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    Peptic Ulcer

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    RAJU
    This document discusses peptic ulcer disease (PUD), including risk factors, types of ulcers, symptoms, diagnosis, and treatment approaches. PUD is caused by excessive acid production and decreased mucosal resistance, and risk factors include heredity, stress, smoking, alcohol, caffeine, diet, drugs like NSAIDs. The main types of ulcers are gastric, duodenal, and stress-related. Diagnosis involves endoscopy, stool tests, and gastric analysis. Treatment involves antacids, H2 blockers, cytoprotective agents, surgery like partial gastrectomy for severe cases. Nursing care focuses on diet, medication administration, monitoring for complications post-surgery like bleeding or infection.

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    Peptic Ulcer

    Uploaded by

    RAJU
    430 views2 pages
    This document discusses peptic ulcer disease (PUD), including risk factors, types of ulcers, symptoms, diagnosis, and treatment approaches. PUD is caused by excessive acid production and decreased mucosal resistance, and risk factors include heredity, stress, smoking, alcohol, caffeine, diet, drugs like NSAIDs. The main types of ulcers are gastric, duodenal, and stress-related. Diagnosis involves endoscopy, stool tests, and gastric analysis. Treatment involves antacids, H2 blockers, cytoprotective agents, surgery like partial gastrectomy for severe cases. Nursing care focuses on diet, medication administration, monitoring for complications post-surgery like bleeding or infection.

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    Peptic Ulcer

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    This document discusses peptic ulcer disease (PUD), including risk factors, types of ulcers, symptoms, diagnosis, and treatment approaches. PUD is caused by excessive acid production and decreased mucosal resistance, and risk factors include heredity, stress, smoking, alcohol, caffeine, diet, drugs like NSAIDs. The main types of ulcers are gastric, duodenal, and stress-related. Diagnosis involves endoscopy, stool tests, and gastric analysis. Treatment involves antacids, H2 blockers, cytoprotective agents, surgery like partial gastrectomy for severe cases. Nursing care focuses on diet, medication administration, monitoring for complications post-surgery like bleeding or infection.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    430 views2 pages

    Peptic Ulcer

    Uploaded by

    RAJU
    This document discusses peptic ulcer disease (PUD), including risk factors, types of ulcers, symptoms, diagnosis, and treatment approaches. PUD is caused by excessive acid production and decreased mucosal resistance, and risk factors include heredity, stress, smoking, alcohol, caffeine, diet, drugs like NSAIDs. The main types of ulcers are gastric, duodenal, and stress-related. Diagnosis involves endoscopy, stool tests, and gastric analysis. Treatment involves antacids, H2 blockers, cytoprotective agents, surgery like partial gastrectomy for severe cases. Nursing care focuses on diet, medication administration, monitoring for complications post-surgery like bleeding or infection.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    PEPTIC ULCER DISEASE (PUD) excoriation / erosion of submucosa & mucosal lining due to:

    a.) Hyper secretion of acid pepsin


    b.) Decrease resistance to mucosal barrier
    Incidence Rate:
    1. Men 40 55 yrs old
    2. Aggressive persons/ type A personality
    3. Hereditary
    4. Emotional Stress
    Predisposing factors:
    1. Hereditary
    2. Emotional
    3. Smoking vasoconstriction GIT ischemia
    4. Alcoholism stimulates release of histamine = Parietal cell release Hcl acid = ulceration
    5. Caffeine tea, soda, chocolate
    6. Irregular diet
    7. Rapid eating
    8. Ulcerogenic drugs NSAIDS, aspirin, steroids, indomethacin, ibuprofen
    Indomethacin - S/E corneal cloudiness. Needs annual eye check up.
    NSAID and steroids= gastropathy
    9. Gastrin producing tumor or gastrinoma Zollinger Ellisons syndrome
    10. Microbial invasion helicobacter pylori. Metronidazole (Flagyl)

    Types of ulcers
    Ascending to severity
    1. Acute affects submucosal lining
    2. Chronic affects underlying tissues
    heals & forms a scar, deeper
    According to location
    1. Stress ulcer
    2. Gastric ulcer
    3. Duodenal ulcer most common
    Stress ulcers common among critically ill clients
    2 types
    1. Curlings ulcer cause: trauma & Burns
    Hypovolemia
    GIT schemia
    Decrease resistance of mucosal barriers to Hcl acid
    Ulcerations
    2. Cushings ulcer cause stroke/CVA/ head injury
    Increase vagal stimulation
    Hyperacidity
    Ulcerations
    Treatment: Vagotomy - done to prevent hemorrhage and shock prior to surgery on the stomach

