Disorders of the Gastrointestinal System, 2nd Edition
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angina (Qureshi, 2019). Other symptoms can include (Kahrilas, 2021): ● Heartburn. ● Chest pain. ● Dysphagia. ● Bloating. ● Sour or bitter taste in the back of the mouth. ● Bleeding. Diagnosis of hiatal hernia is confirmed via various diagnostic tests and is often found during a workup for GERD. A bar- ium swallow upper GI series may show a hernia as an outpouching at the low- er portion of the esophagus. However, small hernias may be difficult to detect. Endoscopic studies allow the examiner to identify hiatal hernias and other gastro- esophageal problems (Qureshi, 2019). | NURSING CONSIDERATION Patients with a hiatal hernia repair are at increased risk for recurrence, with a recurrence rate of 15%–60% (Armijo et al., 2019). Reducing risk factors, in- cluding weight loss and smoking ces- sation, can drastically reduce the risk of recurrence (Qureshi, 2019). There are two types of hiatal hernias (Kahrilas, 2021). Sliding hiatal hernia A sliding hernia occurs when only the gastroesophageal junction slips up into the chest through the diaphragm. Asymp- tomatic hiatal hernias may not require any treatment (Qureshi, 2019). However, sliding hernias may produce gastric reflux symptoms similar to those of GERD. A sliding hiatal hernia may resolve between meals or flare-ups. In this case, treat - ment focuses on relieving and controlling symptoms through medication; avoiding
| NURSING ALERT
Patients with variceal bleeding are at increased risk for infection, with an incidence of 66%. Common infec- tions include peritonitis (after varice- al bleed), urinary tract infections, and pneumonia (Meseeha & Attia, 2022).
DISORDERS OF THE STOMACH
Hiatal hernia Hernia refers to a condition when an in- ternal body part moves or “pushes” into an area where it does not belong, usually through the muscle or connective tissue that typically keeps it contained (Merri - am-Webster, 2022). Hiatal hernia, also called hiatus hernia , is a deficiency or de - fect in the diaphragm that allows part of the stomach to pass through the opening into the chest (Qureshi, 2019). Hiatal hernia is generally caused by muscle weakening during the aging pro- cess, with 70% of cases occurring in those over age 70. They are more common in people who are overweight and in West- ern countries due to low-fiber diets. Hiatal hernias may be caused by injury or trauma or be secondary to chronic esophagitis. Increased abdominal pressure caused by coughing, straining during bowel move- ments, pregnancy, increased peritoneal fluid, or obesity may contribute to devel - oping a hiatal hernia (Qureshi, 2019). Most hiatal hernias are usually asymp - tomatic. A hiatal hernia is generally found when GERD worsens due to the move- ment or trapping of stomach acid in the area of the stomach that has herniated. Because the stomach is displaced or stretched, there may be feelings of full- ness in the chest or chest pain similar to
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