Diaphragmatic Hiatal (Hiatal

Hernia)

- Hiatal Hernia is also called “hiatus” or

“diaphragmatic hernia”.
- A hiatal hernia occurs when the top of
the stomach gets displaced or herniates
through the diaphragm and up into the
chest cavity.
 Hiatal Hernia: Types

Type 1 :(Sliding type)

Most Common (95%)
Gastroesophageal junction becomes displaced
upwards

Type 2: (Paraesophageal hiatal hernia)

Parallel migration of part of the stomach in relation
to the esophagus

Type 3: Type 1 + Type 2

Type 4: Stomach and other internal organs migrate into

the chest
Etiology/Risk Factor
Causes: Congenital or Acquired
Risk Factor:
• Age
• Obesity
• Elevated intra-abdominal pressure
• Smoking
Clinical Manifestation Diagnostic Evaluation
• Heartburn
• Backward flow of swallowed food or liquids
into the mouth, called regurgitation
• Backflow of stomach acid into the esophagus,
called acid reflux
• Trouble swallowing
• Chest or abdominal pain
• Feeling full soon after you eat
• Shortness of breath
• Vomiting of blood or passing of black stools,
which could mean
 Nursing Diagnosis

1. Acute pain related to insistent pressure on the hiatus muscles as

evidenced by patient verbalization of sharp pain in the upper abdominal
area
2. Impaired Swallowing related to function changes as evidenced by chest
pain or inflammation process
3. Ineffective Breathing Pattern related to elevated pressure on the
diaphragm leading to impaired respiratory function as evidenced by
shortness of breath
4. Risk for ineffective tissue perfusion related to impaired blood flow due
to the herniated tissues potential to cause obstruction or strangulation
Management:
• PHARMACOLOGY
• Antacids that neutralize stomach acid.
- Antacids, such as (Aluminum hydroxide gel,
Calcium carbonate, Magnesium hydroxide).
• Medication to reduce acid production.
- known as H-2-receptors blockers- including;
cimetidine (Tagamet HB), famotidine (Pepcid AC),
and nizatidine (Axid AR).
• Medication that block acid production and
heal the esophagus.
- known as proton pump inhibitors
Surgical Management
Laparoscopic Nissen Fundoplication
Nursing Intervention:
 Prepare the patient for diagnostic tests,
as needed.
 Administer prescribed antacids and other
medications as ordered
 To reduce intra-abdominal pressure and
prevent aspiration, have the patient sleep
in a reverse Trendelenburg position with
the head of the bed elevated.
 Assess the patient’s response to
treatment.
 Observe for complications, especially
significant bleeding, pulmonary
aspiration, or incarceration or
strangulation of the herniated stomach
• After endoscopy, watch for signs of Health Teaching:
perforation such as falling blood
pressure, rapid pulse, shock, and  Avoid heavy lifting to prevent strain on
sudden pain caused by endoscope. the diaphragm.
• Encourage the patient to delay lying  Maintain a healthy weight to reduce
down for 2 hours after eating pressure on the diaphragm.
 Follow proper body mechanics to
prevent hernia aggravation.
 Eat smaller, frequent meals to avoid
overloading the stomach.
 Quit smoking, as it can weaken the
diaphragm.
 Report any new or worsening symptoms
promptly to your healthcare provider.
References
• Lord KA, Lippincott J. Hiatal hernia. In: Ferri FF, ed. Ferri's Clinical Advisor 2023. Philadelphia, PA: Elsevier; 2023:749.e2-749.e5.
• Yates RB, Oelschlager BK. Gastroesophageal reflux disease and hiatal hernia. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of