Disorders of the Gastrointestinal System, 2nd Edition
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constrictive clothing; eating small, fre- quent meals instead of large meals; and avoiding alcohol, spicy foods, tomato juices, citrus juices, and nicotine products (Qureshi, 2019). (For details about reduc- ing symptoms produced by gastric reflux, see the preceding section on GERD.) Paraesophageal hernia A paraesophageal hernia occurs when a portion of the stomach itself moves through a defect in the diaphragm and creates a hernia sac. A potentially severe complication of a paraesophageal hernia is severe pain and shock caused by in- carceration. Incarceration occurs when a portion of the stomach is caught above the diaphragm, leading to gastric perfo- ration, strangulation, bleeding, and even gangrene. Emergency surgery is neces- sary if this complication occurs (Kahrilas, 2021). | NURSING CONSIDERATION When incarceration of the herniated tissue has occurred, it can present abruptly with a sudden onset of vom- iting and severe pain (Qureshi, 2019). Surgical treatment Surgical intervention for a hiatal hernia is necessary if the hernia has the poten- tial to become constricted or strangulat- ed. In this case, the hiatal hernia must be “reduced” or put back in its proper place (Kahrilas, 2021). The type of surgery de- pends on the provider’s comfort level and patient presentation. It can include lap- aroscopic surgery, excision of the herni- ated sac, repair with mesh, or surgery to strengthen the LES by manually wrapping the stomach around the lower portion of the esophagus to create a tighter sphinc- ter (Qureshi, 2019). Laparoscopic surgery,
called a fundoplication , involves making several small abdominal incisions. Lapa- roscope and other surgical instruments are then inserted through the incisions. Surgeons can repair the hernia by viewing the internal organs with the laparoscope. Patients can usually ambulate on the day of surgery with assistance, be discharged on post-op day one, and resume regular activities within a week. Soft foods can be slowly into their diet, and patients can usually resume a regular diet within four to six weeks postoperatively (Seeras et al., 2022). Heavy lifting should be avoid- ed for several weeks. Recent studies have shown that a laparoscopic approach to hernia repair can lead to shorter hospital stays and a lower rate of complications (Qureshi, 2019). | NURSING ALERT Because of the possibility of reoc- currence, patients must be taught to recognize the warning signs of the life-threatening complication of hernia strangulation. These signs include se- vere chest or abdominal pain, nausea and vomiting, and inability to have a bowel movement or pass gas (Pastori- no & Alshuqayfi, 2021). Gastritis Gastritis is a common condition char- acterized by inflammation of the lining of the stomach and may be acute or chronic (Feldman & Jensen, 2022). In most peo - ple, gastritis is not serious and resolves quickly; however, some people may de- velop gastric ulcers, which increases the risk of stomach cancer (Feldman & Jen - sen, 2022). Acute gastritis has an abrupt onset but is self-limiting, while chronic gastritis can last indefinitely if not treated.
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