HIATAL HERNIA

Medical-Surgical I
EACC Health Sciences Students
June 13, 2023
Group 4:
EACC2110758
EACC2100402
EACC2100499
Learning Objectives
After this presentation the learner will be able to:
● Define the pathophysiology of hiatal hernia
● Differentiate the two types of hiatal hernias
● Explain the causes of hiatal hernia
● Clinical management and interventions.
Introduction & Pathophysiology

● A Hiatal hernia occurs when a part of the stomach protrudes through the esophageal
hiatus.
● Two types of hiatal hernia:
1. Sliding/Direct: The upper segment of the stomach including the esophageal-stomach
junction slides through the opening in the diaphragm.
2. Paraesophageal/Rolling: The upper segment of the stomach moves into the chest
while the esophageal-stomach junction remains in its normal position.
Sliding/Direct & Paraesophageal Hiatal Hernia
Causes of hiatal hernia and why?
There are several causes of a hiatal hernia:
● Malformation: larger-than-normal esophageal hiatus that allows a portion of the
stomach to enter the thorax.
● Muscle weakness of esophageal hiatus: muscle weakening allows a portion of the
stomach to move into the thorax.
● Esophageal shortening: caused by tissue scarring from gastric acids.
● Obesity: increased pressure variations between thoracic and abdominal cavities
causes stomach protrusion into diaphragm.
Clinical Manifestations:
Small hiatal hernias are usually asymptomatic. The signs and symptoms are usually due to
reflux. Here are a few signs and symptoms and why they happen.
● Feeling of fullness, smothering, and suffocation after meals: occurs more with
paraesophageal hiatal hernia because part of the stomach is in the thorax. Eating
distends the stomach, leading to decreased ability of the lungs to breath.
● Anemia: bleeding of the hernia lining may occur with both types of hernias.
Clinical Investigation
Testing for hiatal hernia is usually done by barium test.
● Barium swallowing is used to detect a hiatal hernia.
● Keep the patient NPO for 6 hrs prior to the test.
● Barium preparation is in a milkshake form, which may cause nausea; serve cold to
make more palatable.
● The client must take a laxative afterward to ensure the elimination of the barium.
● If the barium is not expelled, it will harden and cause fecal impaction.
Another test for hiatal hernia is upper endoscopy. Where an endoscope is inserted through
the mouth into the esophagus to visualise the hernia.
Positive Barium Test for Hiatal Hernia & Endoscopy
Clinical Management & Treatment
● Surgical repair may be needed if symptoms persist after instituting dietary and
medical management. Surgery is more common for large paraesophageal hernias.
The most common technique is LNF (Laparoscopic Nissen Fundoplication)
● Patient teaching includes teaching the client to sit up after eating to keep the stomach
down.
● Lose weight if overweight or obese.
● Eat small frequent meals (4-6 meals/day) to reduce abdominal pressure.
● Avoid carbonated beverages which can increase stomach pressure.
● Avoid meals within 3 hrs of going to bed to reduce reflux caused by larger meals.
● Avoid spicy and high-acid foods which can irritate the esophageal lining.
● Avoid alcohol especially late at night before bedtime.
● Increase fluid intake to help wash gastric contents out of the esophagus.
Cont’d
● Discontinue NSAIDs, as ordered by the physician.
● Elevate the head of the bed 30 degrees or more to prevent reflux during sleep.
● Smoking cessation to improve pressure on LES.
● Avoid constrictive clothing since tight clothes increase intra-abdominal pressure.
● Medications: Over-the-counter antacids and acid reducers (e.g., H2 blockers, proton
pump inhibitors) can provide temporary relief from heartburn and acid reflux
symptoms associated with a hiatal hernia
● Avoid straining and heavy lifting: Straining during bowel movements or lifting heavy
objects can put strain on the abdominal muscles and exacerbate hiatal hernia
symptoms. Take care to avoid these activities or use proper lifting techniques.
● Manage stress: Stress can contribute to digestive issues and worsen symptoms of acid
reflux. Incorporate stress management techniques like exercise, meditation, deep
breathing exercises, or hobbies that help you relax.
Complications
● Strangulation: the hernia can become pinched causing it to lose blood supply.
Immediate surgical intervention is required.
● Esophagitis, esophageal ulceration: chronic reflux(GERD) causes irritation, and
inflammation.
● Barrett's esophagus: a precancerous condition, where the lining of the esophagus
changes and resembles the stomach’s lining.
Conclusion

Hiatal hernias are prevalent/relatively common and risk increases with age. It is advised to
change and adopt a relatively safe lifestyle such as no smoking, no drinking, and no eating
very spicy foods to decrease the chances and risk for hiatal hernias.
References:

Hurst, M. (2011) Medical-Surgical Nursing Review. McGraw-Hill/Appleton & Lange.

Hyun, J.J. and Bak, Y.T. (2011) “Clinical Significance of Hiatal Hernia,” Gut And Liver,

5(3), pp. 267–277. Available at: https://doi.org/10.5009/gnl.2011.5.3.267. Accessed

and Retrieved. June 13, 2023