Hiatal hernias are a classic Surgery Shelf topic because the exam loves the distinction between sliding and paraesophageal hernias. In this episode, Chris and Mars break down the anatomy, the classic symptom patterns, and the key test-taking question: who has reflux and who needs surgery.

They cover the high-yield differences between sliding hiatal hernias, which are common and usually cause GERD symptoms, and paraesophageal hernias, which are less common but more dangerous because of risks like volvulus, incarceration, strangulation, bleeding, and respiratory compromise. The episode also reviews diagnosis with barium swallow and endoscopy, plus when to manage medically versus when surgical repair is required.