HIATAL HERNIA OUTLINE: A. HIATAL HERNIA- protrusion stomach through esophageal hiatus a.

Sliding- e-junction and fundus slide in/out thorax due to change position or increased IAP i. s/s assoc. w/ reflux b. Paraesophageal (rolling)- fundus & greater curvature roll into thorax creating pouch alongside the esophagus. Risk high for VOLVULOS, STRANGULATION, OBSTRUCTION i. Feeling of fullness after eating, breathlessness, suffocation B. CAUSE: a. Increased IAP b. Decreased LES c. Weakened diaphram C. S/S HIATAL HERNIA: a. Heart burn- esp. At nite, after meals, bending over, lying supine b. Chest pain c. Dysphagia d. Belching e. Regurgitation f. Increased symptoms while recumbent D. COMPLICATIONS HIATAL HERNIA a. GERD b. Ulceration herniated portion c. Esophagitis d. Strangulation e. Stenosis f. Hemorrage g. Obstruction h. reguritation E. DEFINITIVE DX: BARIUM SWALLOW F. COLLABORATIVE INTERVENTIONS a. LIFESTYL EMODIFICATION i. Encourage avoid fatty foods, coffee, tea, cola, chocolate, alcohol, acidic & spicy foods, smoking ii. Encourage 4-6sm meals daily, consume liquids between meals iii. Avoid late nite snacks iv. Remain upright 2-3hrs after eating v. Weight reduction vi. Elevate HOB

vii. Eliminate tight clothing, heavy lifting, strenuous exercise, straining b. DRUG THERAPY i. H2 blockers or PPI 1. Ranitidine (zantac), Famotidine (Pepcid) 2. Omeprazole (Prilosec), lansoprazole (Prevacid) ii. Antacids- Maalox, Mylanta

c. SURGICAL THERAPY i. Herniotomy-excision herniated sac ii. Herniorraphy-closure hernia iii. Gastroplexy- attachment stomach sub-diaphragmatically iv. Nissan& Toupet- wraps fundus around esophagus 1. PRE-OP a. Baseline VS b. Assess pt knowledge & re-inforce surgeons explanation c. Inform NG tube d. Assess need drains, lines, catheters e. Bowel prep f. Informed consent g. Teach measure prevent respiratory complications & DVT 2. POST-OP a. Assess complications: resp. Distress, dysphagia, gas bloat, atelectasis , pneumonia, obstruction NG tube b. Pain relief c. Elevate HOB d. Support incision e. Placement 7 patency NG tube f. Oral intake after peristalsis returns, teach avoid carbonated drinks, gas forming foods & drinking w/ straw g. Change position q2