Steps to be Taken for the Treatment of Hiatal Hernia

What is this Condition?

Hiatal hernia is a defect in the diaphragm that permits a portion of the stomach to pass through the diaphragm’s opening into the chest. The three types of hiatal hernia are:

 Sliding hernia - both the stomach and its connection with the esophagus slip up into the chest

Paraesophageal or “rolling” hernia - a part of the big curve of the stomach rolls through the defect in the diaphragm

Mixed hernia - includes features of both of the above.

Sliding hernias are by far the most common type. The risk of developing a hiatal hernia of any type increases with age and women have a higher risk than men.

What causes it?

Hiatal hernia is usually caused by weakened esophageal muscles due to old age or cancer, injury, certain surgical procedures or, possibly, an inherited flaw in the diaphragm. The weakened muscles allow parts of the esophagus and stomach to rise when abdominal pressure is increased. Normal pressure increases occur during bending, straining, coughing, extreme physical exertion, and when you wear tight clothing. Conditions that cause increased pressure include fluid accumulation, pregnancy, and obesity.

What are its Symptoms?

A sliding hernia may not produce any symptoms and, consequently, doesn’t require treatment. When symptoms occur, they typically reflect acid backup and include:

€¢ heartburn from 1 to 4 hours after eating that is aggravated by reclining, belching, and abdominal pressure, and may be accompanied by regurgitation or vomiting

High-chest pain due to backup of stomach acid, stomach distention, and spasm that is aggravated by reclining, belching, and abdominal pressure (more common after meals or at bedtime).

Symptoms that may reflect possible complications include:

€¢ difficulty swallowing due to acid backup into the esophagus, especially after consuming very hot or cold foods, alcoholic beverages, or a large meal

€¢ bleeding (mild or massive) caused by damage to the esophagus or stomach

€¢ severe pain and shock resulting from a trapped hernia (a large part of the stomach is caught above the diaphragm), which may perforate the stomach and requires immediate surgery.

Paraesophageal hernia rarely causes a backflow of stomach acid and therefore usually does not produce symptoms. Often, it is discovered during a barium swallow X-ray ordered for some other reason. Symptoms, when present, are subtle displacement or stretching of the stomach that may give the person a feeling of stomach or chest fullness that mimics angina. Although it has few symptoms, this type of hernia requires surgical treatment because it has a high risk of strangulation.

How is it Diagnosed?

The doctor will use a scope to inspect the esophagus and its muscles for abnormalities and may take a specimen to rule out cancer or other growths. Lab studies and procedures provide more information. For example, chest X-ray can reveal a large hernia, and a barium study may show the hernia as a pouch at the lower end of the esophagus. Other lab tests can confirm stomach acid reflux, bleeding, anemia, or blood in stools.

How is it treated?

Initial treatment focuses on relieving symptoms and preventing complications. The doctor will recommend changes in diet, prescribe drugs to strengthen the lower esophageal sphincter, and explain how positioning can ease discomfort. Also the person will be provided with a list of things to avoid, such as abdominal pressure (coughing, straining, bending), constrictive clothing, and smoking (stimulates gastric acid production). Other suggested treatments include using antiemetics, antacids, cough suppressants, and stool softeners, and losing any extra weight.

If these therapies fail or complications develop, surgery may be required. Most surgeons create an artificial closing mechanism at the end of the esophagus to create a barrier between the stomach and the chest.

 

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Pseudomembranous Enterocolitis

What is this Condition?

Pseudomembranous enterocolitis is an acute inflammation that damages the tissue of the small and large intestines. It usually affects the mucus coating but may extend into submucosa and, rarely, other layers of the intestine. Marked by severe diarrhea, this rare condition is generally fatal in 1 to 7 days from severe dehydration and from toxicity, peritonitis, or perforation.

What Causes it?

The exact cause of pseudomembranous enterocolitis is unknown, but Clostridium difficile may produce a toxin that may playa role in its development. It typically strikes people weakened by abdominal surgery or those receiving broad-spectrum antibiotics. The infection begins suddenly with lots of watery or bloody diarrhea, abdominal pain, and fever. Serious complications may follow this disorder, including severe dehydration, electrolyte imbalance, hypotension, shock, and perforated colon.

How is it Diagnosed?

The doctor may have difficulty making a diagnosis because onset of enterocolitis is sudden and creates an emergency situation. The doctor needs to know the patient’s history, but uses a rectal biopsy to confirm pseudomembranous enterocolitis. Stool cultures can identify C. difficile.

How is it Treated?

