Upper GI disorders
HIATAL HERNIA
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 thorax.
Hiatal hernia occurs more often in women than in men.
There are two main types of hiatal hernias:
o 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 (see Fig. 45-7A). About 95% of patients with esophageal hiatal
hernia have a sliding hernia.
o Paraesophageal hernia occurs when all or part of the stomach pushes through the diaphragm
beside the esophagus
Symptoms:
o May present with vague symptoms of intermittent epigastric pain or fullness after eating.
o Large hiatal hernias may lead to intolerance to food, nausea, and vomiting.
o Sliding hernia may have:
pyrosis, regurgitation, and dysphagia, but many patients are asymptomatic.
commonly associated with GERD
Complications: Hemorrhage, obstruction, and strangulation can occur with any type of hernia
, How is hiatal hernia diagnosed?
o Confirmed by x-ray studies;
o Barium swallow;
o Esophagogastroduodenoscopy (EGD) - 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
After a scope procedure a client is difficult to arouse. The priority action for the nurse to
perform at this time is: Assess the client’s airway
Management
o frequent, small feedings that can pass easily through the esophagus
o advise not to recline for 1 hour after eating, to prevent reflux or movement of the hernia
o elevate the head of the bed on 4- to 8-inch (10- to 20-cm) blocks to prevent the hernia from
sliding upward
o Stop smoking
o 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
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.
The nurse also monitors for postoperative belching, vomiting, gagging, abdominal
distension, and epigastric chest pain, which may indicate the need for surgical revision
HIATAL HERNIA
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 thorax.
Hiatal hernia occurs more often in women than in men.
There are two main types of hiatal hernias:
o 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 (see Fig. 45-7A). About 95% of patients with esophageal hiatal
hernia have a sliding hernia.
o Paraesophageal hernia occurs when all or part of the stomach pushes through the diaphragm
beside the esophagus
Symptoms:
o May present with vague symptoms of intermittent epigastric pain or fullness after eating.
o Large hiatal hernias may lead to intolerance to food, nausea, and vomiting.
o Sliding hernia may have:
pyrosis, regurgitation, and dysphagia, but many patients are asymptomatic.
commonly associated with GERD
Complications: Hemorrhage, obstruction, and strangulation can occur with any type of hernia
, How is hiatal hernia diagnosed?
o Confirmed by x-ray studies;
o Barium swallow;
o Esophagogastroduodenoscopy (EGD) - 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
After a scope procedure a client is difficult to arouse. The priority action for the nurse to
perform at this time is: Assess the client’s airway
Management
o frequent, small feedings that can pass easily through the esophagus
o advise not to recline for 1 hour after eating, to prevent reflux or movement of the hernia
o elevate the head of the bed on 4- to 8-inch (10- to 20-cm) blocks to prevent the hernia from
sliding upward
o Stop smoking
o 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
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.
The nurse also monitors for postoperative belching, vomiting, gagging, abdominal
distension, and epigastric chest pain, which may indicate the need for surgical revision
