Unit 3 HIATAL HERNIA

Question 1

HIATAL HERNIA “diaphragmatic hernia”: Definition –

Answer 1

condition in which lower portion of the esophagus and a portion of the stomach move into the thoracic cavity through hiatus in diaphragm

Question 2

HIATAL HERNIA “diaphragmatic hernia”: Etiology

Answer 2

• Muscle weakness associated with
• Aging (elderly are more prone to hiatal hernias)
• Trauma-Blunt force trauma
• Obesity – places extra intra abdominal pressure
• Pregnancy – places extra intra abdominal pressure
• Surgery that causes damage to the area
• Anything that causes increase in intra abdominal pressure such as:
• Straining
• Lifting heavy objects
• Congenital weakness
• Coughing- chan cause a change in diaphragm
• Vomiting

Question 3

HIATAL HERNIA “diaphragmatic hernia”: Incidence

Answer 3

• Very common -Occurs in 30% of populationmore
• common in women
• 60% of the 60 years and older population
• In most of those cases there are no symptoms present

Question 4

HIATAL HERNIA “diaphragmatic hernia”: Symptoms

Answer 4

• Worse when pt is recumbent (lying down)
• Same as GERD –
• heartburn -regurgitation
• dysphagia -atypical chest pain
• sore throat -hoarseness
• water brash -odynophagia (painful swallowing)

Question 5

HIATAL HERNIA “diaphragmatic hernia”: Diagnosis

Answer 5

-UGI: Barium Swallow Study
Drink a chalky liquid with contrast
X ray under fluoroscope

-Endoscopy
visualizes changes in the esophagus
Can biopsy if needed

Question 6

HIATAL HERNIA “diaphragmatic hernia”: Treatment

Answer 6

• Medications – same as GERD
• Diet – same as GERD
• Lifestyle Modifications – same as GERD
• Surgery – Nissen Fundoplication – to keep tissue of the hernia from becoming strangulated (strangulation = necrosis)

Question 7

HIATAL HERNIA “diaphragmatic hernia”: Treatment: Medications

Answer 7

– same as GERD
Antacids
H2 receptor blockers
PPI’s 
Prokinetic drugs

Question 8

HIATAL HERNIA “diaphragmatic hernia”: Treatment: Diet

Answer 8

– same as GERD
Avoid anything that irritates
Common irritants include: alcohol, chocolate, citrus fruits, fatty foods, mints, coffee, caffeine

Question 9

HIATAL HERNIA “diaphragmatic hernia”: Treatment Lifestyle Modifications

Answer 9

– same as GERD
Smaller meals
Avoid lying down within 3 hours of eating
Elevate HOB
Smoking cessation
Lose weight
Avoid bending
Avoid tight clothing

Question 10

HIATAL HERNIA “diaphragmatic hernia”: Treatment: Surgery:

Answer 10

– Nissen Fundoplication – to keep tissue of the hernia from becoming strangulated (strangulation = necrosis)