- Part of stomach pushes upward through diaphragm.
- Occurs more often in women.
- Most common in people who are age 50 and up.
Causes of Hiatal Hernia
- Muscle weakness in the esophageal hiatus.
- Due to aging process.
- Congenital muscle weakness
- Stress
- Obesity - most common cause
- Poor seated posture (slouching)
- Trauma
- Prolonged increases in intraabdominal pressure like heavy lifting.
Types of Hiatal Hernia
- Sliding Hiatal Hernia
- Protrusion of esophagogastric junction into thoracic cavity and back into the abdominal cavity in relation to position changes.
- Also known as Axial Hernia
- Most common type of Hernia
- Paraesophageal Hernia
- Protrusion of the fundus of the stomach and the greater curvature into the thorax next to the esophagus.
- Also known as Fixed Hiatal Hernia.
- Due to anatomic defect.
Clinical Manifestations
- Heartburns dur to gastroesophageal reflux
- Many people have no symptoms.
- Dyshagia (difficulty of swallowing)
- Odynophagia (painful swallowing)
- Dyspnea due to compression of the lungs.
- Abdominal pain due to compression of the protruding portion of the stomach.
- Nausea and vomiting due to stimulation of sensitive structures in the stomach.
- Gastric Distention, belching, flatulence due to accumulation of gas in the stomach and abdomen due to impaired motility.
Diagnostic Methods
- Barium Swallow
- Radiographic Studies
- Blood Testing
- Flouroscopy
- Endoscopy
- Manometry
Medical Management
- Antacids to relieve heartburns.
- Antiemetics to relieve nausea and vomiting.
- Histamine h2 receptor antagonist to suppress secretion of gastric acid.
- Proton Pump Inhibitors to suppress gastric acid secretion.
- Surgery - surgical procedure for hiatal hernia is Nissen Fundopolication or Gastric Wrap-Around.
Nursing Interventions
- Relieve pain by administering antacids as ordered by the physician.
- High protein diet to enhance lower esophageal sphincter pressure and prevent esophageal reflux
- Small frequent feeding to prevent gastric distention. Also prevents further protrusion of the stomach into the thoracic cavity.
- Instruct patient to eat slowly and chew food properly to reduce gastric motility.
- The client should avoid foods and beverages that decreases lower esophageal sphincter pressure like fatty food, citrus fruits, cola beverages, spicy foods, coffee, tea, chocolate and alcohol.
- The patient should assume upright position before and after eating for 1 to 2 hours to prevent protrusion of the stomach into the thoracic cavity.
- Instruct the patient to avoid eating at least 3 hours before bedtime to prevent night time reflux.
- Instruct patient to avoid evening snacks
- If obese, instruct patient to lose weight.
- Advise patient to promote lifestyle changes.
- Instruct patient to elevate head of bed 6 to 12 inches for sleep.
- Instruct patient to avoid factors that increases abdominal pressure like bending over, straining at stool, heavy lifting and vigorous coughing.
- Instruct patient to avoid smoking. Smoking decreases lower esophageal pressure.
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