandsoftware)isexcellentvisualizationoftheprobe'spositionintheesophagealbody.Becausethereare32pressuresensorswecanappreciatetheesophageallengthoftenfrompharynx

2、tostomachusingClouseVIEW(colorcontourmapping).Becauseofthiscomprehensive'view'oftheesophagealbody,whenahiatalherniaisevident,wecaneasilyappreciatethedifferencebetweenthediaphragmandtheLES.TheprobecanthenbeproperlyplacedwiththereferencelineatthesphinctersoLESrelaxationcanbemeasured. 

3、Apatientmaycomeinwithadiagnosisofhiatalhernia.ThisdoesnotmeanitwillbevisualizedduringaHRiMprocedure.Theymayhavea'sliding'herniameaningthatitissometimesreducedintonormalpositionwiththediaphragmandLESinthesamelocation.ThismayespeciallybetrueduringthisprocedureasthepatientisaskedtobeNP

4、Oandthereforedoesnothavegastricdistention,whichcoulddisplacethehernia.However,ifaseparationofthediaphragmandtheLESisseen-BONUS!(Seepicture) Duringpost-procedurereviewofastudy,whenevaluatingforthepresenceofahiatalhernia,welookforthePIP-PressureInversionPoint(thediaphragm).Belowthispo

5、intisthepositive-pressureabdominalcavity.  Abovethispointisthenegative-pressurethoraciccavity.Hence,theinversionofthepressurewavesfrompositivewithinspirationtonegativewithinspirationasyouscanthewavesfromstomachupthroughtheLESarea. Innormalanatomicalposition,thePIPisatorbelowtheproxi

6、maledgeoftheLES.AsmallhiatalherniamaybeindicatedwhenthePIPisbelowtheHPZ.AlargerhiatalherniaisevidentwhenthePIPisbelowthedistaledgeoftheLES.ThedistancebetweenthePIPandthedistaledgeoftheLESrepresentstheamountofstomachthathasbeenpushedupintotheabdominalcavity. Avalueincludedonyourrepor

7、tintheLESProfileSectionalongwiththeLESlength(normal>3cm)istheintra-abdominalLESlength.Inthenormalanatomicalpositionatleast1cmoftheLESshouldbebelowPIP.Whenahiatalherniaispresent,theintra-abdominallengthwillbeshorterandmayevenbenegative.Forexample,whentheentireLESplus3cmsofstomachhave

8、beendisplacedaboveP