74. A 45-year-old man presents with long-standing heartburn and dyspepsia. An X-ray film of the chest shows a retrocardiac, gas-filled structure. This patient most likely has which of the following conditions?
Answer: D Hiatal hernia
Hiatal hernia is a protrusion of the stomach through an enlarged esophageal hiatus in the diaphragm.
Two basic types of hiatal hernia are observed. In sliding hiatal hernias, an enlargement of the hiatus and laxity of the circumferential connective tissue allows a cap of gastric mucosa to move upward above the diaphragm.
Paraesophageal hiatal hernias are characterized by herniation of a portion of the gastric fundus alongside the esophagus through a defect in the diaphragmatic connective tissue membrane that defines the esophageal hiatus.
Symptoms of hiatal hernia, particularly heartburn and regurgitation, are attributed to the reflux of gastric contents, which is primarily related to incompetence of the lower esophageal sphincter. Classically, the symptoms are exacerbated when the affected person is recumbent.
Large herniations carry a risk of gastric volvulus or intrathoracic gastric dilation.
Boerhaave syndrome represents rupture of the esophagus as a result of vomiting.
Mallory-Weiss syndrome refers to mucosal laceration of the upper stomach and lower esophagus in the setting of severe retching.