Hiatal Hernia (Diaphragmatic Hernia)

• 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.