Which of the following conditions can cause a hiatal hernia?
A. Increased intrathoracic pressure.
B. Weakness of the esophageal muscle.
C. Increased esophageal muscle pressure.
D. Weakness of the diaphragmatic muscle.
Correct Answer: D. Weakness of the diaphragmatic muscle.
A hiatal hernia is caused by weakness of the diaphragmatic muscle and increased intra-abdominal—not intrathoracic—pressure. This weakness allows the stomach to slide into the esophagus. The esophageal supports weaken, but esophageal muscle weakness or increased esophageal muscle pressure isn’t a factor in hiatal hernia. A hiatal hernia is a medical condition in which the upper part of the stomach or other internal organ bulges through an opening in the diaphragm.
Option A: The diaphragm is a muscular structure that assists in respiration and has a small opening, a hiatus, through which the esophagus passes prior to connecting to the stomach. This is called the gastroesophageal junction (GEJ). In a hiatal hernia, the stomach pushes through that opening and into the chest and compromises the lower esophageal sphincter (LES).
Option B: Hiatal hernias may be congenital or acquired. There is an increased prevalence in older people. It is believed that muscle weakness with loss of flexibility and elasticity with age predisposes to the development of a hiatal hernia. This may cause the upper part of the stomach to not return to its natural position below the diaphragm during swallowing.
Option C: Other predisposing factors have been identified, such as elevated intra abdominal pressure. This typically is a result of obesity, pregnancy, chronic constipation, and chronic obstructive pulmonary disease (COPD). Trauma, age, previous surgeries, and genetics can also play a role in the development of a hiatal hernia.
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