Differentials
Angina pectoris
SIGNS / SYMPTOMS
Angina pectoris is brought on by exertion. Chest pain from paraesophageal hernia is usually related to eating or drinking.
INVESTIGATIONS
Cardiac exercise testing: stress test may be positive.
Gastroesophageal reflux disease (GERD)
SIGNS / SYMPTOMS
May be unable to distinguish between GERD and hiatal hernia on clinical findings.
INVESTIGATIONS
Upper gastrointestinal series: may show esophagitis (erosion, ulcerations, strictures) or Barrett esophagus; hiatal hernia absent.
Pneumonia
SIGNS / SYMPTOMS
With pneumonia, the patient may have fever, productive cough, pleurisy, and shortness of breath.
INVESTIGATIONS
A chest x-ray will demonstrate a pulmonary infiltrate.
Gastric outlet obstruction
SIGNS / SYMPTOMS
The patient may have vomiting of undigested food.
INVESTIGATIONS
An upper gastrointestinal series, abdominal CT scan, or both will demonstrate obstruction at the level of the pylorus.
Esophageal motility disorder
SIGNS / SYMPTOMS
Esophageal motility disorders are difficult to diagnose based on symptomatology alone.
INVESTIGATIONS
An upper gastrointestinal series may indicate gross esophageal dysmotility.
Manometry can provide precise measurements by which various motility disorders may be ruled in or ruled out.
Gastric atonia
SIGNS / SYMPTOMS
Gastric atonia is difficult to diagnose based on symptomatology alone.
INVESTIGATIONS
An upper gastrointestinal series will rule out hiatal hernia and may indicate gastric atonia. A nuclear gastric emptying study is useful for diagnosis of atonia, by showing a delay or absence of gastric emptying after ingestion of the nuclear tracer.
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