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Hiatal hernia


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Hiatal hernia

  1. 1. Hiatal Hernia
  2. 2. Hiatal Hernia • A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm, and up into the chest. This opening is called a esophageal hiatus or diaphragmatic hiatus. OR • A hiatus hernia or hiatal hernia is the protrusion of the upper part of the stomach into the chest through a tear or weakness in the diaphragm.
  3. 3. Pathpysiology • Normally, the esophagus or food tube passes down through the chest, crosses the diaphragm, and enters the abdomen through a hole in the diaphragm called the esophageal hiatus. Just below the diaphragm, the esophagus joins the stomach. • In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes through the hiatus and enter into the chest.
  4. 4. Types Of Hiatal Hernia There are 2 types of hiatal hernia.  Sliding hiatal hernia: • The sliding type, as its name implies, occurs when the junction between the stomach and esophagus slides up through the esophageal hiatus during moments of increased pressure in the abdominal cavity. • When the pressure is relieved, the stomach falls back down with gravity to its normal position. • Approximately 90% of all hiatal hernias are the sliding type.
  5. 5. Paraesophageal hiatal hernia • Paraesophageal hiatal hernia: • In paraesophageal hiatal there is no sliding up and down. A portion of the stomach remains stuck in the chest cavity. • These hernias remain in the chest at all times. • This type is less common.
  6. 6. Causes Of Hiatal Hernia • Increased pressure within the abdomen caused by: o Heavy lifting or bending over. o Frequent or hard coughing. o Hard sneezing. o Pregnancy and delivery. o Vomiting. o Constipation. o Obesity.
  7. 7. Clinical Manifestation  The patient with sliding hernia may have, • Heart burn • Regurgitation and • Dysphagia but at least 50% are Asymptomatic.  The patient with paraoesophageal hernia usually feels a sense of fullness after eating or may be asymptomatic.
  8. 8. Medical Diagnosis • Various tests are used to diagnose a hiatal hernia, the following tests are routinely used: • chest x-ray • Barium x-rays: Barium x-rays, also known as barium swallow, are diagnostic x-rays in which barium is used to diagnose abnormalities of the digestive tract, including hiatal hernias. • Upper endoscopy: The upper endoscopy (also known as esophagogastroduodenoscopy or EGD) allows the doctor to examine the inside of the patient's esophagus, stomach, and duodenum (the first part of the small intestine) with an instrument called an endoscope.
  9. 9. Treatment • Medical treatment for hiatal hernia may include prescription-strength antacids & PPIs • When hernia symptoms are severe and chronic acid reflux is involved, surgery is sometimes recommended, • The surgical procedure used is called Nissen fundoplication. • In fundoplication, the gastric fundus(upper part) of the stomach is wrapped, or plicated, around the inferior part of the esophagus, preventing herniation of the stomach through the hiatus in the diaphragm and the reflux of gastric acid.
  10. 10. Complications • Dysphagia. • Esophagitis. • Gastroesophageal reflex. • Infection or bleeding. • Damage of the internal organ e.g. heart, lungs etc. • Heart burn.
  11. 11. Nursing Diagnosis & interventions Class Activity