In the human body, a hernia refers to a protrusion of an organ or tissue into an area in which it does not belong. The term Hiatus refers to the opening in the diaphragm which separates the chest cavity from the abdomen.
Typically, only the esophagus transverses through the hiatus. In the case of a hiatal hernia, the opening now allows some or all of the stomach to protrude.
The diaphragm is a primary core stabilizing muscle. A hiatal hernia may be the result of tearing or even genetic predisposition; therefore, not all are painful or symptomatic.
5 Signs and Symptoms of a Hiatal Hernia
Diagnosis is by a medical physician through a combination of patient history, physical examination, and specialized diagnostic tests. Get to know the significant symptoms of a hiatal hernia now.
1. Regurgitation of Food
A hiatal hernia is diagnosed through specialized x-rays, called a barium swallow, or an endoscopy. A large percentage of hiatal hernias are not diagnosed due to their asymptomatic nature.
It is believed asymptomatic hiatal hernias may have been present since birth, potentially occurring in individuals with a naturally widened opening. A strong symptom of a hiatal hernia is the regurgitation of food.
Undigested or partially digested food in the stomach can remain in the area that herniates upwards. This forces the food up and into the esophagus, thus causing regurgitation. The risk of the regurgitation of food increases with the size of the hiatal hernia.
But, the most likely time food regurgitates is when an individual lays down quickly after eating. The primary complaint is of a bitter taste in the mouth, but a dentist may also see changes in a patient’s teeth.
2. Vomiting Blood
While the direct cause of a hiatal hernia is typically unknown, increased intra-abdominal pressure may contribute. Pregnancy, severe cough, obesity and straining during bowel movements are times during which a hernia may form due to increased intra-abdominal pressure.
Vomiting blood can be a scary indicator for hernia. Most of the time, the blood is actually a darkened brown or even black, described as coffee-colored.
Blood from a hiatal hernia is rarely red. Red or foamy red blood in vomit typically indicates blood from the respiratory tract, not a hiatal hernia.
This brown coloring is the chemical reaction of the blood mixed with stomach acids as well as the darkening which occurs as a result of old versus fresh blood. Left untreated, vomiting blood may lead to anemia.
By definition, anemia is a medical condition that develops when blood lacks enough healthy red blood cells or hemoglobin. Most commonly, anemia is a result of iron deficiency, which is the type of anemia seen with hiatal hernias.
3. Heartburn and Acid Reflux
There are four type classifications of hiatal hernias. Type I, a sliding hiatal hernia, is the most common. It accounts for approximately ninety-five percent of all hernias.
Type II, also known as a paraesophageal hiatal hernia, accounts for five percent of all cases, but causes most of the complications. In this type of hernia, the herniated portion of the stomach can torsion, cutting off its blood supply.
This may lead to a serious infection if left untreated. A paraesophageal hernia is associated with heartburn and acid reflux as the dominant symptoms.
These symptoms are greatest immediately after a meal or at night when one lays flat. With a pH probe study, these hiatal hernias will have a higher than normal acid content which accounts for the symptoms.
Medications known as proton-pump inhibitors are often utilized to reduce stomach acid and symptoms of reflux. However, with the risks involved in a paraesophageal hiatal hernia, this type is most likely to require surgical correction.
4. Pain in The Chest or Abdomen
The structures involved in a hiatal hernia are all extensively innervated, have a good nerve supply, giving the potential for any one or more of them to generate pain.
While heartburn is a type of discomfort, the pain in the chest or abdomen from a hiatal hernia is more likely to be severe or intense. The pain is typically located behind the sternum or breast bone.
Its location, as well as the burning or heavy pain, may cause concern regarding a cardiac component to the pain. One distinguishing characteristic is that the pain itself increases after eating, or postprandially, and when lying down.
Cardiac pain does not typically change in intensity or character based upon any change in activity or function.
5. Trouble Swallowing
Trouble swallowing, also called dysphagia, occurs when a hiatal hernia causes an obstruction in the lower esophagus or stomach. This results in a delay in the emptying of stomach contents, resulting in dysphagia.
Trouble swallowing is very disconcerting, and individuals who struggle with it indicate significant anxiety surrounding the condition. Fear of choking is paramount. In most circumstances, complete obstruction does not occur as a result of a hernia.
However, if difficulty swallowing is persistently problematic, it may prompt a surgical repair. In this case, the hiatal hernia itself is surgically corrected.
The surgery may also include a component that stretches the esophagus to improve the propulsion of food. For any suspected hiatal hernia, proper evaluation is imperative.
A complete history, physical examination, and specialized diagnostic testing is the first step towards resolving a variety of symptoms stemming from a hiatal hernia.
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