what dietary education should the nurse provide to a client diagnosed with a hiatal hernia

Overview

What is a hiatal hernia?

A hiatal hernia occurs when the upper function of the tummy pushes through an opening in the diaphragm and into the breast crenel. The diaphragm is the thin muscle wall that separates the chest cavity from the belly. The opening in the diaphragm is where the esophagus and stomach bring together.

Who is at risk for developing a hiatal hernia?

A hiatal hernia tin can develop in people of all ages and both sexes, although it often occurs in people age 50 and older. Hiatal hernia occurs more than often in overweight people and smokers.

Symptoms and Causes

What causes a hiatal hernia?

The most common cause of a hiatal hernia is an increase in force per unit area in the intestinal cavity. Your abdominal crenel is the space in the middle of your torso that holds several organs, including the:

Lower role of the esophagus and breadbasket.
Pocket-sized intestine, colon and rectum.
Liver.
Gallbladder, pancreas and spleen.
Kidneys.
Bladder.

This pressure tin can build up from things like:

Coughing.
Vomiting.
Straining during a bowel movement.
Heavy lifting.
Physical strain.

At that place are also other reasons a hiatal hernia could develop. You lot may experience a hiatal hernia during pregnancy, if y'all are obese, or if there's actress fluid in your belly.

A coughing man with hiatal hernia

Increased pressure in the belly (arrows) causes part of the tum to push through the diaphragm and into the chest cavity.

What are the symptoms of a hiatal hernia?

Many people with a hiatal hernia never have symptoms. Some people with hiatal hernia have some of the same symptoms as gastroesophageal reflex affliction (GERD). GERD occurs when digestive juices movement from the tummy back into the esophagus. Symptoms of GERD include:

Heartburn.
Biting or sour taste in the back of the pharynx.
Bloating and belching.
Discomfort or pain in the tum or esophagus.

Although there appears to be a link betwixt hiatal hernia and GERD, one status does not seem to cause the other. Many people take a hiatal hernia without having GERD, and others accept GERD without having a hiatal hernia.

Another symptom of a hiatal hernia is chest pain. Since chest pain can likewise be a symptom of a eye attack, information technology'due south important to contact your healthcare provider or become to the emergency room if you lot experience any chest hurting.

Diagnosis and Tests

How is a hiatal hernia diagnosed?

Several tests can exist done to help diagnose a hiatal hernia. These include a barium swallow test, an endoscopy process, esophageal manometric studies, a pH test and gastric emptying studies.

A barium consume involves drinking a special liquid, and so taking X-rays to aid come across problems in the esophagus (such as swallowing disorders) and the stomach (such as ulcers and tumors). It also shows how big the hiatal hernia is and if at that place is twisting of the breadbasket as a event of the hernia.
An endoscopy is a procedure in which the inside of the upper digestive arrangement is viewed with an endoscope (a long, thin, flexible instrument most 1/two inch in diameter).
An esophageal manometry measures the strength and muscle coordination of your esophagus when you consume.
A pH examination measures the acrid levels in the esophagus and helps decide which symptoms are related to acrid in the esophagus.
Gastric emptying studies examine how fast nutrient leaves the tummy. Results from this test are especially important in patients who have nausea and vomiting. There could exist other causes of the nausea and vomiting besides a hiatal hernia.

Direction and Treatment

How is a hiatal hernia treated?

Most hiatal hernias do not cause bug and rarely need handling. Notwithstanding, since some patients with a hiatal hernia have symptoms of GERD, treatment starts with methods used to manage GERD. These include making such lifestyle changes equally:

Losing weight if you're overweight.
Decreasing the portion sizes of meals.
Avoiding certain acidic foods—such as tomato sauce and citrus fruits or juices—that can irritate the esophageal lining.
Limiting fried and fatty foods, foods or drinks containing caffeine (including chocolate), peppermint, carbonated beverages, alcoholic beverages, ketchup and mustard, and vinegar.
Eating meals at least three to iv hours before lying down, and fugitive bedtime snacks.
Keeping your head six inches higher than the rest of your torso when lying on your dorsum. Raising the level of your head helps gravity go along your stomach's contents in the tum. Raising the head of your bed by angling your mattress works best—piling your pillows doesn't work as well considering it makes you crunch your middle instead of simply angling your torso upwards.
Quitting smoking.
Not wearing a tight belt or tight vesture that can increase the pressure on the abdomen — such as control height hosiery and torso shapers.
Taking medications after eating to reduce acid in the stomach. These over-the-counter medications include antacids, Gaviscon®, or H-blockers (such as Pepcid Ac® or Zantac®).

