Hiatal Hernia

Introduction:

This is also known as a diaphragmatic hernia. A part of the stomach protrudes up
through the diaphragm near the esophagus into the chest. Patients may be asymp-
tomatic or have daily symptoms of gastroesophageal reflux disease (GERD). The
hernia may be a sliding hiatal hernia which allows movement of the upper portion
of the stomach including the lower esophageal sphincter up and down through
the diaphragm. These patients typically have symptoms of GERD. Another type
of hiatal hernia is a rolling hernia in which a portion of the stomach protrudes up
through the diaphragm, but the lower esophageal sphincter area remains below the
level of the diaphragm. These patients do not generally suffer from reflux.

PROGNOSIS

Lifestyle modifications may help control the symptoms of hiatal hernia. Some
patients who do not get adequate control of symptoms or are refractory to treat-
ment may need surgery to correct the movement through the diaphragm.

SIGNS AND SYMPTOMS

• Sliding hernia:
• Heartburn
• Difficulty swallowing (dysphagia)
• Burping (eructation)
• Chest pain
• Rolling hernia:
• Chest pain
• Shortness of breath after eating
• Feeling of fullness after eating

TREATMENT

• Administer antacids for patients with reflux symptoms:
• Maalox, Mylanta, Tums, Gaviscon
• Administer histamine type 2 (H2) blockers to reduce stomach acid:
• ranitidine, nizatidine, famotidine, cimetidine
• Administer proton pump inhibitors to reduce the production of acid:
• omeprazole, esomeprazole, pantoprazole, rabeprazole, lansoprazole
• Avoid lying down after eating.
• Modify eating schedule; small, frequent meals.
• Elevate head of bed.

NURSING DIAGNOSES

• Acute pain
• Chronic pain

NURSING INTERVENTION

• Monitor vital signs.
• Assess abdomen for distention, bowel sounds.
• Teach patient about lifestyle modifications:
• Medication management.
• Avoid clothing that is tight around the waist.
• Not to lie down after eating.
• Elevate head of bed.
• Avoid wearing clothing that is tight at waist.
• Avoid acidic foods (citrus, vinegar, tomato), peppermint, caffeine, alcohol.
• Stop smoking.
• Lose weight if overweight.