Hiatal Hernia

Question 1

What is a Hiatal Hernia?

Answer 1

A portion of the stomach protrudes upward through the esophageal hiatus and into the thoracic cavity

Question 2

Two Types

Answer 2

• Type 1: Sliding Type (most common)
• Type 2: Rolling type

Question 3

Sliding Hernia

Answer 3

• Usually from wear and tear after the age of 50
• Strictures and Schatzki’s rings present
• Development of cameron lesions (erosions or ulcers by the diaphragmatic hiatus)

Question 4

Rolling Hernia

Answer 4

• Paraesophageal
• Anatomical defect that causes improper anchoring to the stomach below the diaphragm

Question 5

Risk Factors

Answer 5

• Lack of dietary fiber
• Unnatural sitting positions that cause straining
• Age
• Obesity, pregnancy, and smoking

Question 6

Type 1 Hernia Manifestations

Answer 6

• Heartburn
• Regurgitation
• Chest pain
• Dysphagia
• Belching
• GERD

Question 7

Type 2 Hernia Manifestations

Answer 7

• Feeling full after eating
• Feeling breathless after eating
• Feeling of suffocation
• Chest pain (angina)
• Increased symptoms when lying flat
• GERD

Question 8

Diagnostics

Answer 8

• Upper abdominal X-Ray
• Endoscopy
• Barium swallow with fluoroscopy (most specific test)
  EGD (views esophagus and stomach lining)

Question 9

Medications

Answer 9

• Antacids (neutralize stomach acid)
• H receptor agonists (acid production is decreased)
• Proton Pump Inhibitors (decrease acid production)
• Pro-kinetic meds (gastric emptying is increased (REGLAN))

Question 10

Surgical

Answer 10

• Herniotomy (removal of herniated sac)
• Herniorrhaphy (repaid of hiatal defect)
• Anti-reflux procedure
• Gasatropexy (attachment of stomach below the diaphragm)
• Reduction (Pushing hernia back into abdomen)

Question 11

Laparoscopic Nissen Fundoplication

Answer 11

Gold standard and is performed most often for hiatal hernia repair

Question 12

Type 1 Major Complications

Answer 12

GERD - occurs when exposure to the ES to the low pressure of the thorax
- Symptoms: coughing, obesity, ascites, and positional changes such as bending and lying supine

Question 13

Type 2 Major Complication

Answer 13

• Iron-anemia from ulcers and erosions
• Supra-diaphragmatic volvulus and obstruction are rare

Question 14

Nursing Diagnoses Ex.

Answer 14

• Impaired swallowing related to esophageal narrowing
• Anxiety related to impaired breathing

Question 15

Assessment findings

Answer 15

• Breathlessness, feelings of suffocation, chest pain, palpitations (resp. triggered by night time aspiration)
• Dysphagia: Strictures and lower esophageal mucosal rings. GERD.
• Heart burn, pain, regurgitations, eructation, Belching
• N&V
• Iron-deficiency anemia: chronic blood loss from erosions and ulcerations

Question 16

Nursing Actions

Answer 16

• Administer medications
• Position patient on right side and HOB elevated at least 30 degrees (promotes gastric emptying and elevating head promotes peristalsis)

Question 16

Patient Education

Answer 16

• Limit spicy/fatty foods, caffeine, chocolate, carbonated beverages, acidic foods, peppermint, alcohol, and certain medications like (calcium channel blockers)
• Wait 2 hours after eating to lay down (allow for gastric emptying)
• Wear non-restrictive clothing (decrease risk of increasing intra-abdominal pressure)
• Proper position after eating