Stomach Disorders: Hiatal Hernia

Question 1

What is the esophageal hiatus?

Answer 1

• An opening in the diaphragm through which the esophagus and the vagus nerve pass.

Question 2

What is a hiatal hernia?

Answer 2

• This occurs when a portion of the upper part of the stomach bulges through the diaphragm

Question 3

What are some causes of hiatal hernia?

Answer 3

• Obesity
• Weakened diaphragm
• Pregnancy
• Ascites
• Tumors
• Heavy lifting

Question 4

What are the general s/s of hiatal herniation?

Answer 4

• Same as GERD w/ the exception of the rolling hernia which adds fullness and difficulty breathing to the list

Question 5

What are the two types of hiatal hernia?

Answer 5

• Sliding
• Paraesophageal (rolling)

Question 6

What is a sliding hiatal hernia?

Answer 6

• Occurs when the stomach and the lower part of your esophagus slide up into your chest through the diaphragm.
• This is the most common type of hiatal hernia

Question 7

What is a paraesophageal hernia?

Answer 7

• Occurs when the esophagus and stomach stay where they should be, but part of the stomach squeezes through the hiatus to sit next to the esophagus.
• This is more dangerous as:
  
  • The stomach can become squeezed and lose its blood supply
  • It can apply direct pressure against the heart

Question 8

What are the s/s of a sliding hiatal hernia?

Answer 8

• Similar to those w/ acid reflux/GERD
• Worsens after meals or in supine position

Question 9

What are the s/s of a rolling hernia?

Answer 9

• Feelings of fullness after eating
• Breathlessness or suffocation
• Usually no reflux

Question 10

What diagnostic tests are used for hiatal hernia?

Answer 10

• Barium swallow
• Upper endoscopy

Question 11

What is the tx for a sliding hiatal hernia?

Answer 11

• Similar to GERD
• Weight loss
• No bent lifting

Question 12

What is the tx for a rolling hernia?

Answer 12

• Surgical
  
  • Laparoscopic Nissen Fundoplication (LNF)

Question 13

How does a Laparoscopic Nissen Fundoplication (LNF) help prevent/resolve paraesophageal hernia?

Answer 13

• The procedure wraps part of the stomach around the cardiac sphincter reinforcing it and making the area larger and more difficult to penetrate through the hiatus.

Question 14

What are two types of drugs that can help manage s/s of hiatal herniation?

Answer 14

• Antacids
• H2R Blockers (such as Ranitidine (Zantac))

Question 15

Post LNF nursing management will include:

Answer 15

• Typical surgical post-op care
• NG tube management
• Post-op teaching for self-care and prevention

Question 16

What is the nursing education provided for hiatal hernia patients?

Answer 16

• Small frequent meals
• Minimize the amount of liquid
• Avoid anticholinergic drugs
• Lose weight
• Do not recline for one hour after eating
• Sleep with head of bed elevated

Question 17

What are some possible complications of a hiatal hernia?

Answer 17

• Severe GERD (gastroesophageal reflux disease)
• Lung problems or pneumonia because stomach contents have moved up into your esophagus and into one or both lungs.
• Strangulation of the hernia, cutting off blood flow to your stomach (medical emergency)

Question 18

What are some possible post LNF complications?

Answer 18

• Gas bloat syndrome
• Inability to belch and vomit
• Dysphagia