This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': "Hiatus hernia is treated by-a) Surgery when medical treatment has failedb) Nissens' fundoplicationc) Medical treatment onlyd) None of the above \nSelect and explain. \nA. ac, B. ab, C. ad, D. bc", 'role': 'user'}, {'content': 'Answer: B \nExplanation: • Greater than 95% of HHs is type I or sliding hernias\n• Of all PEHs, type III is the most common\n• PEHs are more common in females and have an autosomal dominant mode of transmission.\n• MC structure to herniate is the fundus of the stomach; other structures that may be located in the hernia sac include the spleen, colon, and omentum\n• Type IV PEH has a higher incidence of serious results, with 50% of patients presenting emergently.\nClinical Features\n• Most common preoperative symptom and finding is the typical heatburn\n• Others are chest pain, epigastric pain, dysphagia, postprandial fullness, regurgitation, vomiting, weight loss, anemia, and respiratory symptoms.\n• Hematemesis or anemia is evident in about a third of patients with PEH.\nDiagnosis\n• Barium swallow is the most important diagnostic test.\n• Endoscopy helps to identify mucosal erosions as a source of gastrointestinal blood loss.\n• Manometry is needed to determine the motor function of the esophageal body.\nTreatment\n• Surgical approach: Transabdominal (laparoscopic or open) or transthoracic.\n• Transabdominal laparoscopic approach for HH repair is preferred\nCameron Ulcer or Riding Ulcer\n• Bleeding can be caused by ischemia of the gastric mucosa or by riding ulcers or Cameron’s ulcers.\n• Cameron’s ulcers are due to the constant abrasive force as the stomach rubs against or is pinched by the diaphragmatic hiatus.\n• The continuous movement of the stomach and esophagus as they travel up and down with respiration and swallowing compounds the problem.\n• Anemia from a PEH resolves in 92% of patients after surgical repair.', 'role': 'assistant'}]