Hiatal Hernia Case Study

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Hiatal Hernia Case Study

• By Sally Smith
• Pathophysiology
• 5/2010

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Symptoms History

• A 56 y/o male c/o experiencing pain about an inch
  beneath his sternum and sharp pains in radiating
  towards his left shoulder. It varies in intensity
  and is increased immediately after eating spicy
  foods. After most meals, he c/o suffering from
  mild heartburn. His PCP initially prescribed a
  two week course of Omeprazole, which alleviated
  the symptoms, but they returned after a few days.

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Physical Findings

• The physical examination does not disclose any
  strong evidence. The patient is obese, lacks
  regular physical activities and poor diet. All
  other findings are within normal limits

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Diagnostic methods (X-Ray)

• Although a chest radiograph may reveal a large
  hiatal hernia (and many incidentally diagnosed
  hiatal hernias are discovered in this manner), a
  barium study of the esophagus helps establish the
  diagnosis with greater accuracy .

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Diagnostic methods (X-Ray)

• Typical findings include
• An outpouching of barium at the lower end of the
  esophagus
• A wide hiatus through which gastric folds are
  seen in continuum with those in the stomach
• And occasionally, free reflux of barium.

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Other Possible Diagnosis

• If it is not a hiatal hernia, there could be a
  mass obstructing the area and causing pain. Heart
  work up would be done first to r/o any cardiac
  issues.

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Treatment options

• The goals of treatment are to relieve symptoms
  and prevent further complications.
• Reducing the gastroesophageal reflux will relieve
  pain. Medications may be prescribed, which this
  patient has already used.
• Other measures to reduce symptoms include
• Avoiding large or heavy meals
• Not lying down or bending over immediately after
  a meal
• Reducing weight and not smoking
• If these measures fail to control the symptoms,
  or complications occur, surgical repair of the
  hernia may be necessary.

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Prognosis

• Most symptoms are alleviated with treatment so
  prognosis is excellent.
• Chronic untreated GERD can cause serious
  complications.
• Inflammation of the esophagus from refluxed
  stomach acid can damage the lining and cause
  bleeding or ulcersalso called esophagitis.
• Scars from tissue damage can lead to
  stricturesnarrowing of the esophagusthat make
  swallowing difficult.
• Some people develop Barretts esophagus, in which
  cells in the esophageal lining take on an
  abnormal shape and color. Over time, the cells
  can lead to esophageal cancer, which is often
  fatal.
• Persons with GERD and its complications should be
  monitored closely by a physician.
• Studies have shown that GERD may worsen or
  contribute to asthma, chronic cough, and
  pulmonary fibrosis. This may be due to chronic
  aspiration.

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Disease changes for different age groups

• Hiatal hernias are common in people over 50 years
  old. They can occur in pediatrics, but not very
  often. If they do, treatments are the same as for
  adults.
• Infants with symptoms are placed prone with
  elevation of the head at least 30 degrees to
  reduce the possibility of aspiration.

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Resources

• Allison PR. Reflux esophagitis, sliding hiatal
  hernia, and the anatomy of repair. Surg Gynecol
  Obstet. 1951 Apr92(4)419431.
• Bettex M, Kuffer F. Long-term results of
  fundoplication in hiatus hernia and
  cardio-esophageal chalasia in infants and
  children. Report of 112 consecutive cases. J
  Pediatr Surg. 1969 Oct4(5)526530.
• Borema I, Germs R. Fixation of the lesser
  curvature of the stomach to the anterior
  abdominal wall after reposition of the hernia
  through the oesophageal hiatus. Arch Chir Neerl.
  19557(4)351359.
• Orlando RC. Diseases of the esophagus. In
  Goldman L, Ausiello D, eds. Cecil Medicine. 23rd
  ed. Philadelphia, Pa Saunders Elsevier
  2007chap 140.