A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 2-month-old infant is brought to his pediatrician because of recurrent episodes of vomiting. Specifically, his parents say that he starts to vomit as soon as he is laid down after feeding. He was born at full term and had no complications in the perinatal period. Contrast radiograph reveals part of the stomach is within the thoracic cavity. Which of the following symptoms would most likely be experienced if this patient's condition presented in an adult?
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A
CholecystitisIncorrect. Cholecystitis is biliary disease unrelated to hiatal hernia; it would not be caused by gastric herniation through the diaphragm.
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B
DyspneaIncorrect. Dyspnea can occur with very large paraesophageal or congenital diaphragmatic hernias, but is not the typical adult symptom; reflux/heartburn is far more common.
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C
PancreatitisIncorrect. Pancreatitis is not a recognized complication of hiatal hernia or sliding gastric herniation.
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D
RefluxCorrect. In adults, a hiatal hernia disrupts lower esophageal sphincter function and most commonly causes gastroesophageal reflux (heartburn, regurgitation).
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E
HematocheziaIncorrect. Hematochezia indicates lower GI bleeding (e.g., diverticular bleed, hemorrhoids); a hiatal hernia does not cause lower GI bleeding and most commonly presents with reflux symptoms.
↑ Tap an answer to reveal the reasoning
Answer: D. A 2-month-old infant with recurrent vomiting (worse when laid down after feeding) and a contrast study showing stomach within the thoracic cavity has a congenital diaphragmatic hernia or, more specifically given the chronic indolent course, a hiatal hernia (sliding type). In an infant, this allows reflux of gastric contents and causes positional vomiting.
In an ADULT, sliding hiatal hernias most commonly manifest as gastroesophageal reflux disease (GERD) symptoms: heartburn, regurgitation, dyspepsia. The lower esophageal sphincter is displaced above the diaphragm, disrupting its competence and allowing reflux of acidic gastric contents into the esophagus.
Key distinctions: cholecystitis is not typically caused by hiatal hernia. Dyspnea CAN occur in very large paraesophageal (type II-IV) hernias or with bowel/stomach in the thoracic cavity (true congenital diaphragmatic hernia like Bochdalek), but reflux is the more typical adult presenting symptom for the common sliding type. Pancreatitis is not a typical complication of hiatal hernia. Reflux is the best single answer for what an adult with this condition would experience.
**Why each option:**
**A.** Cholecystitis is biliary disease unrelated to hiatal hernia; it would not be caused by gastric herniation through the diaphragm.
**B.** Dyspnea can occur with very large paraesophageal or congenital diaphragmatic hernias, but is not the typical adult symptom; reflux/heartburn is far more common.
**C.** Pancreatitis is not a recognized complication of hiatal hernia or sliding gastric herniation.
**D.** Correct. In adults, a hiatal hernia disrupts lower esophageal sphincter function and most commonly causes gastroesophageal reflux (heartburn, regurgitation).