hiatial hernia and pud Flashcards
What is a hiatal hernia?
Herniation of part of the stomach into the esophagus through the opening in the diaphragm. Also called a diaphragmatic or esophageal hernia.
What are the two types of hiatal hernia?
- Sliding Hiatal Hernia 2. Paraesophageal (Rolling) Hiatal Hernia
What is a sliding hiatal hernia?
The junction of the stomach and esophagus moves above the diaphragm. The stomach slides through the hiatal opening when the patient is supine and returns when standing. (Most common type)
What is a paraesophageal (rolling) hiatal hernia?
The fundus and greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophagus. The esophagogastric junction stays in its normal position.
Why is an acute paraesophageal hernia a medical emergency?
It can cause strangulation, cutting off blood supply to the stomach.
What causes a hiatal hernia?
Structural changes (weakening of diaphragm muscles) occur with aging. Increased intra-abdominal pressure from obesity, pregnancy, ascites, tumors, intense physical exertion, or heavy lifting also contributes.
What are the signs and symptoms of a hiatal hernia?
Many are asymptomatic, but symptoms are similar to GERD, including heartburn, regurgitation, and dysphagia.
What are complications of a hiatal hernia?
GERD, esophagitis, bleeding from erosion, esophageal stenosis, ulceration of herniated stomach, strangulation, and aspiration from regurgitation.
What are the conservative treatments for a hiatal hernia?
Similar to GERD management: lifestyle changes, dietary modifications, weight management, avoiding triggers, and medications (PPIs, H2 blockers).
What is the goal of medical treatment for a hiatal hernia?
Reduce the hernia, provide acceptable lower esophageal sphincter (LES) pressure, and prevent movement of the gastroesophageal junction.
What is a herniotomy?
Surgical excision of the hernia sac.
What is a hergastropexy?
Surgical attachment of the stomach below the diaphragm to prevent re-herniation.
What are the laparoscopic surgical techniques for hiatal hernia?
Nissen or Toupet fundoplication – procedures that reinforce the lower esophageal sphincter by wrapping the stomach around the esophagus.
What is the goal of surgical treatment for a hiatal hernia?
To reduce the hernia, maintain adequate LES pressure, and prevent movement of the gastroesophageal junction.
What is an esophagram (barium swallow) used for in diagnosing a hiatal hernia?
It shows the protrusion of gastric mucosa through the esophageal hiatus.
How does an endoscopy help diagnose a hiatal hernia?
It provides visualization of the lower esophagus to assess the degree of mucosal inflammation or other abnormalities.
What other tests may be used to diagnose a hiatal hernia?
The same tests used for GERD, including esophageal manometry and pH monitoring.
What is peptic ulcer disease (PUD)?
Erosion of GI mucosa due to digestive action of HCl acid and pepsin. Can affect the lower esophagus, stomach, duodenum, and margins of a gastrojejunal anastomosis after surgery.
What are the two types of peptic ulcers?
Acute and Chronic
What characterizes an acute peptic ulcer?
Superficial erosion with minimal inflammation.
What characterizes a chronic peptic ulcer?
Erodes the muscular wall with formation of fibrous tissue. It may be present continuously for months or intermittently throughout life. (More common type)
What is the major risk factor for peptic ulcer disease?
H. pylori infection
What are the symptoms of a gastric ulcer?
- Discomfort high in the epigastrium 1-2 hours after meals - Pain described as burning or gaseous - Eating worsens pain if ulcer has eroded through mucosa - Earliest symptoms may be from serious complications like perforation
What are the symptoms of a duodenal ulcer?
- Pain 2-5 hours after meals - Burning or cramp-like pain in the midepigastric region or back - Food helps buffer acid, reducing symptoms temporarily
What are other common symptoms of peptic ulcers?
Bloating, nausea, vomiting, and early satiety (feeling full quickly).
What are “silent” ulcers?
Ulcers that do not cause pain or discomfort, often occurring in older adults and those taking NSAIDs.
What are nursing interventions for peptic ulcer disease?
- Adequate rest - Smoking and alcohol cessation - Stress management
What is the role of the nurse in surgical treatment for peptic ulcer disease?
- Provide preoperative and postoperative care. - Monitor for complications such as bleeding, infection, and nutritional deficiencies. - Educate the patient on dietary modifications and lifestyle changes.
What surgical procedure is done for gastric outlet obstruction?
Pyloroplasty (surgical enlargement of the pyloric sphincter) and vagotomy (cutting the vagus nerve to reduce acid secretion).
How is a perforated ulcer treated surgically?
Simple closure with an omentum graft to cover the perforation and prevent leakage.
What surgeries are done for ulcer removal or reduction?
Billroth I (gastroduodenostomy) and Billroth II (gastrojejunostomy) procedures remove part of the stomach and reconnect it to the small intestine.
What is a vagotomy?
Surgical cutting of the vagus nerve to decrease acid secretion in the stomach.
What is the most accurate procedure to determine the presence and location of a peptic ulcer?
Endoscopy – allows direct visualization of gastric and duodenal mucosa and collection of tissue specimens.
What is the purpose of tissue specimens taken during an endoscopy?
To check for H. pylori infection and rule out stomach cancer.
What tests identify an active H. pylori infection?
Urea breath test and stool antigen test.
What laboratory tests may be used to diagnose peptic ulcer disease?
- Complete blood count (CBC) - Liver enzyme tests - Serum amylase - Stool test for blood
What imaging or additional procedures may be done for PUD?
- Endoscopic ultrasound - Upper GI endoscopy with biopsy - History and physical assessment
What is the purpose of antibiotics in peptic ulcer treatment?
To eradicate H. pylori infection.
What is the most effective class of medications for reducing gastric acid secretion and promoting ulcer healing?
Proton pump inhibitors (PPIs) (e.g., omeprazole, pantoprazole).
What medications can be used as adjunctive therapy for PUD?
- H2-receptor blockers (e.g., ranitidine, famotidine) - Cytoprotective drugs (e.g., sucralfate) - Antacids
