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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Could Prolonged Pain And Swelling In Upper Abdomen Indicate Hiatal Hernia?

Hello! I have been experiencing upper abdominal pain and massive swelling for several weeks. (ULQ) I suspect a hiatal hernia??? I was admitted to hospital in Feb, 2015 with a possible diagnosis of Pancreatitis; however when I was seen by a Gasterinterologist he diagnosed a bowel problem, I had a colonscopy which showed nothing abnormal and was sent home 5 days later. I am thinking of going to the local ER this a.m.. What do you suggest?
Mon, 27 Jul 2015
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General & Family Physician,  's  Response
You have not described the exact location of swelling and also the pattern of its development. It may be due to various causes. In hiatal hernia there would be a positive cough reflex. It means if you cough or if the abdominal pressure increases there is a thrust felt over the swelling. Pain is generally absent if there is no obstruction.
A upper abdominal swelling can be differentiated clinically whether its extraperitoneal or intraperitoneal in origin. You have not described if there is presence of any bowel disturbances like projectile vomiting, constipation, severe loss of apetite, black stool etc. Each of them has a great clinical significance in diagnosis the cause. Gastric outlet obstruction or pyloric ca may be a cause. There may be development of pseudopancreatic cyst. Its recommended to do an ultrasound which can help to lead a diagnosis.
If the problems persist you are adviced to visit a doctor. If ultrasound, endoscopy, MRI fail to get a diagnosis and you are facing same problems a diagnostic laparotomy may be performed.
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Could Prolonged Pain And Swelling In Upper Abdomen Indicate Hiatal Hernia?

You have not described the exact location of swelling and also the pattern of its development. It may be due to various causes. In hiatal hernia there would be a positive cough reflex. It means if you cough or if the abdominal pressure increases there is a thrust felt over the swelling. Pain is generally absent if there is no obstruction. A upper abdominal swelling can be differentiated clinically whether its extraperitoneal or intraperitoneal in origin. You have not described if there is presence of any bowel disturbances like projectile vomiting, constipation, severe loss of apetite, black stool etc. Each of them has a great clinical significance in diagnosis the cause. Gastric outlet obstruction or pyloric ca may be a cause. There may be development of pseudopancreatic cyst. Its recommended to do an ultrasound which can help to lead a diagnosis. If the problems persist you are adviced to visit a doctor. If ultrasound, endoscopy, MRI fail to get a diagnosis and you are facing same problems a diagnostic laparotomy may be performed.