Sweet Lea

[Guest guest]

Goodmorning Sweet Lea, and Dear Superman ~

Girl, I am so sorry you are so sick. I just wanted to share

some information with you that I have been researching.

I am having surgery June 3rd, they are gonna scope me

and do some biopsys because on the pet scan it looks

like I have cancer. You know me, I have been researching

my butt off trying to find anything else it could be other

than cancer. I want you to read this article, parts of it

sound so much like your symptoms.........I want you to ask

your doctors about this.........do you know if you have a

hiatle hernia ? ?

Bless your heart, you are in all my prayers, lots of love to

you and Superman ! Please keep me posted on how you are

feeling, and if you arent up to it, have Superman send me a note.

Love you bunches ! Dede

The Society of Thoracic Surgeons ,

http://www.sts.org/sections/patientinformation/esophageal/barretts/,

WHAT ARE THE SYMPTOMS OF BARRETT'S ESOPHAGUS?

Barrett's esophagus usually doesn't produce any specific symptoms on its own. People with chronic acid reflux problems may experience a variety of symptoms including heartburn, regurgitation of food, swallowing difficulties, excess belching, hoarseness, sore throat, cough, or breathing problems similar to asthma such as shortness of breath and wheezing. The columnar lining may become irritated and bleed, resulting in anemia (low blood count), or may develop ulcerations which cause pain, but these problems aren't common. Search Results: hiatle hernia ,

Paraesophageal Hiatal Hernia Text ,

http://www.ctsnet.org/doc/5948,

Symptoms: -produce few symptoms when small, which is why the defects are large when discovered -long history of postprandial distress/discomfort -substernal fullness and belching -true dysphagia uncommon -absence of heartburn/esophagitis -pulmonary complications are common: recurrent pneumonia; chronic atelectasis; dyspnea classically after a large meal—from pleural space compression by the huge hernial sac -ulceration of the herniated stomach with resultant bleeding and anemia -incarceration, obstruction, torsion, gangrene, and perforation -most feared and lethal complication is gastric volvulus with strangulation which usually occurs post-prandially—this is a true surgical emergency if the stomach cannot be decompressed. Almost 30% of paraesophageal hernis present in this fashion. The stomach becomes twisted and angulated in its midportion just proximal to the antrum. Most prominent manifestation is the inability to swallow or regurgitate. -Borchardt’s triad: chest pain, retching but unable to vomit, and inability to pass a nasogastric tube indicate gastric volvulus

Diagnosis/Therapy

-CXR--retrocardiac air-fluid level -Barium Swallow to show an intrathoracic upside down stomach; look for signs of peptic esophagitis/position of GE junction -Technical points:

antireflux procedure—routinely vs. those with signs of peptic esophagitis surgical approach—transthoracic [ease of hernial sac dissection and esophageal mobilization when necessary] vs. abdominal [placement of a gastrostomy tube] -Technique—principals of repair are reduction of the hernia and its contents to the abdominal cavity along with repair of the defect -mobilize esophagus; GE junction below diaphragm -narrow the hiatus posteriorly first until tip of finger can be admitted -fix stomach below the diaphragm (Hill repair—stomach fixed to median arcuate lig) -+/- Nissan fundoplication -gastrostomy -resection for gangrene/perforation

Results

-elective repair has ~1% mortality -emergent procedures (volvulus) has ~15% mortality -long term results are generally excellent whether or not an anti-reflux procedure is performed

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