Lecture 4. hiatal hrernia.pptx presentation

Hiatal Hernia

1. HIATAL HERNIA Prepared by Ms. Maira Shaheen

2. Learning Objectives By the end of the session learners will be able to: Discuss the causes, pathophysiology and manifestation of the hiatal hernia. Discuss the diagnostic, medical and surgical management of the hiatal hernia.

3. Hiatal Hernia Definition Part of stomach protrudes through the esophageal hiatus of the diaphragm into thoracic cavity

4. Cont.…. A hiatal hernia is when your stomach bulges up into your chest through an opening in your diaphragm, the muscle that separates the two areas. The opening is called the hiatus, so this condition is also called a hiatus hernia.

5. Predisposing factors Increased intra-abdominal pressure Increased age Trauma Congenital weakness Forced recumbent position

6. Cont.…. Most cases are asymptomatic; incidence increases with age

7. TYPES OF HITAL HERNIA Sliding hiatal hernia Gastroesophageal junction and fundus of stomach slide through the esophageal hiatus  Esophagus (food pipe) goes through the hiatus and attaches to your stomach. In a sliding hiatal hernia, your stomach and the lower part of your esophagus slide up into your chest through the diaphragm.

8. Paraoesophageal hiatal hernia The gastroesophageal junction is in normal place but part of stomach herniates through esophageal hiatus; hernia can become strangulated; client may develop gastritis with bleeding

9. Cont.… A paraesophageal hernia is more dangerous. Your esophagus and stomach stay where they should be, but part of your stomach squeezes through the hiatus to sit next to your esophagus. Your stomach can become squeezed and lose its blood supply. Your doctor might call this a strangulated hernia.

10. Pathophysiology 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.

11. Cont.… A hiatal hernia compromises reflux barrier Reduced LES pressure Reduced esophageal acid clearance Transient LES relaxation episodes particularly at night time

12. Paraesophageal hernias may be further classified as types II, III, or IV, depending on the extent of herniation, with type IV having the greatest herniation.

13. Causes Doctors don’t know why most hiatal hernias happen. Causes might include: Being born with a larger hiatal opening than usual Injury to the area Changes in your diaphragm as you age An increased intraabdominal pressure as from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet

14. Manifestations similar to GERD Heartburn from gastroesophageal reflux disease (GERD) Chest pain Trouble swallowing Bad taste in your mouth An upset stomach and vomiting Backflow of food or liquid from your stomach into your mouth Shortness of breath

15. Diagnostic Tests Barium swallow X-rays Upper endoscopy

16. Treatment Similar to GERD: diet and lifestyle changes, medications LIFESTYLE MODIFICATION Stop smoking, weight loss elevate head of bed no meals <3h prior to sleeping smaller and more frequent meals, avoid too much alcohol, coffee, mint and fat.

17. Surgical Treatment If medical treatment is not effective or hernia becomes incarcerated, then surgery; usually Nissen fundoplication by thoracic or abdominal approach Folding the lower esophageal sphincter by wrapping a portion of the stomach around it to anchor it in place

18. Nursing Interventions and patient education Don’t exercise or lie down for 3 or 4 hours after you eat. Avoid acidic foods like orange juice, tomato sauce, and soda. A diet of mashed and soft foods is recommended for up to 2-3 weeks after surgery. Limit fried and fatty foods, alcohol, vinegar, chocolate, and caffeine. Eat smaller meals (four or five small meals each day) and eat slowly.

19. Lift the head of your bed about 6 inches. Don’t wear tight belts or clothes that put pressure on your belly. Lose extra pounds. Don’t smoke. Smoking is an intense heartburn generator.

20. REFERENCE Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s textbook of medical- surgical nursing (12th ed.)Philadelphia:Lippincott Williams & Wilkins.