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Woman with recurrent vomiting


Clinical introduction A 69-year-old woman presented to the ED with a chief complaint of recurrent vomiting for 3 weeks. She was afebrile, blood pressure was 100/67 mm Hg, HR was 114/min, RR was 19/min and oxygen saturation was 98%. On physical examination, she had mild epigastric tenderness without guarding. Blood tests were normal except for hyponatraemia of 128 mmol/L and hypokalaemia of 2.7 mmol/L. The ECG demonstrated sinus tachycardia with first-degree atrioventricular block. Chest radiograph posteroanterior view (CXR) was performed (figure 1).

Figure 1

Chest radiograph posteroanterior view. The patient presented to the ED with a complaint of recurrent vomiting for 3 weeks.

Question Due to continuous vomiting of this patient, which of the following is the most appropriate management?

  1. Abdominal ultrasonography.

  2. Chest and abdominal CT.

  3. Barium swallow.

  4. Oesophagogastroduodenoscopy (EGD).

For answer see page 02

For question see page 01

  • hiatal hernia
  • paraesophageal hiatal hernia (PEH)
  • chest radiograph
  • computed tomography
  • laparoscopic repair

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