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.

Assessment

1. Maybe asymptomatic.
2. Patient may report feeling of fullness or chest pain resembling angina.
3. 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.
4. Severe pain or shock may result from incarceration of stomach in thoracic cavity with paraesophageal hernia.

Diagnostic Evaluation

1. Upper gastric intestinal series with barium contrast shows outline of hernia in esophagus.
2. Endoscopy visualizes defect and rules out other disorders, such as tumors or esophagitis.

Therapeutic Intervention

1. Elevate head of the bed 6 to 8 inches (15 to 20) to reduce nighttime reflux.

Pharmacologic Interventions

1. Antacids neutralize gastric acid and reduce pain.
2. 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.

Surgical Interventions

1. Gastropexy to fix the stomach in position is indicated if symptoms are severe.

Nursing Interventions

1. 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.
2. Advise the patient to report health care facility immediately at onset of acute chest pain – may indicate incarceration of paraesophageal hernia.
3. 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.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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