Peptic Ulcer Disease
Peptic Ulcer Disease
Peptic Ulcer Disease
Types:
1. Gastric
2. Duodenal
3. Esophageal
Significant Predisposing Factors
1. Increased secretion of HCl acid – may be assoc. with:
• Stress and anxiety
• Ingestion of milk and caffeinated beverages
• Smoking
• Alcohol
• Spicy foods
2.Familial tendency – Type O blood
3. Co-morbid states – COPD, CKD, ZES
• ZES – Zollinger Ellison Syndrome ( gastrin-producing
malignant or benign tumors of the pancreas)
4. Infection – H. pylori; acquired through ingestion of
food and water, direct contact or exposure to emesis
5. Medications – NSAIDs, corticosteroids
Pathophysiology
Increase concentration or activity of acid-pepsin or
decrease resistance of the mucosa
Ulcerations
CLINICAL MANIFESTATIONS
1. PE
2. Barium study of upper GIT – x-ray studies
3. Endoscopy – procedure of choice
4. Stool exam for occult blood
5. Gastric secretory studies – endoscopy and
histologic examination of a tissue specimen
obtained by biopsy
6. Serologic testing for H.pylori, urea breath test,
stool antigen test
Urea Breath Test
- To determine presence of H. pylori (which
metabolizes urea rapidly)
1. Ingest a capsule of carbon-labeled urea
(radioactive carbon 13c)
2. Breath sample obtained 10-20 min after (30min -
2hrs)
3. Carbon-labeled urea – absorbed quickly (+) H.
pylori
MEDICAL MANAGEMENT
1. Pharmacologic Therapy
• For ulcer healing: H2 receptor antagonist
and proton pump inhibitors (for NSAID-
induced and non-H.pylori associated PUD)
• H2 blockers: Ranitidine, Cimetidine,
Famotidine, Nizatidine
• PPI’s: Omeprazole, Lansoprazole,
Pantoprazole, Esomeprazole
• Initial Treatment for H. pylori
• 1st line: Triple therapy = PPI 2x/day +
Clarithromycin 2x/day or Metronidazole
2x/day for 10-14days
• 2nd line: Pepto-bismol 2 tabs 4x/day +
Tetracycline 4x/day + Metronidazole 4x/day
for 14 days
Jejunum
Shock-like manifestations
…Dumping syndrome
• Early s/s occur 5-30 min after eating:
• weakness, tachycardia, dizziness, diaphoresis, pallor, feeling of
fullness or discomfort, nausea, abdominal cramps and diarrhea
• Late s/s: occur 2-3 hrs after
• initially hyperglycemia then hypoglycemia
• Measures that slow gastric emptying:
• Eat in lying position
• Left-side lying position after meals
• SFF
• High protein diet (CHON empties stomach slowly in 3-4
hrs after eating)
• Limit CHO, no simple sugars
• Administer anticholinergics or antispasmodics 30 min
before meals
Nursing Diagnoses
• Acute Pain r/t the effect of gastric acid
secretion on damaged tissue
• Anxiety r/t to an acute illness
• Altered Nutrition: Less than Body
Requirements, r/t changes in diet
• Knowledge Deficit about prevention of
symptoms and management of the condition
• Fluid Volume Deficit r/t hemorrhage
Implementation
1. Relieving pain
• Administer prescribed meds.
• Advise patient about irritating effects of certain
drugs and foods
• Eat meals regularly at paced intervals
• Relaxation techniques
2. Reduce anxiety
• Give information
• Relaxed manner
• Identify stressors, coping and relaxation methods
• Family participation
3. Maintain optimal nutritional status
• Assess for malnutrition and weight loss
Evaluation
• Freedom from pain
• Feeling less anxious
• Complies with therapeutic regimen:
• Avoids irritating foods & beverages
• Eats regularly
• Uses coping mechanisms to deal with stress
• Maintains weight
• Exhibits no complications
END
GASTRITIS
GASTRITIS
• Inflammation of the gastric or stomach mucosa
• Acute (hours to days) or chronic (resulting from
repeated exposure to irritating agents or recurring
episodes of acute gastritis
Causes:
1. Acute
• dietary indiscretion (irritating, too highly seasoned,
contaminated with disease-causing microorganisms)
• overuse of aspirin/ NSAIDs
• excessive alcohol intake
• bile reflux
• radiation therapy
• ingestion of strong acid or alkali
• traumatic injuries, burns, severe infection, hepatic,
renal, or respiratory failure; major surgery
2. Chronic
• Benign or malignant ulcers of the stomach
• H.pylori infection
• Autoimmune diseases i.e. Pernecious anemia
• Diet: caffeine
• Medications: NSAIDs; biphosphonates
• