Geriatrik Hastalarda Hiatal Herni Olgularına Tanısal Yaklaşım

Year 2014, Volume: 3 Issue: 2, 761 - 769, 01.04.2014

Alptekin Tosun İsmail Şerifoğlu

Abstract

Yaşlı bireylerde gastroözefagial reflü şikayeti varlığında hiatal herni düşünülmelidir. Hiatal herninin erken ve doğru tanısının konması tedaviyi yönlendirmesi açısından önemlidir. Bu yazımızda hiatal herni hastalarının tanısında öncelikle uygulanacak radyolojik yöntemi vurgulamayı amaçladık. 65 yaş üzeri 7 hastanın yapılan tetkiklerinde hiatal herni saptandı. Tüm hastaların ortak semptomu gastroözefagial reflü idi. Tüm olgulara abdominal ultrasonografi tetkiki uygulandı. 6 hastada Bilgisayarlı Tomografi ve 1 hastada ise Manyetik Rezonans Görüntüleme bir sonraki görüntüleme yöntemiydi. Hastaların 5’inde (%71) reflü şikayetinin yanında karın ağrısı, şişkinlik, kabızlık gibi diğer gastrointestinal sistem şikayetleri mevcuttu. 6 hastada (%86) göğüs ağrısı, çarpıntı ve hipertansiyon mevcuttu. Rutin abdominal ultrasonografi ile hiatal herni teşhis edilemedi. Radyolojik görüntüleme yöntemleri ile hiatal herniye ek olarak, 1 hastada (%14) Bochdalek hernisi, 2 hastada (%29) hiler kalsifiye LAP, 1 hastada (%14) karaciğerde hepatoselüler karsinom, 1 hastada (%14) sol sürrenal bez lojunda kalsifiye lezyon saptandı. 1 hastada (%14) aberran sağ subklavian arter varyasyonu mevcuttu. 3 hastada (%43) aort çapı normalden genişti ve 1 hastada (%14) aort anevrizmasına eşlik eden splenik arter anevrizması saptandı. Geriatrik hastalarda gastroözefagial reflü semptomu varlığında hiatal herni düşünülmelidir. Radyolojik görüntüleme yöntemi olarak abdominal ultrasonografi yerine Bilgisayarlı Tomografi tanıda ilk basamak olmalıdır.

Keywords

Hiatal Herni, Geriatrik Değerlendirme, Tanısal Görüntüleme

Hiatal Hernia In Geriatric Patients

Abstract

Hiatal hernia has to be considered in reflux symptoms of elderly individuals. The first step imaging technique in diagnosis is defined.  Hiatal hernia was diagnosed in 7 patients aged over 65. All patients had a common symptom of gastroesophageal reflux. All patients underwent abdominal ultrasonography examination. Computed Tomography was the next imaging method in 6 patients and Magnetic Resonance Imaging was the next method in 1 patient. 5 patients (71%) had gastrointestinal system symptoms such as abdominal pain, swelling, constipation with existence of reflux complaint. 6 patients (86%) had chest pain, palpitations, and hypertension. Hiatal hernia was not diagnosed by routine abdominal ultrasonography. Bochdalek hernia in 1 patient (14%), calcified hilar LAP in 2 patients (29%), hepatocellular carcinoma in 1 patient (14%), calcified lesion in the left adrenal gland region in 1 patient (14%) were existed to hiatal hernia in radiological imaging methods. 1 patient (14%) had an aberrant right subclavian artery variation. Aortic diameter was enlarged in 3 patients (43%) and 1 patient (14%) had an aortic aneurysm associated with splenic artery aneurysm. Hiatal hernia has to be in diagnosis with gastroesophageal reflux symptom in geriatric patients. CT should be the first radiological imaging method instead of abdominal ultrasonography.

Keywords

Hiatal Hernia, Geriatric Assessment, Diagnostic Imaging

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