Sometimes, a medication called a proton-pump inhibitor might be used to treat hiatal hernia. This medication is some other style to subtract the amount of stomach acrid y'all have, which tin aid forbid reflux. When you take this medication, your torso doesn't make as much stomach acid as normal. This is similar to H-blocker medications.

Can over-the-counter medications help salve my hiatal hernia symptoms?

In many cases, over-the-counter medications can assist you with some symptoms of hiatal hernia. Antacids are the well-nigh mutual medication you might use for relief. Yet, if you take over-the-counter medications for longer than two weeks without any improvement, see your healthcare provider. Prescription medications are typically the next pace. These tin can include:

Pantoprazole (Protonix®).
Rabeprazole (Aciphex®).
Esomeprazole (Nexium®).
Omeprazole (Prilosec®).
Lansoprazole (Prevacid®).

When is surgery for a hiatal hernia needed?

If the portion of the breadbasket entering the esophagus is being squeezed so tightly that the blood supply is existence cut off, you'll need to accept surgery. Surgery may as well be needed in people with a hiatal hernia who have severe, long-lasting (chronic) esophageal reflux whose symptoms are non relieved by medical treatments. The goal of this surgery is to correct gastroesophageal reflux by creating an improved valve mechanism at the lesser of the esophagus. Recollect of this valve as a swinging door. It opens to let food pass down into the stomach and then closes to keep stomach contents from going dorsum up the esophagus. When this valve doesn't work correctly, your tummy contents tin go the wrong style and damage your esophagus. If left untreated, chronic gastroesophageal reflux can crusade complications such as esophagitis (inflammation), esophageal ulcers, bleeding or scarring of the esophagus.

How is surgery for a hiatal hernia performed?

Surgery for repairing a hiatal hernia involves:

Pulling the hiatal hernia back into the abdomen.
Improving the valve at the lesser of the esophagus.
Endmost the pigsty in the diaphragm muscle.

During surgery, your surgeon will wrap the upper part of the stomach (chosen the fundus) around the lower portion of the esophagus. This creates a permanently tight sphincter (the valve) so that stomach contents volition not move dorsum (reflux) into the esophagus.

Called a fundoplication, there are ii versions of this surgery. An open up fundoplication surgery involves a larger incision. This type of procedure may need to be done in some very astringent cases and it allows for greater visibility during surgery. However, open surgeries require a longer recovery time in the hospital. In many cases, the surgeon will decide to use a laparoscopic approach instead.

A laparoscopic surgery is washed through several pocket-sized incisions instead of one big cut. This is considered a minimally invasive choice. The specific laparoscopic process used to repair a hiatal hernia is called the Nissen fundoplication. This procedure creates a permanent solution to your hiatal hernia symptoms. During the process, your surgeon will make 5 or six tiny incisions in the abdomen. The laparoscope (a tool that allows the surgical team to meet your internal organs on a screen in the operating room) and other surgical instruments are inserted through the small incisions. The fundus is wrapped around the esophagus and the sphincter is tightened during surgery. The advantages of laparoscopic surgery compared to an open up surgery include:

Smaller incisions.
Less risk of infection.
Less hurting and scarring.
A shorter recovery.

Outlook / Prognosis

How constructive is surgery for a hiatal hernia?

A laparoscopic repair of hiatal hernia and reflux, called Nissen Fundoplication, is very constructive in most patients. This surgery requires general anesthesia and a short stay in the infirmary. If y'all need to have an open surgical procedure, the recovery time will be longer and you may need to stay in the hospital for several days. Afterward surgery, about patients no longer require long-term treatment with prescription or over-the-counter antacid medications.

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Source: https://my.clevelandclinic.org/health/diseases/8098-hiatal-hernia