Medical Surgical Hiatal Hernia #2

Question

A client admitted for a hiatal hernia has developed worsening symptoms of abdominal pain, abdominal rigidity, nausea/vomiting, and fever. The client has tachycardia, hypotension and tachypnea. Which complication of hiatal hernia is the client most likely experiencing?

Answers

  1. Peritonitis
    • Rationale:

      This answer is correct because these are signs of peritonitis, which is one complication of hiatal hernia. Peritonitis is inflammation or infection of the peritoneal cavity. Many times peritonitis rapidly progresses into shock. Symptoms include abdominal rigidity, guarding, pallor, tachycardia, and progressive abdominal distention.

  2. Ulceration
    • Rationale:

      This answer is not correct because these symptoms are not indicative of ulceration. Symptoms of ulceration are melena, hematemesis, and burning epigastric pain.

  3. Aspiration
    • Rationale:

      This answer is not correct because the client is showing no signs of aspiration. Choking, cough, retractions and cyanosis are signs of aspiration.

  4. Hemorrhage
    • Rationale:

      This answer is not correct because the client is experiencing no clinical signs of a GI bleed. There is no mention of melena or epigastric pain.

Overview

A hiatal hernia is when a part of the stomach breaches through the diaphragm and into the thorax. Complications include aspiration, ulceration, hemorrhage, or peritonitis. Peritonitis signs include abdominal rigidity, guarding, pallor, tachycardia, and progressive abdominal distention.

Explanation

Learning Outcomes

A hiatal hernia is when part of the stomach breaches through the diaphragm and into the thorax. When this happens, complications can occur. Peritonitis is the most harmful since it can progress rapidly into septic shock. The peritoneal cavity becomes inflamed and infection can set in. Signs of shock are tachycardia, hypotension, and tachypnea. Due to the difficulty swallowing with hiatal hernia, aspiration can also occur. The pressure that occurs as a result of the hiatal hernia squeezes the stomach so that it retains acid and this can cause ulceration. With ulceration, sometimes comes hemorrhage. It is important to monitor for these complications with hiatal hernias.

Test Taking Tip

Know the complications that can occur from certain diagnoses. Especially, if the complications can progress into septic shock. Always know what the vitals will do with shock: High heart rate, low blood pressure, rapid breathing.

Video Rationale