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Hiatal Hernia: Symptoms & Management

A hiatal hernia occurs when part of the stomach pushes through an enlarged opening in the diaphragm. There are two main types: sliding hernias, which affect 90% of patients and involve the upper stomach sliding up into the chest, and paraesophageal hernias, where part of the stomach pushes through beside the esophagus. Hiatal hernias may cause heartburn, regurgitation, and difficulty swallowing, and are often diagnosed using x-rays, barium swallows, or fluoroscopy. Treatment involves making lifestyle and diet changes, along with medication in some cases, while surgery is needed for about 15% of patients.

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95 views1 page

Hiatal Hernia: Symptoms & Management

A hiatal hernia occurs when part of the stomach pushes through an enlarged opening in the diaphragm. There are two main types: sliding hernias, which affect 90% of patients and involve the upper stomach sliding up into the chest, and paraesophageal hernias, where part of the stomach pushes through beside the esophagus. Hiatal hernias may cause heartburn, regurgitation, and difficulty swallowing, and are often diagnosed using x-rays, barium swallows, or fluoroscopy. Treatment involves making lifestyle and diet changes, along with medication in some cases, while surgery is needed for about 15% of patients.

Uploaded by

Gracia Nieves
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Hiatal Hernia

In a hiatal (hiatus) hernia, 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. There are
two types of hernias: sliding and paraesophageal. Sliding, or type I, hiatal hernia occurs when the upper
stomach and the gastroesophageal junction are displaced upward and slide in and out of the thorax; this
occurs in about 90% of patients with esophageal hiatal hernias. The less frequent paraesophageal hernias
are classified by extent of herniation (type II, III, or IV) and occur when all or part of the stomach pushes
through the diaphragm beside the esoph- agus. Hiatal hernia occurs more often in women than men.

Clinical Manifestations

Sliding Hernia

•Heartburn, regurgitation, and dysphagia; at least half of cases are asymptomatic


• Often implicated in reflux
•
Paraesophageal Hernia

• Sense of fullness or chest pain after eating or may be asymp- tomatic.


• Reflux does not usually occur.
• •Complications of hemorrhage, obstruction, and strangula-
• tion possible.
•
• Assessment and Diagnostic Methods
•
• Diagnosis is confirmed by x-ray studies, barium swallow, and fluoroscopy.
•
• Medical Management
•
• • Frequent, small feedings that easily pass through the esoph- agus are given.
• • Advise patient not to recline for 1 hour after eating (pre- H vents reflux or hernia movement).
• • Elevate the head of bed on 4- to 8-in blocks to prevent her- nia from sliding upward.
• •Surgery is indicated in about 15% of patients; parae- sophageal hernias may require emergency
surgery.
• • Medical and surgical management of paraesophageal hernias is similar to that for gastroesophageal
reflux: antacids, his- tamine blockers, gastric acid pump inhibitors, or prokinetic agents
(metoclopramide [Reglan], cisapride [Propulsid]).

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