Beware of cute 90 year old females

The cutest 90 year old female came in to the clinic today for a regular appointment.  Little did I know about her and her cane. As I ran to the front desk to make sure she got her medications, I tripped over her cane sticking out in the hallway.  After catching myself from falling face forward into the ground, I glanced up to see who this fool was with their cane out in the hallway.  It was the cute 90 year old patient I just saw..she immediately responded with, "oh!  was that me??  Maybe I shouldn't be sticking my cane out in the hallway killing people..."  She was no longer cute, she was adorable and I couldn't stop laughing at this little old 90 year old lady getting so much amusement from tripping people with her cane.

Hereditary Hiatal Hernias

As a newly graduated physician assistant with just 2 months of clinical experience under my belt, my supervising physician Dr. M has made it part of his mission to teach me everything he knows about medicine.  I think that would take an eternity!  

Much like his own personalized residency program, he often asks me to do research, read articles, and to look up information about certain diseases, symptoms, causes, and treatment options.  He also encourages me to challenge and discuss with Benji those topics as well so that we can better serve our future patients.  He's a fantastic mentor.

The topic he wanted me to research today was hiatal hernias.  He told me that he has a hiatal hernia and so does his son, and he has an inkling it's hereditary.  

First off, a hiatal hernia is best described as a bulging of your stomach sticking out of the superior portion of the diaphragm.  The diaphragm is simply a sheet of muscle that separates your chest from your abdomen and helps you expand your lungs as you inhale.  And for all my Barry PA classmates out there...at what level does the esophagus puncture the diaphragm?  That's right! T-10....  Here's an illustration:

So, there are two types of hiatal hernias:  the sliding and paraesophageal hernia.  The latter is the more serious one because the strangulation of part of the stomach could lead to a decrease in blood supply which would result in intense stomach pain and possibly death of that part of the stomach.  Yikes!  Nonetheless, patients with one or the other could present asymptomatically and could also be easily misdiagnosed.  Normally, symptoms of hiatal hernia are very similar to heartburn symptoms which include chest pain especially after eating, difficulty swallowing and/or pain while bending forward or lying down.  Folks who are overweight  have a higher risk of developing this; however, anyone can develop this too.  

Cause of a hiatal hernia is unknown and anyone can get it.  It's important to understand that symptoms presenting as a hiatal hernia can be easily mistaken for heartburn.  Additionally, heartburn can easily be mistaken as a heart attack.  Each will present with chest pain and/or pain that can radiate to the jaw, shoulder or arm.  The only way we can really specifically diagnose hiatal hernia is with two things: a barium swallow or an esophagogastroduodenoscopy aka EGD.  Whew!  Say that five times fast.  Of course, the main important thing is to rule out the possibility of a heart attack first, then you can proceed on to those tests.  

If you are diagnosed with hiatal hernia, have no fear because there is treatment and ways to reduce the symptoms.  You can add proton pump inhibitors such as omeprazole, acid reducing medications such as pepcid, avoiding heavy meals, not lying down or bending after meals, and/or avoiding spicy, acidic, and heavy greasy foods.  There has also been proven benefit with weight reduction and smoke avoidance, as we all know smoking can cause a lot of bad things to our bodies.  Don't even get me started.

If all that fails, you can have a procedure done called the Nissen fundoplication which essentially reinforces the lower esophageal sphincter (a valve that keeps the acid in your stomach and not creepin' in your esophagus) and that can be done laparoscopically aka without cutting you halfway open.  

So back to the main question...are hiatal hernias hereditary?  Yes, they are.  A research article produced in 1999 in Northern Ireland proved that hiatal hernias are indeed hereditary.  So if your grandfather had a hiatal hernia, you may very well have one too.  They are very common, but the good thing is that they are treatable.