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Where do hiatal hernia occur?

the opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper stomach tends to move up into the lower portion of the thorax.


Are hiatal hernias more common in men or women?



What are the 2 types of hiatal hernias?

Sliding-(axial)or type I, hiatal hernia occurs when the upper stomach and the gastro esophageal junction are displaced upward and slide in and out of the thorax.

paraesophageal hernia occurs when all or part of the stomach pushes through the diaphragm beside the esophagus. Paraesophageal hernias are classified as types II, III, or IV.


What type of hiatal hernia accounts for 90% of esophageal hiatal hernias?



What are nursing intervention for hiatal hernias?

-small feeding that can pass thru the esophagus
-not to recline for 1 hour after meals to prevent reflux or movement of the hernia and to elevate the hob on 4-8 inch blocks to prevent the hernia from sliding upward
-Surgery is indicated in about 15% of patients
-may require emergency surgery to correct torsion (twisting) of the stomach or other body organ that leads to restriction of blood flow to that area
-Bland diet
-avoid coffee
-smoking (increases gastric acid secretions); -eat sitting up
-avoid tight clothes
-wt reduction
-avoid bending at the waist.


What is the surgical intervention for a hiatal hernia?

Nissen fundoplicaton: thru a transabdominal incision the fundus of the stomach is wrapped around the lower 4-6 cm of the esophagus and is sutured in place. The upper part of the stomach and cardioesophageal junction are sutured to the median arcuate ligament.


What is an Abdominal Hernia?

protrusion of an organ or structure thru the wall of the cavity in which it’s naturally contained.


What is an Inguinal hernia?

a hernia in which a loop of intestine enters the inguinal canal, sometimes filling the entire scrotal sack. Results from congenital or acquired weakness of abdominal wall, coupled with sustained increased intra-abdominal pressure from coughing or straining.


What is an Umbilical hernia?

failure of the umbilical orifice to close. Common in children, obese people, and people with increased abdominal pressure such as ascites.


What is a Ventral hernia?

(incisional) weakness in abdominal wall on incision line.


What is a Femoral hernia?

below inguinal ligament is a round bulge, more frequent in women due to changes during pregnancy.


What are Non surgical treatment for hernia?

-Truss-to wear for support, does not cure,
-abdomen binder
-scrotal sac supporter.


What are Major complication of a hernia?

obstruction, usually surgical repair is done before this occurs.


What is a Reducible hernia?

Mass can be replaced back into the abdomen with pressure and when lying down.


What is a Incarcerated hernia?

(irreducible) cannot be reduced and intestinal flow may be obstructed.


What is a Strangulated hernia?

blood and intestinal flow thru intestinal hernia ceases completely.


What kind of Surgical treatment is done for a hernia?

Inguinal Herniorrhaphy is done before strangulation occurs: when done if elective, no not do if coughing, sneezing, due to pressure it puts on incision site. Do deep breath, not cough: After surgery splint if coughing, check for urinary retention, edema, elevate scrotum (ice pack) narcotics for pain, antibiotics to prevent epididymitis.


What are the S/S of hiatal hernia?

are heartburn, regurgitation, and dysphasia, but at least 50% of patients are asymptomatic. Sliding hiatal hernias is often implicated in reflux. The patient with paraesophageal hernia usually feels a sense of fullness after eating or chest pain or there may be no s/s.


PUD occurs most frequently in people between what ages?



How are peptic ulcer referred to?

As there location

gastric, duodenal, or esophageal ulcer,


what is PUD?

It is an excavation (hollowed-out area) that forms in the mucosal wall of the stomach, in the pylorus (the opening between the stomach and duodenum), in the duodenum (the first part of the small intestine), or in the esopha


How do you know is someone has PUD?

They have an ulcer


What causes PUD?

Erosion of a circumscribed area of mucous membrane is the cause.


What pathogen causes PUD?

Most common cause is H. pylori, which may be acquired through ingestion of food and water. Person-to-person transmission may also occur thru close contact and exposure to emesis.


What are signs and symptoms of PUD?

-dull gnawing pain or burning sensation in the midepigastric region or in the back.
Other symptoms include:
-pyrosis (heartburn)
-constipation or diarrhea


What are the 2 most common causes of UGI tract bleeding from Peptic Ulcers?

gastritis and hemorrhage


What is the most common complication of PUD?


occurs in 10-20% of patients with peptic ulcers.


What will occur if a PUD patient is experiencing hemorrhage?

-Melena or hematemesis.
The vomited blood can be bright red, or it can have dark “coffee grounds” appearance from the oxidation of hemoglobin to methemoglobin. When the hemorrhage is large, most of the blood is vomited. When the hemorrhage is small, much or all of the blood is passed in the stools, which appear tarry black b/c of the digested hgb. Monitor for faintness, dizziness, n&v, which may precede or accompany bleeding. Monitor v/s, evaluate for tachycardia, hypotension, and tachypnea. Monitor H&H.


What is PUD perforation ?

is the erosion of the ulcer thru the gastric serosa into the peritoneal cavity without warning. It is an abdominal catastrophe and requires immediate surgery.


What is PUD Penetration?

It is erosion of the ulcer thru the gastric serosa into adjacent structures such as the pancreas, biliary tract, or gastrohepatic omentum.