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Mary Fowler, aged 68, presents to the emergency department, or ED, with vomiting and abdominal pain and distention.
Her symptoms worsened over the last 2 days, and she has been unable to keep food or liquid down over the last 24 hours.
Mary is diagnosed with a large incarcerated paraesophageal hiatal hernia, confirmed with an abdominal X-ray and computerized tomography, or CT scan.
She will be cared for in the ED while she awaits surgical repair of her hernia.
Underneath the diaphragm, the esophagus then connects with the stomach to form the gastroesophageal junction and the lower esophageal sphincter, or LES, a ring of muscles that opens to allow food and liquids into the stomach and closes to keep gastric contents from coming back up through the esophagus.
There are two main types of hiatal hernias.
The most common type is a sliding hernia, where the gastroesophageal junction slides up and down through the hiatus.
Likewise, anything that increases pressure inside the abdomen, like coughing, obesity, pregnancy, straining, or heavy lifting increases the risk of hernia development.
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