What is Hiatal Hernia
- Is a protrusion of part of the stomach through the hiatus of the diaphragm and into the thoracic cavity.
- 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.
- Hiatal hernia results from muscle weakening caused by aging or other conditions such as esophageal carcinoma, trauma, or after certain surgical procedures.
- Treatment can prevent incarceration of the involved portion of the stomach in the thorax, which constricts gastric blood supply.
- Maybe asymptomatic.
- Patient may report feeling of fullness or chest pain resembling angina.
- Sliding hernia may cause dysphagia, heartburn (with or without regurgitation of gastric contents into the mouth), or restrosternal or substernal chest pain from gastric reflux.
- Severe pain or shock may result from incarceration of stomach in thoracic cavity with paraesophageal hernia.
- Upper gastric intestinal series with barium contrast shows outline of hernia in esophagus.
- Endoscopy visualizes defect and rules out other disorders, such as tumors or esophagitis.
- Elevate head of the bed 6 to 8 inches (15 to 20) to reduce nighttime reflux.
- 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.
- Gastropexy to fix the stomach in position is indicated if symptoms are severe.
- 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.
- Advise the patient to report health care facility immediately at onset of acute chest pain – may indicate incarceration of paraesophageal hernia.
- 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 patient’s health care provider.