Hiatal Hernia

• Hiatal Hernia

- Occurs when the lower part of the esophagus and/or with the upper portion of the stomach protrudes through the hiatus

- a.k.a diaphragmatic or esophageal hernia

- More often in women than men about ages 40-70

- Causes:

- Congenital weakness of hiatus

- Increase abdominal pressure: obesity, pregnancy, ascites, heavy lifting,tumors

- Clinical manifestations

- Heartburn

- Feeling of fullness

- Discomfort, pain

- Regurgitation

- Dysphagia, odynophagia

- Bleeding

- Diagnostics: Same as GERD

-

Management:

- Antacids

- H2 blockers

- Surgery

- Nissen fundoplication- transabdominal approach by wrapping of the fundus around the esophagus (360- degrees wrap)

- Hill Gastroplexy – anchoring stomach and esophagus to a ligament (180 degrees wrap)

- Belsey repair – transthoracic approach, attaches the anterior and lateral aspects of the stomach onto esophagus (270 degrees wrap)

- Nursing Management

- Diet: bland, high CHON, moderate CHO, low fat

- Small frequent meals and minimize fluid with meals

- Upright while and after meals

- Administer medications as ordered

- Prepare for surgery: NGT insertion

- Avoidance of carbonated and caffeinated beverages

- Avoidance of heavy lifting

- Importance of managing persistent cough

- Weight loss if indicated