Hiatus Hernia

Hiatus: an opening
Hernia: protrusion of any part of the intestinal organ through the structure enclosing them


Hiatus Hernia is herniation of a portion of the esophagus through an opening or hiatus, in the diaphragm. It is also referred as diaphragmatic hernia & esophageal hernia. Hiatus hernia is common in older adults & occurs more frequently in women than in men.

Classification of Hiatus Hernia:

Sliding Hiatus Hernia:

Description: The junction of the stomach & esophagus is above the hiatus of diaphragm

  1. a part of the stomach slides through the hiatus opening in the diaphragm. It slides into the thoracic cavity when the patient is supine & usually goes back into the abdominal cavity when the patient is standing upright.

Para-esophageal or Rolling Hernia:

Description: The esophagus-gastric junction remains in the normal position but the fundus and the greater curvature of the stomach roll up through the diaphragm forming a pocket alongside the esophagus.


  1. Weakling of the muscles in the diaphragm
  2. Obesity
  3. Pregnancy
  4. Ascites
  5. Poor nutrition
  6. Congenital weakness (in rare cases)

Clinical features:

Sliding Hiatus Hernia:

  1. Heart burn (30-60 min after meal)
  2. Reflux
  3. Nocturnal attack Para-esophageal or Rolling Hernia:
  4. Feeling of fullness after eating
  5. Dysponea
  6. Anginal pain (worst at recumbent position)


  1. Hemorrhage
  2. Stenosis
  3. Ulceration
  4. Strangulation of Hernia
  5. Regurgitation with tracheal aspiration
  6. Oesophagitis


  1. Barium swallow
  2. Biopsy
  3. Gastro-esophagealscopy

Medical Management:

  1. Antacids
  2. Anti-secretory agents

Surgical Management:

  1. Hernioplasty
  2. Herniotomy
  3. Herniarraphy

Nursing Management:

Pre-operative care:

  1. Elimination of constricting garments
  2. Avoidance of lifting & straining
  3. Elimination of alcohol & smoking
  4. Elevation of bed on 4-6 inch blocks
  5. Try to prevent from reflux & tracheal aspiration
  6. If obese, the client is encouraged to lose weight
  7. Nurse should teach about NG tube that will be inserted during surgery
  8. Post-operative care:
  9. Maintains of fluids & electrolytes balance
  10. Preventive measures of the infection
  11. Observe for regurgitation & heart burn
  12. General Management:
  13. Normal diet can be resumed within 6 weeks
  14. Monitor TPR & BP
  15. Patient should be avoided for foods those causing gas problems
  16. Try to prevent the patient from gastric distention
  17. Food should be thoroughly chewed

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