2. Definition :
It is herniation of a portion of the stomach into the esophagus
through an opening or hiatus in the diaphragm.
It is also referred as diaphragmatic or esophageal hernia.
Incidence :
It is more often in women than men.
3.
4. Types :
It is classified into two types.
1) Sliding / Type I:
- It occurs when the upper stomach and the gastro esophageal
junction are displaced upward & slide in and out of the thorax.
- The stomach “slides” into the thoracic cavity when the patient
is in supine and goes back into the abdominal cavity when the
patient standing upright.
- 95% of the hiatal hernia cases are sliding type.
5. 2) Paraesophageal or Rolling:
• It occurs when all or part of stomach pushes through the
diaphragm beside the esophagus forming a pocket.
• The Esophago – gastric junction remains in the normal
position.
• It is classified into type II, III or IV depending on the extent of
herniation.
6. Etiology :
- The actual cause is unknown.
- Contributing factors are :
o structural changes like weakening of muscles in the diaphragm
around esophageal opening.
o Factors that increase intra-abdominal pressure such as Obesity,
Pregnancy, Ascites, Tumors, intense physical exertion and
Heavy lifting on a continual basis.
o Other factors include increased age, trauma, poor nutrition and
forced recumbent position.
7. Clinical Manifestations :
- Many patients remain asymptomatic.
- Pyrosis or Heartburn (after a meal / in lying position)
- Regurgitation
- Dysphagia
- Epigastric pain relieved by sitting or standing.
- Fullness after eating.
8. Complications :
- GERD
- Hemorrhage from erosion
- Ulceration of the Herniated part.
- Stenosis
- Regurgitation with Tracheal aspiration.
9. Diagnostic Studies :
- History collection & Physical Examination
- X – ray
- Barium Swallow is an important diagnostic measure.
- Esophagogastroduodenoscopy (EGD)
- Esophageal manometry
- CT Scan of chest.
10. Management :
Surgical :
It is indicated when the patients are symptomatic.
It is recommended to have laproscopic approach with an open
transabdominal or transthoracic method.
The common procedure is Nissen Fundoplication, which
involve “wrapping” fundus of stomach around lower portion
of esophagus in varying positions. They provide an acceptable
LES Pressure and prevent movement of gastroesophageal
junction.
11. Nursing :
- Small & frequent feedings.
- Reduction of intraabdominal pressure by eliminating
constricting garments.
- Avoiding lifting and straining.
- Eliminating alcohol & smoking.
- Elevating the head of bed.
- Elevation of bed on 4 to 6 inches.
- Administer Antacids & Antisecretory agents.
