American Board of Surgery Qualifying Exam (ABS QE) Practice Test

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What is a defining feature of Type 4 PEH?

Only the stomach is involved
Both the GEJ and part of stomach plus another organ
Only the GEJ is above the diaphragm
Stomach is completely below the diaphragm

The correct answer is: Both the GEJ and part of stomach plus another organ

The defining feature of Type 4 Paraesophageal Hernia (PEH) is that both the gastroesophageal junction (GEJ) and a portion of the stomach, as well as an additional organ, are positioned above the diaphragm. This type of hernia is more complex than other types because it involves a combination of findings, which can include organs such as the colon or spleen, in addition to the stomach and GEJ being displaced. Type 4 PEH is categorized by this involvement of multiple organs, contrasting with simpler types where only the stomach or the GEJ are involved. In other types of hernias, like Type 1, only the stomach moves above the diaphragm, and in Type 2 or Type 3, there may be the stomach or GEJ but not necessarily additional organs. Understanding these classifications is important for diagnosis and treatment planning, especially since Type 4 PEH can lead to serious complications due to organ displacement and can require more extensive surgical intervention.