Hiatal Hernia

ICD-9: 553.3


A hiatal hernia is the protrusion of some portion of the stomach into the thoracic cavity through the opening in the diaphragm through which the esophagus passes (the esophageal hiatus). The two major varieties of hiatal hernia are (1) sliding hernias (most common), in which the gastroesophageal junction and the upper portion of the stomach slide upward through the esophageal hiatus; and (2) paraesophageal, or “rolling,” hernias, in which the gastroesophageal junction remains fixed, but some portion of the stomach passes through the esophageal hiatus. Occasionally, a hiatal hernia exhibits characteristics of both the sliding and rolling hernia.

Types of hiatal hernias

FIGURE. Types of hiatal hernias.


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The cause of hiatal hernias is unclear. They may be due to intra-abdominal pressure or weakening of the gastroesophageal junction caused by loss of muscle tone or trauma. Risk factors include severe coughing or vomiting, lifting heavy objects, pregnancy, and straining at stool. The incidence of hiatal hernia increases with age. Prevalence is higher in women than in men, and obesity is a contributing factor.

Signs and Symptoms

Over half of hiatal hernias may remain asymptomatic. If symptoms are present, they commonly include heartburn—aggravated by reclining, belching, esophageal reflux or GERD, dysphagia, or severe pain if a large portion of the stomach is caught above the diaphragm.

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Diagnostic Procedures

Diagnosis of hiatal hernias is made by chest x-ray, barium x-ray, endoscopy and biopsy, and pH studies of any reflux (to eliminate the possibility of gastric ulcer).


The goal in treatment is to alleviate symptoms. Surgery is not the first choice of treatment unless strangulation of the hernia is evident or symptoms cannot be controlled. An attempt is made to reduce heartburn and reflux or GERD through dietary modification or by strengthening the LES with medication. Antacids, H2 blockers, and PPIs likely are prescribed. Activity restrictions may be indicated to reduce intra-abdominal pressure, and persons may be advised to avoid tight or restrictive clothing. Stool softeners and laxatives to prevent straining at stool may be prescribed. Avoidance of food intake before sleep and elevation of the head of the bed may be suggested.

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Complementary Therapy

Diet modifications include avoidance of spicy or fried foods, caffeine, carbonated drinks, citrus juices, alcohol, peppermint, and green and red peppers and strictly avoiding overeating. Deep breathing exercises to strengthen the diaphragm and expand the lungs may be helpful.


Explain diagnostic tests, treatment, and significant symptoms to clients. Describe dietary restrictions and warn against activities that increase intra-abdominal pressure.


The prognosis for a hiatal hernia is good with proper treatment. Complications including stricture, significant bleeding, pulmonary aspiration, or strangulation require surgical repair. Strangulation is a medical emergency. It occurs when the hernia contents become swollen and compromise blood supply to the bowel. This causes significant abdominal pain and vomiting.

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There is no known prevention of hiatal hernias.

Digestive system anatomy and physiology review The digestive system consists of the set of organs and glands associated with the ingestion and digestion of food and the absorption of nutrients. It may be the system that is most taken for granted. Whether a person is eating foods of little value or a well-balanced diet, the task of the digestive system is the same—to nourish the cells of the body. The basic functions of the digestive system are to ingest, digest, and absorb the nutrients taken in, creating simple organic and inorganic molecules that can be transported to the body’s cells through blood and lymph. This system also eliminates solid, mostly indigestible, wastes from the body through the large intestine. FIGURE. The digestive system Often the digestive system is referred to as the upper gastrointestinal (GI) tract and the lower GI tract. The system is composed of the alimentary canal and the accessory organs of digestion. The canal is a tube that passes from the mouth to the anus. The parts of the alimentary canal ...
Hemorrhoids ICD-9: 455.6 Description Hemorrhoids are dilated, tortuous veins in the mucous membrane of the anus or rectum. They are common and usually insignificant unless they bleed or cause pain and itching. There are two kinds: external hemorrhoids, those involving veins below the anorectal line; and internal hemorrhoids, those involving veins above or along the anorectal line. About 50% of adults over age 50 have hemorrhoids. FIGURE. Hemorrhoids. Etiology Straining at stool, chronic constipation or diarrhea, prolonged sitting, pregnancy, anal intercourse, and anorectal infections are factors that contribute to the development of hemorrhoids. Another factor may be loss of muscle tone due to old age. Signs and Symptoms There may be rectal bleeding, pruritus, and vague discomfort. In some cases, the hemorrhoids may protrude from the anus. There may be a discharge of mucus from the rectum, too. Diagnostic Procedures Physical examination will reveal external hemorrhoids. Pr...
Crohn Disease (Regional Enteritis, Granulomatous Colitis) ICD-9: 555.9 Description Crohn disease, sometimes called regional enteritis or granulomatous colitis, is a serious, chronic inflammation, usually of the ileum, although it may affect any portion of the GI tract. Crohn disease is distinguished from closely related bowel disorders by its inflammatory pattern. The inflammation extending through all layers of the intestinal wall results in a characteristic thickening or toughening of the wall and narrowing of the intestinal lumen. The inflammation tends to be patchy or segmented. In Crohn disease, all layers of the intestine may be involved, with normal healthy bowel found between diseased sections of bowel. Crohn disease affects men and women equally and seems familial in nature. It is most often diagnosed in people between ages 20 and 30. Etiology The cause of Crohn disease is unknown. Researchers now believe that emotional stress and psychological changes are the result of chronic and severe symptoms of Crohn disease rather th...
Pancreatitis ICD-9: 577.0 Description Pancreatitis, or inflammation of the pancreas, may occur in acute or chronic forms. In this disease, pancreatic enzymes that normally remain inactive until reaching the duodenum begin digesting pancreatic tissue, causing varying degrees of edema, swelling, tissue necrosis, and hemorrhage. The pancreas is both an exocrine and endocrine organ; thus, if the islet cells are damaged, diabetes mellitus results. The disease can be mild and self-limiting or chronic and fatal. It is more common in men than in women. Etiology The causes of this autodigestive process in pancreatitis are not well understood, although a number of conditions are known to lead to the disease. Commonly, acute pancreatitis is caused by the presence of gallstones—small, pebblelike substances made of hardened bile—that cause inflammation in the pancreas as they pass through the common bile duct. The second most likely cause is alcoholism (mostly in men) and biliary tract disease (more c...
Abdominal and Inguinal Hernias ICD-9: 553.x Description An abdominal hernia is the protrusion of an internal organ, typically a portion of the intestine, through an abnormal opening in the musculature of the abdominal wall. Abdominal hernias are categorized according to the location of the herniation and include umbilical, inguinal, and femoral hernias. Inguinal hernias are the most common type and occur in men more often than in women. FIGURE. Hernias and their locations Etiology Hernias may result from a congenital weakness in the abdominal wall or muscle or increased pressure within the abdomen. Heavy lifting, pregnancy, obesity, and straining at stool are predisposing factors. Signs and Symptoms Inguinal and umbilical hernias are evidenced by the appearance, over the herniated area, of a lump that tends to disappear when the person is supine. Sharp, steady, accompanying pain may be present in the groin. Strangulation of a herniated portion of the intestine will cause severe pain and can cause ...