Gastrointestinal System Disorders Q 160 - Gyan Darpan : Learning Portal
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Wednesday, 13 April 2022

Gastrointestinal System Disorders Q 160

Which of the following symptoms is common with a hiatal hernia?
    A. Left arm pain
    B. Lower back pain
    C. Esophageal reflux
    D. Abdominal cramping

Correct Answer: C. Esophageal reflux

Esophageal reflux is a common symptom of a hiatal hernia. This seems to be associated with chronic exposure of the lower esophageal sphincter to the lower pressure of the thorax, making it less effective. In a hiatal hernia, the stomach pushes through that opening and into the chest and compromises the lower esophageal sphincter (LES). This laxity of the LES can allow gastric content and acid to back up into the esophagus and is the leading cause of gastroesophageal reflux disease (GERD).

Option A: There is no left arm pain in hiatal hernia. The typical presentation leading to an evaluation for a hiatal hernia is gastroesophageal reflux disease (GERD). Patients typically complain of heartburn and sometimes regurgitation. While heartburn is the most common complaint, some patients will present with extra-esophageal symptoms such as a chronic cough or asthma.
Option B: Lower back pain is not associated with hiatal hernia. The presentation of regurgitation or extra-esophageal symptoms typically is a sign of disease progression. However, not all patients with regurgitation have GERD, and it is important to note if the regurgitated food is digested or undigested.
Option D: Abdominal cramping is not a symptom of hiatal hernia. Physical examination in patients with a hiatal hernia and GERD rarely helps confirm the diagnosis. The presence of abnormal supraclavicular lymph nodes in patients with heartburn and dysphasia may suggest esophageal or gastric cancer and is an important part of the evaluation.

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