Hiatal Hernia PDF

Hiatal Hernia The opening in the diaphragm which esophagus passes becomes enlarged and part of the stomach herniates into the lower portion of the thorax. This occurs more often in women than in men because during pregnancy the gravid uterus pushes the stomac...

Hiatal Hernia The opening in the diaphragm which esophagus passes becomes enlarged and part of the stomach herniates into the lower portion of the thorax. This occurs more often in women than in men because during pregnancy the gravid uterus pushes the stomach upward. 2 types: 1. Sliding Type 1 Upper portion of the stomach and the gastroesophageal junction are displaced upward ○ Wherein in Hernia, slides in and out of the thorax. Take note: 90-95% of patients with Hiatal Hernia have a SLIDING type of hernia. This is the most common type. 2. Paraesophageal Classified into II, III, IV All or part or the stomach pushes through the diaphragm Type IV has the greatest herniation Because the other abdominal structures herniates the diaphragm (e.g Colon omentum small bowels along with the stomach) Other abdominal structures moves up through the diaphragm Clinical Manifestations Pyrosis Regurgitation and dysphagia Intermittent epigastric pain Fullness after eating Intolerance to food N&V Hemorrhage, obstruction, volvulus, strangulation (complications if not managed properly) Volvulus - this is the obstruction of the bowels caused by a twist in the intestine and supporting mesentery which may lead to strangulation. Take note: Most patients are asymptomatic and they have a vague symptom of intermittent epigastric pain or fullness after eating. Diagnosis X-ray studies (considered as confirmatory na ito) Confirmatory Barium swallow (extent of hernia) Esophagogastroduodenoscopy (determine presence of hiatal hernia) Esophageal manometry (measure the pressure & constriction of the esophagus during swallowing) CT scan (to determine hiatal hernia) Management Frequent, small feeding ○ So that food can pass easily through esophagus Recline for 1 hour after eating ○ To prevent reflux and movement of hernia Elevate head of bed 4-8 inches or 10-20 cm ○ To prevent hernia from sliding upward ○ Surgical repair is INDICATED for patients with hiatal hernia particularly those symptomatic Toupet or Nissen fundoplication ○ These are laparoscopic procedures and are considered as the Kared(?) Guideline. ○ Indicated for patients with complications such as bleeding, adhesions and injury to the spleen. ○ Toupet fundoplication, this involves creating a barrier between the esophagus and stomach. ○ Nissen fundoplication, this is the wrapping portion. Yung kaninang na-discuss. Postop ○ Progressive liquid to solid diet ○ Manage N&V, nutritional intake, weight monitoring ○ WOF (watch out for) belching, abdominal distention, epigastric pain Because these manifestations may indicate the need for surgical revision and should be reported IMMEDIATELY to the primary care provider.