A person who is receiving broad-spectrum antibiotic therapy must immediately stop. The doctor usually prescribes orally administered Flagyl. Oral Vancocin is typically given for severe or resistant cases. A person with mild pseudomembranous enterocolitis may take anion exchange resins, such as Questran, to bind the toxin produced by C. difficile. The person must be protected from dehydration, hypotension, and shock.

 

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Crohn’s Disease

What is this Condition?

Crohn’s disease is an inflammation of any part of the digestive tract. The inflammation extends through the intestinal wall. Swelling caused by a blockage in the intestinal wall leads to inflammation, sores, narrowing of passages and, possibly, abscesses and fistulas (abnormal passages between body cavities).
The most common site is the end of the small intestine. It may affect nearby lymph nodes as well as the membrane that holds the small intestines. Mild cases are relieved by changes in diet and life­style.

What Causes it?

Crohn’s disease is most common in adults ages 20 to 40 and may run in families. Its exact cause is unknown. Some experts suspect allergies and other immune disorders or infection; others are investigating possible genetic links.

What are its Symptoms?

Symptoms depend on the location and size of the inflammation. The mild, yet persistent symptoms of chronic Crohn’s disease are most common and include diarrhea, pain in the lower right abdomen, excessive fat in the stools, weight loss, occasionally fatigue and, rarely, clubbing of the fingers. In a flare-up of Crohn’s disease, symptoms mimic those of appendicitis: steady, colicky, pain in the lower right abdomen, cramping, tenderness, release of gas, nausea, fever, diarrhea and, possibly, bloody stools. Complications can include intestinal obstruction, bowel-bladder fistulas, abscesses in the abdomen and around the anus or rectum, and perforation.

How is it Diagnosed?

Lab tests will show an increase in white blood cells and other imbalances. A barium enema X-ray and other X-ray studies may be used to check changes in the shape of the bowel. Also, the doctor may use a special scope to inspect for patchy areas of inflammation to rule out ulcerative colitis. However, biopsy (obtaining a tissue specimen for study) is the only way to confirm a diagnosis.

How is it Treated?

Initial treatment involves easing symptoms. For example, if the person is very sick, the doctor will order intravenous liquids and nutrients to rest the gastrointestinal tract and prescribe drugs to reduce inflammation, subdue the body’s immune system, and fight bacterial infection. Serious side effects may necessitate surgery to correct bowel perforation or massive bleeding. Only in the most severe cases is the diseased colon surgically removed.

What can a Person with Crohn’s Disease do?

The most helpful steps you can take involve making lifestyle changes: get more rest, restrict dietary fiber (no fruit or vegetables), and eliminate dairy products (for lactose intolerance). If stress is clearly an aggravating factor, consider getting counseling.

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Irritable Bowel Syndrome

What is this Condition?

Irritable bowel syndrome is a common condition marked by chronic or occasional diarrhea, alternating with constipation and accompanied by straining and abdominal cramps. Most people can control or eliminate this condition by avoiding the foods and activities that cause it.

What Causes it?

This problem with the way the digestive tract works is often linked to psychological stress. However, irritable bowel may be caused by disease, abuse of laxatives, food poisoning, colon cancer or, most probably, eating and drinking things that a person can’t tolerate.

What are its Symptoms?

Irritable bowel syndrome usually produces lower abdominal pain (often relieved by a bowel movement or passage of gas) and diarrhea during the day. These symptoms alternate with constipation or normal bowel function. Stools are often small and contain visible mucus. The person may have indigestion and bloating too.

How is it Diagnosed?

The doctor will ask about recent events in the person’s life, such as a stressful change that may interfere with his or her digestion. The doctor will also rule out other disorders, such as infections, colon cancer, and lactose intolerance. The exam may include using a scope to see into the intestine, a barium enema X-ray, rectal biopsy, and stool analysis for blood, parasites, and bacteria.

How is it Treated?

The doctor may recommend counseling if the person needs to learn about the relationship between stress and illness. Strict dietary restrictions aren’t necessary, but the person can pinpoint foods that are irritating and avoid them.

Rest and heat applied to the abdomen are helpful, as is judicious use of sedatives, such as Barbita, and antispasmodics. However, with continued use, a person could become dependent on these drugs. If the cause of irritable bowel syndrome is chronic laxative abuse, the individual can learn other methods to achieve regularity.

What can a Person with Irritable Bowel Syndrome do?

While you work on discovering what foods to avoid, investigate the value of increased bulk in your diet to avoid laxatives. Getting help with the stress in your life may be the best way to avoid dependence on sedatives or antispasmodics.

Finally, even though you may solve your immediate problem, get regular checkups because irritable bowel syndrome is associated with a higher-than-normal chance of diverticulitis and colon cancer. If you are over age 40, get an annual sigmoidoscopy and rectal exam to be safe .

 

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