Hiatal Hernia.pptx

Hiatal Hernia for Nursing Students and Moreover for Nurses with Continue Nursing Education

1. PRESENTED BY Mr. CHETAN R SANGATI, M.Sc (N) CCH ASSISTANT PROFESSOR DEPT OF MEDICAL SURGICAL NURSING

2. INTRODUCTION A hiatus hernia, or hiatal hernia, is when part of the stomach squeezes up into the chest through an opening ("hiatus") in the diaphragm. The diaphragm is a large, thin sheet of muscle between the chest and the abdomen (tummy).

3. Definition A hiatal hernia is a condition where the top of your stomach bulges through an opening in your diaphragm. This can happen to people of any age and any gender.  Incidence: A hiatal hernia can develop in people of all ages and both sexes, although it frequently occurs in people aged 50 and older. Hiatal hernia occurs more often in people with overweight/obesity and smokers.

4. Types of hiatus hernia There are 3  main types of hiatus hernia. They are: S liding hiatus hernias – hernias that move up and down, in and out of the chest area (more than 80% of hiatus hernias are of this type)

5. P ara- oesophageal hiatus hernias – also called rolling hiatus hernias, where part of the stomach pushes up through the hole in the diaphragm next to the oesophagus (about 5-15% of hiatus hernias are of this type)

6. The mixed or compound hiatus hernia The mixed or compound hiatus hernia is the most common type of paraesophageal hernia. The GEJ is displaced into the thorax with a large portion of the stomach.

7. Causes The most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. Coughing : A hiatus hernia can result in a cough that is dry and persistent. Many individuals document this cough mainly at night. This symptom occurs when you lay down after a meal at night, resulting in stomach acid reflux. The recurrent stomach acid reflux irritates the cough centers in the throat resulting in a cough. Vomiting. Straining during a bowel movement. Heavy lifting. Physical strain. hiatal hernia during pregnancy, If you have obesity, or if there’s extra fluid in your abdomen.

8. Pathophysiology

9. Clinical sign and symptoms Heartburn Regurgitation of food or liquids into the mouth Backflow of stomach acid into the esophagus (acid reflux) Difficulty swallowing Chest or abdominal pain Feeling full soon after you eat Shortness of breath Vomiting of blood or passing of black stools, which may indicate gastrointestinal bleeding

10. Diagnostic evaluation X-ray of your upper digestive system.  X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine. Upper endoscopy.  Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach and check for inflammation. Esophageal manometry .  This test measures the rhythmic muscle contractions in your esophagus when you swallow. Esophageal manometry also measures the coordination and force exerted by the muscles of your esophagus.

11. Gastroscopy The gastroscope will be inserted into your mouth and down your throat, and will be used to help identify any problems. The procedure may be carried out using a local anaesthetic or a sedative to help you relax. Barium meal X-ray The barium meal X-ray, also called the barium swallow test, is an effective way of identifying a hiatus hernia. As part of the test, you'll be asked to drink some barium solution. Barium is a non-toxic chemical that shows up clearly on an X-ray. Once the barium moves down into your digestive system, a series of X-rays will be taken to identify any problems.

12. Management PARMACOLOGY Antacids that neutralize stomach acid.  Antacids, such as Aluminum hydroxide gel. Calcium carbonate Magnesium hydroxide may provide quick relief. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney problems . Medications to reduce acid production.  These medications — known as H-2-receptor blockers — include cimetidine ( Tagamet HB), famotidine ( Pepcid AC) and nizatidine ( Axid AR). 

13. Medications that block acid production and heal the esophagus.  These medications — known as proton pump inhibitors — are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole ( Prevacid 24HR) and omeprazole ( Prilosec , Zegerid ). 

14. SUGICAL MANAGEMENT Hiatus repair surgery.  This surgery uses sutures and prosthetic mesh to tighten and decrease the size of the enlarged hiatus, which is the opening in the diaphragm that the esophagus travels through on its way to the stomach. It prevents your stomach from bulging upward through the hiatus and is used for early-stage Hiatal hernias.

15. Nissen Fundoplication .  This procedure involves using stitches to wrap the upper part of the stomach, called the fundus , around the bottom portion of the esophagus in order to hold the stomach in place below the diaphragmatic hiatus. The stitches create pressure at the end of your esophagus which prevents stomach acid and food from flowing up from the stomach.

16. Collis- Nissen gastroplasty .  This surgery is used to lengthen the esophagus in patients with more complex forms of Hiatal hernia due to esophageal shortening. In this procedure, a surgeon will use tissue from the upper part of your stomach to extend your esophagus.

17. BELSEY MARK IV FUNDOPLICATION A ntireflux fundoplication is a classic procedure that has proven to be a successful and durable antireflux operation. Over a 15-year period, Ronald Belsey performed clinical trials to develop and refine the operation, culminating in 4 iterations, with the fourth or Mark IV being the final and most successful.

18. HILL REPAIR The Hill repair for correction of hiatal hernia and surgical management of gastroesophageal reflux disease .The repair includes restoration of the gastroesophageal junction (GEJ) with posterior anchoring and reconstruction of the gastroesophageal flap-valve mechanism (GEV). Intraoperative measurement of the lower esophageal sphincter pressure (LESP) is also performed on a routine basis.

19. COMPLICATION E pigastria hernia includes any basic complications surrounding surgery and general anesthesia as well as those related to this specific surgical procedure. These complications may include: Bleeding Pain Wound infection at the surgical site Scarring left after healing blood clots Development of a lump that isn’t a hernia A low chance of the hernia recurring

20. Nursing Interventions Advise the patient about preventing reflux of gastric contents into esophagus by: Eating smaller meals to reduce stomach bulk. Avoiding stimulation of gastric secretions by omitting caffeine and alcohol, which may intensify symptoms. Refraining from smoking, which stimulates gastric acid secretions. Avoiding fatty foods, which promote reflux and delay gastric emptying. Refraining from lying down for at least 1 hour after meals. Losing weight, if obese. Avoiding bending from the waist or wearing tight-fitting clothes.

21. Advise the patient to report health care facility immediately at onset of acute chest pain – may indicate incarceration of paraesophageal hernia. Reassure patient that he or she is not having a heart attack, but all instances of chest pain should be taken seriously and reported to the patient’s health care provider.

22. I) Nursing Diagnosis Acute Pain May be related to Surgical repair Possibly evidenced by Change in facial expression in the child Irritability in infant Verbalization of pain Guarding behavior Crying, Moaning Refusal to move Desired Outcomes The client will express feelings of comfort and reduce pain as described using a pain scale.

23. II) Nursing Diagnosis Deficient Knowledge May be related to Lack of knowledge about postoperative care Possibly evidenced by Request for information about activity allowed, wound care, diet, bathing, and comfort measures Desired Outcomes Parents will obtain knowledge about postoperative care.