Wk 2 Flashcards
What differentiates hiatal hernia (HH) from hiatal hernia syndrome (HHS)?
Class notes:The HHS is termed such when you don’t have the images to prove a HH exists, but the symptom picture matches (anxiety, fatigue, easy satiety, reflux, shallow breathing, chest pain, arrhythmia)
Functional gastroenterology: HH: gastric pathology in which the proximal stomach is herniated into the mediastinum. HHS: proximal stomach may only cause upward pressure against the diaphragmatic hiatus and not actually protrude into the chest
what are the common symptoms, diagnosis and treatment of hiatal hernia and HHS.
Sx: General/Emotional- anxiety, spare tire bulge, fatigue, mental dullness
GI- reflux, regurgitation, easy satiety, dysphagia, flatulence,
Cardiac- arrhythmia including A. Fib, chest pain
Resp- shallow breathing, stitching pain, tickling cough
Dx: endoscopy, CT, barrium swallow
Tx: visceral manipulation, functional breathing, NMT/MR at T10-11& C0, Nissen Gastric Fundoplication, Esophyx endoscopic fundoplication
What is the relationship between spinal levels and hiatal hernia syndrome?
T10-11 important to assess for fixation or disarticulation and C0
What are the various options for determining if a patient has hypochlorhydria?
Heidelberg testing (definitive), Gastric string test (screening), Riddler’s gastric acid point (left of xyphoid, functional), B/L weakness of pectoral major clavicular (functional), clinical picture, HCl challenge
What is the relationship between hypochlorhydria and gastroparesis? How could gastroparesis be life-threatening?
Gastroparesis: Partial paralysis of the stomach, causing delayed gastric emptying
-Most commonly associated with poorly managed DM
The effect of gastroparesis (the slowing of carbohydrate coming from the stomach) is especially dangerous for diabetics. Ex: They have injected a calculated dose of insulin with their meal but the transit time for that meal (carb absorption) has been delayed for 8-10 hours. This could cause a very dangerous level of hypoglycemia for the individual.
How does the temperature of food and drink affect orocecal transit time?
Cold: Slows transit
Hot: Enhance motility
What is the explanation for reflux causing symptoms (including heartburn) if a patient has hypochlorhydria?
Alkaline reflux contains achlorhydric gastric contents and/or bile and causes esophageal pain and/or esophagitis.
What are the available treatments for hypochlorhydria?
avoid overeating and excess fluids with meals
avoid excess fat and sugar
combine protein with vegetables, limit starch, sweet fruit alone
calm down before meals
enhance the cephalic phase of digestion
bitter herbs (gentian and scutellaria/ginger) or vinegar 10-20 min before meals
betaine HCl w pepsin
