Hiatus Hernia: Causes, Types, Diagnosis, Treatment, Management

A type of hernia in which part of the stomach protrudes up through the esophageal opening of the Diaphragm. Hiatus hernia is an anatomical abnormality in which the part of the stomach protrudes up through the diaphragm into the chest. The exact cause is unknown. It may be due to, Increased pressure within the abdominal cavity. It may be due to – Heavy lifting, Pregnancy, Ascites, Frequent or hard coughing, Boilent vomiting, Starving etc…

Definition | Causes | Types of Hiatus Hernia | Clinical Feature | Diagnosis | Complication | Nursing Management | Management|

Hiatus Hernia: Symptoms and causes, Treatment

Definition:-

A type of hernia in which part of the stomach protrudes up through the esophageal opening of the Diaphragm. Hiatus hernia is an anatomical abnormality in which the part of the stomach protrudes up through the diaphragm into the chest.

Causes:-

   The exact cause is unknown. It may be due to,

  • Increased pressure within the abdominal cavity. It may be due to – Heavy lifting, Pregnancy, Ascites, Frequent or hard coughing, Boilent vomiting, Starving.
  • Weak LES.
  • Obesity.
  • Aging.

Types:-

  1. type 1st:- Sliding Hiatus Hernia:-

  • Herniation of both the stomach and gastroesophageal junction in the thorax.
  • The most common type of hiatus hernia (90%).

      2.Type 2nd :- Paraesophageal Hiatus Hernia:-

  • It is also known as rolling hiatus hernia.
  • Herniation of all or part of stomach through the esophagus into the thorax,with an undisplaced G.E.junction.
  • It is less common (10%).

Clinical Features:-

  1. In most of the cases, hiatus hernia remains asymptomatic,the disease discovers accidentally.
  2. the clinical feature are :-
  • Heartburn.
  • Dull chest pain.
  • Shortness of breath.
  • Regurgitation.
  • Dysphagia.
  • Palpitaion.
  • Reteosternal chest pain.

Diagnosis:-

  • Endoscopy.
  • Barium swallow X-ray.
  • Chest X-ray.
  • C.T. scan.

Complications:-

  • GERD (most common).
  • Esophagitis.
  • Esophageal ulcer.
  • Aspiration pneumonia.
  • Perforation (cutting of mucus membrane).

Management:-

General Management:-

General Management includes:-

  • Weight Loss.
  • Stop smoking.
  • Maintaining an upright position after taking food.
  • Elevate the head of the bed (20 to 35 cm.).
  • Small and frequent meals.
  • Not lying down or bending over after taking a meal.
  • Avoid tea, coffee, alcohol.

Pharmacological Management:-

  • Antacid.
  • H2- blocker drug.
  • Proton pump inhibitors.

Surgical Management:-

surgical management includes Nissen fundoplication surgery.

Nursing Management:-

  • Prepare the patient for diagnostic tests as needed.
  • Administration Prescribed antacids and other medications.
  • To reduce intra-abdominal pressure and prevent aspiration have the patient sleep in a reverse Trendelenburg position with the head of the bed elevated.
  • Assess the patient’s response to treatment.
  • Observe for complications especially significant bleeding, pulmonary aspiration.
  • Often endoscopy watches for signs of perforation such as falling blood pressure rapid pulse, shock, and sudden pain caused by the endoscope.
  • review prescribed medications, explaining their desired actions and possible adverse effect.
  • Teach the client dietary changes to reduce reflex.
  • Encourage the client to delay lying down for 2 hours after eating.

Gastritis or Stomach Inflammation: Types, Etiology, Clinical Feature, Diet Management

Inflammation of the gastritis mucus membrane is called Gastritis. It may occur as a short episode or may be of long duration. clinically gastritis is classifies into types these are Acute Gastritis and Chronic Gastritis. on the basis of histology or endoscopic appearance classified into three types those are hemorrhagic , Non-Erosive and Specific gastritis.

Definition | Types of Gastritis | Etiology of Gastritis | Clinical Feature of Gastritis | Diagnostic Evaluation |Diet management | Management |

Definition:-

Inflammation of the gastritis mucus membrane is called Gastritis. It may occur as a short episode or may be of long duration.

Types of Gastritis:-

Clinically Gastritis is classified into two types:-

  1. Acute Gastritis 
  2. Chronic Gastritis

On the basis of histology / endoscopic appearance. Gastritis is classified into three types:-

  1. Erosive/Hemorrhagic Gastritis:- Acute
  2. Non-Erosive Gastritis:-chronic
  3. Specific Gastritis

  Etiology of Gastritis:-

      Most common causes include:-

  • Infection of Helicobacter pylori (H-pylori)
  • NSAID’s (Nonsteroidal anti-inflammatory drugs)
  • Heavy alcohol drinking

     less common cause includes:-

  • Excessive stress
  • May develop after major surgery of the stomach
  • Irritating food/contaminated food

Clinical Features or Sign and Symptoms of Gastritis:-

  1. Anorexia 
  2. Nausea and vomiting
  3. Abdominal discomfort
  4. Epigastric tenderness
  5. Heartburn after eating
  6. Belching
  7. Frequent hiccough
  8. Dehydration
  9. Acidic test in the mouth.

