HIATAL HERNIA swallow is finished, the herniated part of the

stomach falls back into the abdomen.

A hiatal hernia occurs when the upper part of your
stomach bulges through the large muscle The primary cause of sliding hiatal hernia is
separating your abdomen and chest (diaphragm). muscle weakness in the esophageal hiatus (the
Your diaphragm has a small opening (hiatus) opening between the two domes of diaphragm
through which your food tube (esophagus) passes where the esophagus enters the abdominal cavity).
before connecting to your stomach. In a hiatal This may be due to aging process, congenital
hernia, the stomach pushes up through that muscle weakness, obesity trauma, surgery, or
opening and into your chest. prolonged increases in intra-abdominal pressure
like heavy lifting and obesity.
A small hiatal hernia usually doesn't cause
problems. You may never know you have one PARAESOPHAGEAL HERNIA
unless your doctor discovers it when checking for
Paraesophageal hernias are hernias in which the
another condition. But a large hiatal hernia can
gastroesophageal junction stays where it belongs
allow food and acid to back up into your
(attached at the level of the diaphragm), but part of
esophagus, leading to heartburn. Self-care
the stomach passes or bulges into the chest beside
measures or medications can usually relieve these
the esophagus. The paraesophageal hernias
symptoms. A very large hiatal hernia might require
themselves remain in the chest at all times and are
surgery.
not affected by swallows.
TWO TYPES OF HIATAL HERNIA
A paraesophageal hiatal hernia that is large,
 Sliding Hernia particularly if it compresses the adjacent
 Paraesophageal/Rolling Hernia esophagus, may impede the passage of food into
the stomach and cause food to stick in the
SLIDING HERNIA
esophagus after it is swallowed. Ulcers also may
Sliding hiatal hernias are those in which the form in the herniated stomach due to the trauma
junction of the esophagus and stomach, referred to caused by food that is stuck or acid from the
as the gastroesophageal junction, and part of the stomach. Fortunately, large paraesophageal hernias
stomach protrude into the chest. The junction may are uncommon.
reside permanently in the chest, but often it juts
CAUSES
into the chest only during a swallow. This occurs
because with each swallow the muscle of the A hiatal hernia occurs when weakened muscle
esophagus contracts causing the esophagus to tissue allows your stomach to bulge up through
shorten and to pull up the stomach. When the
your diaphragm. It's not always clear why this 1. MEDICATIONS
happens. But a hiatal hernia might be caused by: a) Antacids to relieve heartburn
b) Antiemetic to relieve nausea and vomiting
 Age-related changes in your diaphragm
EXAMPLES:
 Injury to the area, for example, after
o Vontrol (Diphenidol HCl)
trauma or certain types of surgery
o Anzemet (Dolasetron)
 Being born with an unusually large hiatus
o Marinol (Dronabinol)
 Persistent and intense pressure on the
o Kytril (Granisetron)
surrounding muscles, such as while
o Atarax (Hydroxyzine HCl)
coughing, vomiting, straining during a
o Vistaril (Hydroxyzine Pamoate)
bowel movement, exercising or lifting
o Antivert (Meclizine HCl)
heavy objects
o Reglan (Metochloporamide)
RISK FACTORS o Zofran (Ondansetron)
o Compazine (Prochlorperazine)
Hiatal hernia is most common in people who are:
o Phenergan (Promethazine HCl)
 Age 50 or older o Transderm – Scop (Scopolamine
 Obese Transdermal)
o Torecan (Thiethylpeazine Maleate)
CLINICAL MANIFESTATIONS
o Tigan (Trimethobenzamide HCl)
 Heartburns due to gastroesophageal reflux c) Histamine H2 receptor antagonists to
 Dysphagia (difficulty swallowing), suppress secretion of gastric acid.
odynophagia (painful swallowing) are due o Tagamet (Cimetidine)
to the compression of the esophagus. o Zantac (Ranitidine)
 Dyspnea due to compression of the lungs. o Axid (Nizatidine)
 Abdominal pain due to compression of the o Pepcid (Famotidine)
protruding portion of the stomach. d) Proton pump inhibitors to suppress gastric
 Nausea and vomiting due to stimulation of acid secretion
sensitive structures in the stomach. o Nexium (Esomeprazole)
 Gastric distention, belching, flatulence due o Prevacid (Lansoprazole)
to accumulation of gas in the stomach and o Prilosec (Omeprazole)
abdomen. This is caused by impaired o Protonix (Pantoprazole)
motility. o Aciphex (Rabeprazole)

COLLABORATIVE MANAGEMENT FOR HIATAL

HERNIA
  The client with hiatal hernia should avoid  Advise client to reduce body weight, if
drugs that lower LESS pressure. To prevent obese.
gastroesophageal reflux. The drugs to be  Advise client to promote lifestyle changes:
avoided by the client are as follows: o Elevate head of bed 6 to 12 inches
anticholinergics, Xanthine derivatives, for sleep
calcium – channel blockers and diazepam. o Avoid factors that increase
abdominal pressure like use of
NURSING INTERVENTIONS
constrictive clothing, straining at
 Relieve pain by administering antacids stool, heavy lifting, bending,
 Modify diet. stooping, and vigorous coughing.
 High protein diet to enhance LES pressure o Avoid cigarette smoking. Smoking
and prevent esophageal reflux causes rapid and significant drop in
 Small frequent feedings to prevent gastric LES pressure.
distention. This also prevents further
SURGERY
protrusion of the stomach into the thoracic
cavity.  The surgical procedure for hiatal hernia is
 Instruct client to eat slowly and chew food NISSEN FUNDOPLICATION OR GASTRIC
proper WRAP-AROUND.
 Instruct client to eat slowly and chew food
DIAGNOSIS
properly. To reduce gastric motility.
 The client should avoid foods and beverages  X-ray studies
that decrease LES pressure like fatty foods,  Barium swallow
cola beverages, coffee, tea, chocolate and  Fluoroscopy
alcohol.
 The client should assume UPRIGHT
POSITION BEFORE AND AFTER EATING
FOR 1 to 2 HOURS. This prevents
protrusion of the stomach into the thoracic
cavity.
 Instruct client to avoid eating at least 3
hours before bedtime. To prevent night time
reflux.
 Instruct the client to avoid evening snacks.