    GASTRIC ULCER
    SITE
    PAIN

    HYPERSECRETION
    VOMITING
    HEMORRHAGE
    WT
    COMPLICATIONS
    HIGH RISK
    INCIDENCE

    Antrum or lesser curvature


    - 30 min 1 hr after eating
    - epigastrium
    - gaseous & burning
    - not usually relieved by food & antacid
    - Eating leads to pain
    Normal gastric acid secretion
    common
    hematemesis
    Wt loss
    a. stomach cancer
    b. hemorrhage
    50 or 60 years old and above
    Male; female = 1:1
    15% of peptic ulcers are gastric

    DUODENAL ULCER
    Duodenal bulb
    - 2-3 hrs after eating
    - mid epigastrium
    - cramping & burning pain
    - usually relieved by food & antacid
    - 12 MN 3am pain
    - Eating lessens pain
    Increased gastric acid secretion
    Not common
    Melena
    Wt gain
    a. perforation
    20 years old and above
    Male: Female = 2-3:1
    80% of peptic ulcers are duodenal

    90-95% is cases of duodenal ulcers - less bicarbonate ions, decrease so increase incidence
    Diagnosis:
    1. Endoscopic exam
    2. Stool from occult blood (+)
    3. Gastric analysis Gastric Ulcer: normal gastric acid secretion
    Duodenal: increased gastric acid secretion
    4. GI series confirms presence of ulceration
    Nursing Mgt:
    1. Diet bland, non irritating, non spicy
    2. Avoid caffeine & milk/ milk products
    Increase gastric acid secretion
    3. Administer meds
    a.) Antacids
    ACA
    Aluminum containing antacids

    Magnesium containing antacids

    ex. aluminum hydroxide gel


    ex. milk of magnesia
    (Amphogel)
    S/E diarrhea
    S/E constipation
    Maalox (fever S/E)
    b.) H2 receptor antagonist:
    1. Ranitidine (Zantac) SE: fever
    2. Cimetidine (Tagamet)hastens the effect of oral anticoagulants
    3. Famotidine (Pepcid) SE: fever
    - Avoid smoking decrease effectiveness of drug
    Nursing Mgt:
    1. Administer antacid & H2 receptor antagonist (Cimetidine) 1hr apart
    -Cemetidine decrease antacid absorption & vise versa
    c.) Cytoprotective agents
    Ex
    1. Sucralfate (Carafate) - Provides a paste like subs that coats mucosal lining of stomach
    2. Misoprostol (Cytotec) SE: menstrual spotting
    d.) Sedatives/ Tranquilizers - Valium, lithium
    e.) Anticholinergics / Antispasmodic
    1. Atropine SO4
    2. Prophantheline Bromide (Profanthene)
    (Pt has history of hpn crisis with peptic ulcer disease. Rn should not administer alka seltzer- has large amount of Na.
    3. Surgery: subtotal gastrectomy - Partial removal of stomach
    Billroth I (Gastroduodenostomy)

    Removal of of stomach & anastomoses of


    gastric stump to the duodenum.

    Billroth II (Gastrojejunostomy)
    Removal of -3/4 of stomach & duodenal bulb &
    anastomostoses of gastric stump to jejunum.

    Before surgery for BI or BII - Do vagotomy (severing of vagus nerve) & pyloroplasty (drainage) first.
    Nursing Mgt:
    1. Monitor NGT output or drainage immediately post op- bright red
    a.) Immediately post op should be bright red
    b.) Within 36- 48h output is yellow green
    c.) After 48h output is dark red due to HCl acid
    2. Administer meds:
    a.) Analgesic
    b.) Antibiotic
    c.) Antiemetics
    3. Maintain patent IV line
    4. VS, I&O & bowel sounds
    5. Complications:
    a.) Hemorrhage hypovolemic shock
    Late signs anuria
    b.) Peritonitis
    c.) Paralytic ileus most feared
    d.) Hypokalemia
    e.) Thrombophlebitis
    f.) Pernicious anemia
    g.) Septicemia

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