A hiatal hernia occurs when part of the stomach pushes upward into the chest through an opening in the diaphragm. While many individuals with a hiatal hernia experience no symptoms, others may encounter discomfort that does not require emergency care. Understanding when symptoms escalate to an emergency is important for knowing when to seek immediate medical attention.
What is a Hiatal Hernia?
A hiatal hernia forms when a portion of the stomach protrudes into the chest cavity through a small opening in the diaphragm, which is the muscle separating the abdomen from the chest. This opening, called the esophageal hiatus, normally allows the esophagus to pass through and connect to the stomach.
There are two primary types of hiatal hernias: sliding and paraesophageal. A sliding hiatal hernia, the more common type, occurs when the junction of the esophagus and stomach, along with a portion of the stomach, slides up into the chest. Paraesophageal hernias are less common but can be more serious, as a part of the stomach pushes up next to the esophagus.
Common Hiatal Hernia Symptoms
Many individuals with a hiatal hernia may not experience any symptoms at all. When symptoms do occur, they are frequently associated with gastroesophageal reflux disease (GERD), where stomach acid flows back into the esophagus. These common symptoms often include heartburn, particularly after eating.
Other typical symptoms include regurgitation of food or liquids, a sour or bitter taste, and difficulty swallowing, sometimes described as a lump in the throat. Individuals might also experience belching, bloating, or a feeling of fullness after consuming small amounts of food. These symptoms are usually managed with lifestyle adjustments or medication and do not require an emergency room visit.
Emergency Symptoms for Hiatal Hernia
Certain severe symptoms indicate a medical emergency and warrant immediate attention at an emergency room. A sudden, sharp, or worsening pain in the chest or abdomen is a significant warning sign. This type of pain can suggest a serious complication, such as the stomach or other abdominal organs twisting or rotating, which can cut off blood supply in a condition known as strangulation.
Persistent, forceful vomiting, especially if it contains blood that may resemble coffee grounds or bile, requires urgent evaluation. This can signal severe bleeding within the digestive tract or an obstruction. An inability to pass gas or have a bowel movement points towards a bowel obstruction, where the hernia blocks the digestive system, preventing the passage of food and gas.
Difficulty breathing or shortness of breath accompanied by pain indicates an emergency, as a large hernia can sometimes compress the lungs. Bluish discoloration of the skin (cyanosis) indicates a lack of oxygen. Symptoms of shock, such as a rapid heart rate, low blood pressure, dizziness, or confusion, also require immediate medical intervention. Any sudden and drastic change from usual discomfort to acute, severe distress should prompt an emergency room visit.
What to Expect at the ER for a Hiatal Hernia
Upon arrival at the emergency room for suspected hiatal hernia complications, medical professionals will conduct an initial assessment. This includes a physical examination to evaluate your symptoms and general condition. Imaging tests may also be performed.
Imaging tests may include X-rays to visualize the stomach’s position, or a CT scan for detailed cross-sectional images of the chest and abdomen. A barium swallow, where you drink a liquid containing barium to coat the esophagus and stomach, might also be used to highlight these structures on an X-ray. Blood tests may be ordered to check for signs of infection, bleeding, or organ damage. Depending on the findings, immediate interventions, such as pain management or fluid administration, may be initiated, and consultation with a gastroenterologist or surgeon will determine the appropriate course of action.