b. Etiology. This type of hernia can be caused by a congenital weakness in the
diaphragm or a blow to the diaphragm with a blunt object. Persons who are obese or
women who have had multiple pregnancies have a high incidence of hiatal hernia.
c. Signs/Symptoms. There is no visible bulge with this hernia. The first
symptom is usually heartburn, a condition that is worse after the patient has just eaten a
heavy meal or when he lies down or bends over. Eventually, the patient may
experience more severe pain, pain which is aggravated by highly seasoned foods or
alcoholic beverages. In a small number of cases, contents of the stomach may flow
backward causing distress. If the patient suffers very severe pain which lasts for
several hours, consider that the hernia may have become strangulated. This is a
medical emergency, and surgery is indicated.
d. Treatment. Most hiatal hernias can be treated without surgery. The patient
(1) Take antacids. Either cimetidine or Tagamet in the dose of 300 mg can
be taken 4 times a day; that is, before each meal and at bedtime.
Sleep with his head elevated (blocks can be placed under the head of
Avoid bending, stooping, and lifting heavy objects.
Wear loose rather than tight fitting clothing across the abdomen.
Strive to maintain a relaxed attitude in his daily routine.
(6) Avoid foods that contain substances which strongly initiate acid
secretion; for example, alcohol, coffee, etc.
Eat small meals.
Avoid certain drugs, specific foods, and smoking as recommended by a
(9) If the hiatal hernia does not respond to this treatment, surgery might be
necessary. Surgical correction involves putting the protruding stomach back into the
abdominal cavity and repairing the diaphragmal defect that allowed the stomach to push