Hiatal Hernia

• A hiatal hernia occurs when the

upper part of the stomach pushes
through an opening in the
diaphragm, and up into the chest. o rm
latf
This opening is called a n al
P
tio
esophageal hiatus or d uc
a
,E
diaphragmatic hiatus. a nis
h
h D
a
OR bdull
A
• A hiatus hernia or hiatal hernia is
the protrusion of the upper part
of the stomach into
the thorax through a tear or
weakness in the diaphragm.
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 Pathpysiology
• Normally, the esophagus or food tube passes down
through the chest, crosses the diaphragm, and
enters the abdomen through a hole intfothe rm
la
diaphragm called the esophageal hiatus. na
l P Just below
ti o
the diaphragm, the esophagusdujoins ca the stomach.
E
h,
• In individuals with hiatal Dhernias,
an
i s the opening of
lah
the esophageal hiatusdul(hiatal opening) is larger
Ab
than normal, and a portion of the upper stomach
slips up or passes through the hiatus and enter into
the chest.

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 Types Of Hiatal Hernia
There are 2 types of hiatal hernia.
 Sliding hiatal hernia:
• The sliding type, as its name
implies, occurs when the junction
between the stomach and o rm
Platf
esophagus slides up through the tional
ca
esophageal hiatus during , Ed
u
is h
moments of increased pressure Da n in
lah
the abdominal cavity. bd u l
A
• When the pressure is relieved, the
stomach falls back down with
gravity to its normal position.
• Approximately 90% of all hiatal
hernias are the sliding type.
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 Paraesophageal hiatal hernia
• Paraesophageal hiatal hernia:
• In paraesophageal hiatal there
o rm
is no sliding up and down. A Platf
n al
portion of the stomach atio
d uc
remains stuck in the chestish, E
an
cavity. ll ah
D
du
• These hernias remainAb in the
chest at all times.
• This type is less common.

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 Causes Of Hiatal Hernia
• Increased pressure within the abdomen caused by:
o Heavy lifting or bending over.
o Frequent or hard coughing.
o rm
o Hard sneezing. Platf
n al
o Pregnancy and delivery. ucatio
, Ed
o Vomiting. a nis h
D
ll ah
o Straining with constipation.
b du
A
o Obesity.
• Heredity.
• Smoking.
• Stress and Diaphragm weakness.
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 Signs & Symptoms
• Chest pain or pressure 
• Heartburn 
• Difficulty swallowing  o rm
latf
• Coughing  & Shortness of breath n al
P
atio
• Belching  ,E
d uc
h
• nis
Hiccups (sudden, involuntary
h Da contractions of the
lla
diaphragm muscle)Ab
d u

• Nausea & Vomiting

• Gastric reflux
• A sour or bitter taste in the mouth
• Abdominal discomfort.
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 Medical Diagnosis
• Various tests are used to diagnose a hiatal hernia, the
following tests are routinely used:
• Upright chest x-ray
rm
• Barium x-rays: Barium x-rays, also known Platf
o
as barium
al
swallow, are diagnostic x-rays incawhich tio
n barium is used to
u
diagnose abnormalities of the s h , Eddigestive tract, including
ni
hiatal hernias. ah Da
u ll
d
• Upper endoscopy: The Ab upper endoscopy (also known as
esophagogastroduodenoscopy or EGD) allows the doctor
to examine the inside of the patient's esophagus,
stomach, and duodenum (the first part of the small
intestine) with an instrument called an endoscope.
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 Treatment
• Medical treatment for hiatal hernia may include
prescription-strength antacids such
as lansoprazole (Prevacid), omeprazole or rabeprazole. rm
tfo
• When hernia symptoms are severe and a l Plachronic acid reflux is
involved, surgery is sometimes recommended, ti on
u ca
Ed
• The surgical procedure used isish called Nissen fundoplication.
,
Dan
• In fundoplication, the gastric
ll ah fundus(upper part) of the
u
stomach is wrapped, Aorbd plicated, around the inferior part of
the esophagus, preventing herniation of the stomach
through the hiatus in the diaphragm and the reflux of gastric
acid. The procedure is now commonly
performed laparoscopically.
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 Complications
• Dysphagia.
• Esophagitis.
o rm
• Gastroesophageal reflex. Platf
n al
• tio
Infection or bleeding. d uc
a
h ,E
• Damage of the internal Dorgan an
is e.g. heart, lungs etc.
l ah
• Strangulation. b du
l
A
• Heart burn.

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 Nursing Interventions
• Prepare the patient for diagnostic tests, as needed.
• Administer prescribed antacids and other medications
o rm
• To reduce intra-abdominal pressurel Pland atf prevent
na
aspiration, have the patient sleep cati in
o
du
a reverse Trendelenburg position withi s h,
E the head of the
a n
bed elevated. ah
D
u ll
d
• Assess the patient’sAresponse to treatment.
b

• Observe for complications, especially significant

bleeding, pulmonary aspiration, or incarceration or
strangulation of the herniated stomach portion.
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 Cont….
• After endoscopy, watch for signs of perforation such as falling
blood pressure, rapid pulse, shock, and sudden pain caused
by endoscope. o rm
Platf
• To enhance compliance, teach the patient n al about the disorder.
o
Explain significant symptoms, diagnostic cati tests, and prescribed
d u
, E
treatments. nis
h
Da
• Review prescribed medications,ll ah explaining their desired
d u
Ab
actions and possible adverse effects.
• Teach the patient dietary changes to reduce reflux.
• Encourage the patient to delay lying down for 2 hours after
eating. 

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