Hiatal hernias occur when contents of the abdominal cavity protrude through the esophageal hiatus of the diaphragm. Factors that contribute to the development of a hiatal hernia include an enlargement of the esophageal hiatus due to developmental defects, an increased abdominal thoracic pressure gradient, and the depletion of elastic fibers in the phrenoesophageal membrane with aging. There are four different types of hiatal hernias and management varies depending on the type. Type I, also known as a sliding hernia, is a simple displacement of the gastroesophageal junction into the thoracic cavity. The stomach remains in the abdominal cavity. This is the most common type of hiatal hernia, accounting for about 95% of all hiatal hernias. Types II-IV are classified as paraesophageal hernias. Type II occurs when the gastroesophageal junction maintains its position but the gastric fundus herniates through the diaphragmatic hiatus. Type III has both the gastroesophageal junction and the stomach herniate above the diaphragm. When more than 30% of the stomach is herniated into the thoracic cavity, it is termed a “giant” paraesophageal hernia. A patient has a type IV hernia when other organs, such as the colon, in addition to the stomach herniate above the diaphragm.

Endotracheal intubation is a medical procedure in which a tube is placed into the windpipe (trachea) through the mouth or nose. In most emergency situations it is placed through the mouth. Whether you are awake (conscious) or not awake (unconscious), you will be given medicine to make it easier to insert the tube. After endotracheal intubation, you will likely be placed on a breathing machine. If you are awake after the procedure, your health care provider may give you medicine to reduce your anxiety or discomfort.

Most cataracts are associated with the aging process and are common among older Americans. In fact, according to the National Eye Institute (NEI), 68.3 percent of Americans 80 and older had cataracts in 2010. And the prevalence of cataracts in the U.S. is expected to grow significantly in the years ahead, due in part to the aging of the population. In 2010, roughly 24.4 million Americans had cataracts, and that number is projected to grow to 50.2 million by the year 2050, according to NEI.

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Reconstructive surgery is performed to treat structures of the body affected aesthetically or functionally by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally done to improve function and ability, but may also be performed to achieve a more typical appearance of the affected structure. Reconstructive surgery is generally covered by most health insurance policies, although coverage for specific procedures and levels of coverage may vary greatly.

Skin laceration repair is an important skill in family medicine. Sutures, tissue adhesives, staples, and skin-closure tapes are options in the outpatient setting. Physicians should be familiar with various suturing techniques, including simple, running, and half-buried mattress (corner) sutures. Although suturing is the preferred method for laceration repair, tissue adhesives are similar in patient satisfaction, infection rates, and scarring risk in low skin-tension areas and may be more cost-effective. The tissue adhesive hair apposition technique also is effective in repairing scalp lacerations. The sting of local anesthesia injections can be lessened by using smaller gauge needles, administering the injection slowly, and warming or buffering the solution. Studies have shown that tap water is safe to use for irrigation, that white petrolatum ointment is as effective as antibiotic ointment in postprocedure care, and that wetting the wound as early as 12 hours after repair does not increase the risk of infection. Patient education and appropriate procedural coding are important after the repair.

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