Transcript Hiatal Hernia Case Study

HIATAL HERNIA CASE STUDY
By Sally Smith
Pathophysiology
5/2010
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.
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
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 .
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.

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.
TREATMENT OPTIONS

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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.
PROGNOSIS

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Most symptoms are alleviated with treatment so prognosis
is excellent.
Chronic untreated GERD can cause serious complications.


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Inflammation of the esophagus from refluxed stomach acid
can damage the lining and cause bleeding or ulcers—also
called esophagitis.
Scars from tissue damage can lead to strictures—narrowing of
the esophagus—that make swallowing difficult.
Some people develop Barrett’s 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.
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
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Allison PR. Reflux esophagitis, sliding hiatal hernia,
and the anatomy of repair. Surg Gynecol Obstet. 1951
Apr;92(4):419–431.
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 Oct;4(5):526–
530.
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. 1955;7(4):351–359.
Orlando RC. Diseases of the esophagus. In: Goldman
L, Ausiello D, eds. Cecil Medicine. 23rd ed.
Philadelphia, Pa: Saunders Elsevier; 2007:chap 140.