why does hiatal hernia cause chest pain
Any time an internal body part pushes into an area where it doesn't belong, it's called a. The hiatus is an opening in the diaphragm -- the muscular wall separating the chest cavity from the. Normally, the
(food pipe) goes through the hiatus and attaches to the. In a (also called hiatus hernia) the bulges up into the chest through that opening. There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus). In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia. The paraesophageal hernia is less common, but is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become "strangled," or have its supply shut off. Many people with hiatal hernia have no symptoms, but others may have related to gastroesophageal reflux disease, or.
Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia. People with may experience that can easily be confused with the pain of a. That's why it's so important to undergo testing and get properly diagnosed. What Causes a Hiatal Hernia? Most of the time, the cause is not known. A person may be born with a larger hiatal opening. Increased pressure in the abdomen such as from, or straining during may also play a role. Who Is at Risk for Hiatal Hernia? Hiatal hernias occur more often in women, people who are, and people older than 50. How Is a Hiatal Hernia Diagnosed? A hiatal hernia can be diagnosed with a specialized X-ray (using a ) that allows a doctor to see the esophagus or with. By itself, a hiatal hernia causes no symptoms, and most are found incidentally when a person has a chest X-ray or abdominal X-rays (including upper GI series, and CT scans, where the patient swallows barium or another contrast material).
It also is found incidentally during gastrointestinal endoscopy of the esophagus, stomach and duodenum (EGD). Most often if symptoms occur, they are due to gastroesophageal reflux disease (GERD) where the digestive juice containing acid from the stomach moves up into the esophagus. The stomach is a mixing bowl that allows food and digestive juices to mix together to begin the digestive process. The stomach has a protective lining that prevents acid from eating away at the stomach muscle and causing inflammation. Unfortunately, the esophagus does not have a similar protective lining. Instead, it relies on the lower esophageal sphincter (LES), a band of muscle located at the junction of the stomach and esophagus, and the muscle of the diaphragm surrounding the esophagus to act as a valve to prevent acid from refluxing from the stomach into the esophagus. Moreover, to the LES, the normal location of the stomach and esophageal junction within the abdominal cavity is important in keeping acid where it belongs.
There is increased pressure within the abdominal cavity compared to the chest cavity, particularly during inspiration which would normally cause the acid and contents from the stomach to reflux back into the esophagus, but the combination of pressure exerted within the lowermost esophagus from the LES, and the muscle of the diaphragm create a zone of higher pressure that keeps stomach acid in the stomach. In the situation of a sliding hiatal hernia, the GE junction moves above the diaphragm and into the chest, and the portion of the higher-pressure zone due to the diaphragm is lost. Acid is allowed to reflux back into the esophagus causing inflammation of the lining of the esophagus and the symptoms of gastroesophageal reflux disease (GERD). : or burning, waterbrash, the rapid appearance of a large amount of saliva in the mouth that is stimulated by the refluxing acid Symptoms usually are worse after meals, and may be made worse when lying flat.
The symptoms may resolve with sitting up or. In some patients, reflux into the lower esophagus sets off nervous reflexes that can cause a or even spasm of the small airways within the lungs ( ). A few patients may reflux acid droplets into the back of their throat. This acid can be inhaled or aspirated into the lung causing spasms, or repeated infections of the lung including and. This may occur in individuals of all ages, from infants to the elderly. Fortunately, this is very uncommon. Most paraesophageal hiatal hernias have no symptoms of reflux because the GE junction remains below the diaphragm, but if the hernia is large, the way the stomach rotates into the chest, there is the possibility of volvulus of the stomach in which the stomach twists upon itself. Fortunately, paraesophageal hernias are relatively uncommon. Nevertheless, volvulus of the stomach is a surgical emergency and causes difficult, painful swallowing, chest pain, and vomiting.
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