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

Definition:

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.

Etiology:

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)

Complications:

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

Investigation:

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