Diagnostic Evaluation of Gastritis:-

      Diagnosis made on the basis of:-

  • Clinical feature
  • Feature of anemia
  • upper G.I. endoscopy
  • A blood test to check H-pylori
  • CBC for check the anemia

Management of Gastritis:-

Medical Management:-

  • Antacid:- Antacid is a common treatment for mild to moderate gastritis. when antacids do not provide enough relief, medication such as H2 receptor blocker and proton pump inhibitors are given to the client to reduce the amount of acid.
  • Antibiotics

Diet management:-

  • Blend diet, less spicy.
  • prefer liquid food.
  • Frequent small meals.

Nursing management:-

  • Provide a liquid diet to a client, the diet should be less spicy and less irritate.
  • Provide a small and frequent diet.
  • Encourage patients to avoid foods and drinks that trigger heartburn.
  • Assess the patient for hematemesis.

Related post:- Gastroesophageal Reflux Disease (GERD) or Acid Reflux

Gastroesophageal Reflux Disease (GERD): Symptoms, Causes, Treatment

Gastroesophageal Reflux Disease (GERD) is reflux (return) of gastric content (mainly acid) towards the mouth resulting in esophageal tissue damage. This is a chronic disease that occurs when stomach acid (HCL) or bile flows into the food pipe and irritates the inner lining. Gastroesophageal Reflux Disease (GERD) also known as Acid Reflux.

Causes | Clinical features | Complication | Diagnosis of GERD | Management | Nursing Management |

GERD or Acid Reflux- causes, diagnosis, symptoms,management

What is GERD or Acid Reflux?

  • Gastro-Esophageal Reflux Disease (GERD) is reflux (return) of gastric content (mainly acid) towards the mouth resulting in esophageal tissue damage.
  • This is a chronic disease that occurs when stomach acid (HCL) or bile flows into the food pipe and irritates the inner lining.
  • Gastro-Esophageal Reflux Disease (GERD) also known as Acid Reflux.

Causes or Etiology of GERD:-

  • Hiatal Hernia.
  • Obesity.
  • Zollinger Ellison Syndrome:-Hyper-secretion of gastric acid.
  • delayed gastric emptying.
  • delayed esophageal clearance.
  • Increases Intra-abdominal pressure.
  • Inappropriate relaxation of LES (lower esophageal sphincter):- It is the most common cause.
  • Reduce the tone of LES (seen in scleroderma or systemic sclerosis).
  • Food (Alcohol, caffeine, tobacco, spicy food, fried food, etc).

Clinical Feature of GERD:-

most common feature are:-

  • Acidic taste in the mouth.
  • Regurgitation (backflow).
  • Heartburn.

less common feature include:-

  • pain with swallowing.
  • Short throat.
  • Increase salivation (water brash).
  • Chest pain.
  • Coughing.
  • Frequent bleaching.

GERD sometimes causes injury to the esophagus/ Complication:-

  • Reflux esophagitis:- Inflammation of esophageal epithelium which can cause ulcers near the junction of the stomach and esophagus.
  • Esophageal strictures (narrowing):-the persistent narrowing of the esophagus caused by reflux induced inflammation.
  • Barrett’s Esophagus:- Abnormal changes in the cells of the lower esophagus.
  • Esophageal Adenocarcinoma:- A form of cancer.

Diagnosis of GERD:-

  1. EGD:- Esophago Gastro Duodenoscopy:- visualization of the esophagus stomach and first part of the small intestine.
  2. Barium Swallow X-ray:- to assess the presence of an esophageal stricture
  3. Esophageal PH monitoring.

Management of GERD:-

Medical management:-

  • Proton pump inhibitor.
  • H2 receptors antagonist.
  • Antacids.
  • Avoiding drugs like- Aspirin, ibuprofen.
  • Avoiding alcohol, tea, coffee, etc.

Surgical Management:-

  • Nissen Fundoplication:- In this procedure, the upper part of the stomach is wrapped along the lower esophageal sphincter to strengthen the sphincter and prevent acid reflux.

Nursing Management:-

  • Nursing management of Gastro-Esophageal Reflux Disease (GERD) involves teaching the client to avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation.

Nursing Intervention:-

  • Monitor the vital signs of the client.
  • Assess the abdomen for distention and intraabdominal pressure.
  • Encourage the client to small frequent meals of high calories and high protein foods.
  • Instruct the client to remain upright position, at least two hours after meals, and avoiding eating three hours before bedtime.
  • Instruct the client to eat slowly and masticate food well.
  • Advice to clients to avoid spicy food and acidic food.
  • Encourage the client to quit smoking and to lose weight if overweight.

See also:- Gastritis or Stomach Inflammation