Hiatal Hernias

By Jessica Basso, RN

A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue. The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach). Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia; the pressure pushes an organ or tissue through the opening or weak spot. Sometimes the muscle weakness is present at birth; more often, it occurs later in life. Anything that causes an increase in pressure in the abdomen can cause a hernia, including lifting heavy objects without stabilizing abdominal muscles, diarrhea, constipation, and persistent coughing or sneezing. In addition, obesity, poor nutrition, and smoking can all weaken muscles and make hernia’s more likely.

A hiatal hernia shouldn’t be confused with the kinds of hernias that we associate with heavy lifting. The term “hernia” simply refers to any instances in which an organ pushes into another part of the body where it should not ideally be. The hiatus is an opening in the diaphragm (the muscular wall that separates the abdominal area from the chest cavity). Sometimes part of the stomach will push past the hiatus, bulging up into the lower portion of the chest. When this happens, it is known as a hiatal hernia. Hiatal hernias become more likely if a person is older than 50 or if a person is obese or morbidly obese.

There are two types of hiatal hernia’s that may occur, a Sliding Hiatal Hernia or a Paraesophageal Hiatal Hernia. A sliding hiatal hernia refers to cases in which the upper portion of the stomach linked to the lower portion of the esophagus bulges up past the hiatus. A Paraesophageal Hiatal Hernia is a rarer form of a hernia, which the part of the stomach not near the upper portion area squeezes past the hiatus and rests beside the esophagus. This is a much more serious condition than the sliding hernia. Common Symptoms of Hiatal Hernia’s include excessive bleeding, heartburn, chest pain, problems swallowing food, or fatigue. The larger the hernia the more prominent the symptoms.

In order to ensure success with bariatric surgery, these procedures require digestive tracts to be in a healthy and normal condition. It’s important that hiatal hernias be diagnosed and identified in patients having bariatric surgery. Studies such as Upper GI’s or EGD’s can be very helpful in diagnosing hiatal hernias and if a hernia is something that appears on studies it can be corrected at the same time you have your bariatric procedure.

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