Hiatal Hernia

1. Anatomy of the esophagus, the stomach, and the diaphragm.

1. The diaphragm is a large sheet of muscle that separates the abdomen from the chest cavity.

2. The esophagus -the food tube- extends down through a small opening in the diaphragm to connect to the stomach.

3. The stomach lies just below the diaphragm.

2. Two types of hiatal hernias.

1. Sliding hernia occurs when the junction of the stomach and the esophagus move above the diaphragm.

2. Rolling hernia occurs when the junction of the stomach and the esophagus remain below the diaphragm, but a portion of the stomach rolls up above the diaphragm.

3. Factors that may increase risk.

1. Congenital weakness.

2. Advanced age.

3. Trauma.

4. Prolonged illness.

5. Obesity.

6. Pregnancy.

7. Ascites (excess fluid in abdomen).

8. Tumors.

9. Restrictive clothing.

10. Heavy lifting.

4. Signs and symptoms of hiatal hernia, although hiatal hernia frequently exists without symptoms.

1. Heartburn (burning sensation in the esophagus):

1. May occur 30-60 minutes after meals.

2. May occur after lying down.

3. May occur after bending, staining, or lifting.

2. Regurgitation of sour-tasting liquid in the mouth.

3. Difficulty swallowing due to muscles spasms.

5. Measures to control or prevent symptoms and complications of hiatal hernia.

1. Avoid caffeine (coffee, cola, chocolate, etc.).

2. Eat high-protein, low-fat, bland diet. (Provide "Protein in Diet" handout.)

3. Eat small, frequent meals.

4. Drink water after meals to cleanse the esophagus.

5. Avoid lying down after eating:

1. Avoid eating before bedtime.

2. Place blocks under head of bed.

6. Avoid straining at stool:

1. Increase fluids and fiber.

2. Use stool softeners as needed.

7. Avoid heavy lifting, bending, coughing, or vomiting.

8. Avoid constrictive clothing.

9. Lose weight, overweight (Provide "Weight Reduction" handout.)

10. Avoid alcohol and cigarettes.

11. Learn stress management techniques.

12. Take medication as ordered.

6. Possible complications of hiatal hernia.

1. Upper gastrointestinal bleeding (coffee-ground vomitus).

2. Inflammation of the esophagus (pain, difficulty swallowing).

3. Aspiration pneumonia (fever, shortness of breath, pain with breathing, rapid breathing).

4. Ulceration of the herniated portion of the stomach.

5. Gastritis (pain in epigastric area).