Suggest Treatment For Painful Hiatal Hernia

Brief Answer:
Need further ENT and GI evaluation.

Detailed Answer:
Hi XXXXXXXX ! Good morning. I am Dr Shareef, a general surgeon answering your query.

Although it might need a personal physical examination with related investigations to arrive at a definitive cause for the bleeding , we have to rule out a bleed from the esophagitis resulting from your hiatal hernia which might have regurgitated and come out from your nose with the clots during your sleep. But in this case you should have also got similar discharge from your oral cavity as well. The other reason could be a independent bleed from your nostrils without any relationship to the hiatal hernia.

If I were your family physician, after a physical examination ( specially record your blood pressure to rule out elevated blood pressure giving rise to such bleeding from the nose) and basic investigations like a complete blood count, clotting profile and a routine blood sugar, I would consider referring you to a ENT specialist and a gastro enterologist for a possible endoscopic evaluation of your GI tract for a definitive diagnosis and management of your problem.

Till then I might advise you go for a proton pump inhibitor, a gastric coating agent like sucralfate, not to blow or prick your nostrils till an ENT cause is ruled out and also might advise you the following for a symptomatic treatment of your hiatal hernia till you go for a definitive treatment :

1) Elevate the head end of the bed with two blocks on each side, so that the regurgitation does not occur while lying down, and the contents of esophagus and stomach flow down with gravity.
2) Some modification in your diet like more of roughage, enough liquids, avoidance of oily, fried, and fast food
3) Regular routine exercises like morning walk depending on your medical fitness and also to reduce your weight if overweight.

I hope this information would help you in discussing with your family physician/treating doctor in further management of your problem. Please do not hesitate to ask in case of any further doubts.

Thanks for choosing health care magic to clear doubts on your health problems. I wish you an early recovery. Dr Shareef.

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Brief Answer:
Need to expedite the GI assessment.

Detailed Answer:
Hi XXXXXX ! Good to listen from you so soon.

Yes. The weight loss of this kind is no doubt worrying which could of course be due to extreme dieting or due to inability to consume proper food due to any reason. However, I would definitely like to investigate you further for this kind of weight loss and go for some more investigations like an ESR, a Mantoux test, which though non specific tests could help in corroborating with other findings in reaching at a diagnosis. And of course, I would definitely expedite your endoscopic assessment by the gastro-enterologist to rule out any other GI pathology. Last but not the least, you should completely avoid consumption of any alcoholic beverages if you do.

I hope this information could help you in solving your problem along with your treating doctor. Please do not hesitate to ask for any further doubts. All the best.

Dr Shareef.

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