Hiatal Hernia

What does Hiatus mean?

anatomical gap in a structure

What does Hernia mean?

abnormal protrusion of an organ or body part outside of its normal cavity

What does Hiatus Hernia mean altogether?

part or all of the stomach pushes up through the diaphragm opening (esophageal hiatus) into the chest cavity.

What are the two types of Hiatal Hernia?

• Type 1 - sliding (95%)

• Typer 2 - rolling (<5%)

Risk factors associated with Hiatal Hernia?

age, obesity, pregnancy, smoking, trauma (seatbelt injury), an previous surgeries

Hiatal Hernia is most common in…

(women) adults over age 50

Signs and Symptoms associated with Hiatal Hernia?

1. Heartburn

2. Regurgitation

3. Acidic taste

4. Burping/Belting

5. Nausea/Vomiting

6. Nocturnal cough or wheeze

7. Chest pain

8. Dyspnea

9. Possible bowel obstruction

Complications associated with Hiatal Hernia?

• Gastroesophageal reflux

• Supra-diaphragmatic volvulus – twisting of the esophagus and/or stomach

Diagnostic tests for Hiatal Hernia?

• Upper abdominal x-ray

• Endoscopy

• Barium edema (swallow with flurorscopy)

• Esophagogastroduodenoscopy (EGD)

• pH monitoring (may be suggestive)

A Manometry evaluates what?

intraluminal pressure + contractibility

If a person is asymptomatic, what is the treatment?

NONE unless high anatomical risk

What is the lifestyle changes (treatment) are associated with Hiatal Hernia?

• losing weight

• small meals / avoid before bed

• stopping smoking and decreasing alcohol intake

• avoid tight clothing

If symptoms persist, what is the first line of meds used for a pt with Hiatal Hernia?

Proton Pump Inhibitors (“-azole”)

• Omeprazole, Lansoprazole

If symptoms persist, what OTHER meds are used for a pt with Hiatal Hernia?

• Antacids

  • Mylanta, Maalox

• H2-receptor antagonists

  • Tagamet, Pepcid, Zantac

Surgery for Hernia repair is typically for what kind of hernias?

large type 2

What surgical procedure is used to repair a hiatal hernia?

Nissen fundoplication

What are Proton Pump Inhibitors (Prevacid, Prilosec) used for?

to suppress gastric secretions

What are Antacids (Mylanta, Maalox) used for?

Neutralizes gastric acids

What are H2 Receptor Antagonists (Tagamet, Pepcid, Zantac) used for?

Decreases the amount of stomach acid produced

Hiatal hernia may be an _____ finding.

incidental

How should the nurse position a pt with Hiatal hernia?

Position patient SUPINE on RIGHT side

Placing pt Supine position on their right side promotes what?

promotes gastric emptying

When should the HOB be elevated?

After meals (at least 30 degrees)

What does elevating the HOB promote?

peristalsis & uses gravity to return gastric reflux from esophagus to stomach

Nursing Interventions (Education/Teaching) for pt with Hiatal hernia?

• limit foods

• eat meals 2 hours before lying supine/going to bed

• Maintain healthy weight

• Proper positioning after eating

• Postoperative education

• Exercise regularly

• Elevate HOB on 6-inch blocks

What foods should be limited in a pt with a Hiatal hernia?

• spicy/fatty foods

• caffeine, coffee

• chocolate

• carbonated drinks

• acidic foods

• peppermint

• alcohol

• tomatoes

• citrus fruits

What meds should be limited in a pt with a Hiatal hernia?

anticholinergics and Ca+ channel blockers