Pathophysiology
A weakness in the hiatus of the diaphragm coupled with intra-abdominal pressure forcing
protrusion of the stomach and esophagus upward through the hiatus.
Hiatal hernias include the “sliding” type and the “rolling” type.
Assessment and Diagnostic Findings
Discomfort increases when lying down and decreases when standing or sitting upright after meals.
Endoscopy; barium swallow with x-ray, fluoroscopy, and swallowing studies can show the upward displacement of the stomach.
Complications
Scarring and narrowing of the esophagus with noncompliance of the lower esophageal sphincter.
Chronic irritation of the esophagus may lead to Barrett’s esophagus and esophageal CA.
Respiratory difficulties related to aspiration of acidic gastric contents, pain with respiration.
Medical Care and Surgical Treatment
Antacids, H2 blockers, proton pump inhibitors, coating agents, prostaglandins, antiemetics that
increase gastric motility and emptying.
Dilation of the esophagus if narrowing occurs.
Fundoplication, a surgical procedure in which the fundus is wrapped around the lower esophagus,
stabilizes the upper stomach, preventing herniation.
Nutritional counseling.
Keep in Mind
Clothing should be loose around the waist.
Sit upright for 2 hours after eating; don’t eat within 3 hours of retiring; elevate the head of the
bed (HOB) 6–8 inches using shock blocks.
Consume several small meals daily instead of three large meals.
Consume liquids separately from meals to avoid stomach distention
A weakness in the hiatus of the diaphragm coupled with intra-abdominal pressure forcing
protrusion of the stomach and esophagus upward through the hiatus.
Hiatal hernias include the “sliding” type and the “rolling” type.
Assessment and Diagnostic Findings
Discomfort increases when lying down and decreases when standing or sitting upright after meals.
Endoscopy; barium swallow with x-ray, fluoroscopy, and swallowing studies can show the upward displacement of the stomach.
Complications
Scarring and narrowing of the esophagus with noncompliance of the lower esophageal sphincter.
Chronic irritation of the esophagus may lead to Barrett’s esophagus and esophageal CA.
Respiratory difficulties related to aspiration of acidic gastric contents, pain with respiration.
Medical Care and Surgical Treatment
Antacids, H2 blockers, proton pump inhibitors, coating agents, prostaglandins, antiemetics that
increase gastric motility and emptying.
Dilation of the esophagus if narrowing occurs.
Fundoplication, a surgical procedure in which the fundus is wrapped around the lower esophagus,
stabilizes the upper stomach, preventing herniation.
Nutritional counseling.
Keep in Mind
Clothing should be loose around the waist.
Sit upright for 2 hours after eating; don’t eat within 3 hours of retiring; elevate the head of the
bed (HOB) 6–8 inches using shock blocks.
Consume several small meals daily instead of three large meals.
Consume liquids separately from meals to avoid stomach distention