Hiatal hernia.pptx

1. Hiatal hernia
PRESENTED BY :
V.RAMYA,
TUTOR,
SRMTCON.

2.  COURSE : B.SC. NURSING II YEAR
 SUBJECT : MEDICAL SURGICAL NURSING
 UNIT : IV
 TOPIC : HIATAL HERNIA
 PREPARED BY : MRS ,V.RAMYA ,TUTOR.

3. OBJECTIVES
 At the end of the class student will be able to
 Introduce hiatal hernia
 Types of hiatal hernia
 Clinical manifestations of hiatal hernia
 Assessment and diagnostic findings of hiatal hernia
 Management of hiatal hernia
 Surgical management of hiatal hernia

4. introduction
 In the condition known as hiatal hernia , the
opening in the diaphragm through which the
esophagus passes becomes enlarged ,and part of
the upper stomach moves up into the lower portion
of the throax.
 Hiatal hernia occurs more often then in women
than in men.

5. TYPES
There are two main types of hiatal hernias
sliding and paraesophageal .
Sliding or type 1 occurs when the upper
stomach and the gastroesophageal junction
are displaced upward and slide in and out of
the throax .

6. types
 About 95% of patients with esophageal hiatal hernia have
a sliding hernia.
 A paraesophageal hernia occurs when all or part of the
stomach pushes through the diaphragm beside the
esophagus .
 Paraesophageal hernias are further classified as type II ,
type III, or type IV depending on the extent herniation.

7. types
Type IV has the greatest herniation.
With other intra – abdominal viscera such as
the colon, spleen or small bowel evidencing
displacement into the chest along with the
stomach.

8. types

9. Clinical
manifestations
 The patient with a sliding hernia may have
 Pyrosis,
 Regurgitation,
 And dysphagia
 But many patients are asymptomatic.
 The patient may present with vague symptoms of
intermittent epigastric pain or fullness after eating.

10. Clinical
manifestations
 Large hiatal hernias may lead to intolerance of
food ,nausea and vomiting.
 Sliding hiatal hernias are commonly associated
with GERD.
 Hemorrhage ,obstruction, and strangulation can
occur with any type of hernia.

11. Assessment and diagnostic findings
 Diagnosis is typically confirmed by x-ray studies ;
 Barium swallow ,
 Esophagogastroduodenoscopy (EGD),
 Which is the passage of a fiberoptic tube through the
mouth and throat into the digestive tract for visualization
of the esophagus , stomach ,and small intestine
;esophageal manometry
 Or chest CT scan

12. X- ray image

13. esophagogastroduodenoscopy

14. management
 Management for a hiatal hernia includes frequent ,small
feedings that can pass easily through the esophagus.
 The patient is advised not to recline for 1 hour after
eating, to prevent reflux or movement of the hernia , and
to elevate the head of the bed on 4 to 8 inch ( 10 to 20
cm) blocks to prevent the hernia from sliding upward.

15. Surgical management
 Surgical hernia repair is indicated in patients who are
symptomatic ,although the primary reason for the surgery
is typically to relieve GERD symptoms and not repair the
hernia.
 Current quidelines recommend a laparoscopic approach ,
with an open transabdominal or transthoracic approach
reserved for patients with complications such as bleeding
,dense adhesions ,or injury to the spleen.

16. Surgical management

17. Nursing management
 Up to 50% of patients may experience early
postoperative dysphagia;
 Therefore the nurse advances the diet slowly from
liquids to solids ,while managing nausea and
vomiting ,tracking nutritional intake ,and
monitoring weight.

18. Nursing management
 The nurse also monitors for postoperative belching,
 vomiting,
 gagging,
 Abdominal distention,
 And epigastric chest pain , which may need indicate the
need for surgical revision.

19. Nursing management
 These should be reported immediately from the
primary provider .
 Surgical repair is often reserved for patients with
more extreme cases that involves gastric outlet
obstruction or suspected gastric strangulation,
which may result in ischemia ,necrosis ,or
perforation of the stomach.

20. bibliography
 Brunner and Suddarth’s Textbook of Medical- Surgical Nursing ,South
Asian Edition , Volume 1 , Published by Wolters Kluwer . Page reffered
to 856-857.
 Ansari and Kaur, Textbook of Medical – Surgical Nursing 1 . Published
by Pee Vee 2011 Edition, Page reffered to 848 – 849.
 https://www.slideshare.net/shafaatullahkhatt/hiatal-hernia-67541398
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