Risk factors for the development of Hiatal hernias are those that lead to increased abdominal pressure. Which of the following complications can cause increased abdominal pressure?
A. Obesity
B. Volvulus
C. Constipation
D. Intestinal obstruction
Correct Answer: A. Obesity
Obesity may cause increased abdominal pressure that pushes the lower portion of the stomach into the thorax. 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 B: Volvulus occurs when a loop of intestine twists around itself and the mesentery that supports it, causing bowel obstruction. Symptoms include abdominal distension, pain, vomiting, constipation, and bloody stools. The onset of symptoms may be insidious or sudden. The mesentery becomes so tightly twisted that blood supply becomes cut off, resulting in an ischemic bowel.
Option C: The cause of constipation is multifactorial. The problem may arise in the colon or rectum or it may be due to an external cause. In most people, slow colonic motility that occurs after years of laxative abuse is the problem. In a few patients, the cause may be related to an outlet obstruction like rectal prolapse or a rectocele.
Option D: A bowel obstruction can either be a mechanical or functional obstruction of the small or large intestines. The obstruction occurs when the lumen of the bowel becomes either partially or completely blocked. Obstruction frequently causes abdominal pain, nausea, vomiting, constipation-to-obstipation, and distention. This, in turn, prevents the normal movement of digested products.
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