Hernias

-Hiatal hernia Two types of hiatal hernias:

** Sliding hernia the upper stomach and gastroesophageal junction move upward into the chest and slide in and out of the thorax (most common). ** Paraesophageal hernia or rolling hernia, part of the greater curvature of the stomach rolls through the diaphragmatic defect next to the gastroesophageal junction. barium swallow (confirmatory); Endoscopy visualizes defect and rules out other disorders, such as tumors or esophagitis. These are a few diagnostic considerations. Cause: muscle weakening due to aging, congenital, trauma; mostly occurs due to age or because of increased intraabdominal pressure. Comonly asymptomatic; Patient may report feeling of fullness or chest pain resembling angina, if they do have symptoms. Pharmacologic Interventions Antacids neutralize gastric acid and reduce pain; If patient has esophagitis, give histamine-2 receptor antagonist (such as cimetidine or ranitidine) or proton pump inhibitor (such as omeprazole) to decrease acid secretion. Nursing Interventions: 1. Advise the patient about preventing reflux of gastric contents into esophagus by: Eating smaller meals to reduce stomach bulk. Avoiding stimulation of gastric secretions by omitting caffeine and alcohol, which may intensify symptoms. Refraining from smoking, which stimulates gastric acid secretions Avoiding fatty foods, which promote reflux and delay gastric emptying. Refraining from lying down for at least 1 hour after meals. Losing weight, if obese. Avoiding bending from the waist or wearing tight-fitting clothes.

2. Advise the patient to report health care facility immediately at onset of acute chest pain may indicate incarceration of paraesophageal hernia. 3. Reassure patient that he or she is not having a heart attack, but all instances of chest pain should be taken seriously and reported to the patients health care provider. **Complications: Ischemia can result from bloked blood flow from the hernia, requiring surgical intervention ASAP; Upper GI bleding; erosive esophagitis.