Hiatus Hernia

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

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