Dr. Sibi Peter,PhD,RN,CCRN
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Hiatal Hernia
 Herniation of portion of the stomach
into esophagus through an opening or
hiatus in diaphragm
 Also referred to as diaphragmatic
hernia and esophageal hernia
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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Hiatal Hernia
 Most common abnormality found on x-
ray of upper GI
 More common in older adults and in
women
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Two Types of Hiatal Hernias
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Hiatal Hernia
 Two types
 1. Sliding
 Stomach slides into thoracic cavity when
supine, goes back into abdominal cavity when
standing upright.
 Most common type
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Hiatal Hernia
 Two types
 2. Paraesophageal or rolling
 Esophageal junction remains in place, but
fundus and greater curvature of stomach roll
up through diaphragm.
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Hiatal Hernia
Etiology and Pathophysiology
 Many factors involved
 Structural changes
 Weakening of muscles in diaphragm
 Increased intraabdominal pressure
 Obesity
 Pregnancy
 Heavy lifting
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Hiatal Hernia
Etiology and Pathophysiology
 Factors (cont’d)
 Increasing age
 Trauma
 Poor nutrition
 Forced recumbent position
 Congenital weakness
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Hiatal Hernia
Clinical Manifestations
 May be asymptomatic
 Symptoms include
 Heartburn
 After meal or lying supine
 Dysphagia
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Hiatal Hernia
Complications
 GERD
 Esophagitis
 Hemorrhage from erosion
 Stenosis
 Ulcerations of herniated portion
 Strangulation of hernia
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Hiatal Hernia
Complications
 Ulcerations of herniated portion
 Regurgitation with tracheal aspiration
 Increased risk of respiratory problems
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Hiatal Hernia
Diagnostic Studies
 Barium swallow
 May show protrusion of gastric fundus
through esophageal hiatus
 Endoscopy
 Visualize lower esophagus
 Information on degree of inflammation or
other problems
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Hiatal Hernia
Conservative Therapy
 Lifestyle modifications
 Eliminate alcohol.
 Elevate HOB.
 Stop smoking.
 Avoid lifting/straining.
 Reduce weight, if appropriate.
 Use antisecretory agents and antacids.
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Hiatal Hernia
Surgical Therapy
 Reduction of herniated stomach
 Herniotomy
 Excision of hernia sac
 Herniorrhaphy
 Closure of hiatal defect
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Hiatal Hernia
Surgical Therapy
 Antireflux procedure
 Gastropexy
 Attachment of stomach
subdiaphragmatically to prevent
reherniation
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Hiatal Hernia
Surgical Therapy
 Goals
 Reduce hernia.
 Provide acceptable lower esophageal
sphincter (LES) pressure.
 Prevent movement of gastroesophageal
junction.
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Hiatal Hernia
Surgical Therapy
 Laparoscopically performed Nissen and
Toupet techniques are standard
antireflux surgeries.
 Thoracic or open abdominal approach
is used in select cases.
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Nissen Fundoplication
Fig. 42-5. A, Normal esophagus. B, Sliding hiatal hernia.
C, Rolling or paraesophageal hernia.
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Hiatal Hernia
Gerontologic Considerations
 ↑ incidence with age
 Medications commonly taken by older
patients can ↓ LES pressure.
 LES may become less competent with
aging.
 First indication may be esophageal
bleeding or respiratory complications.
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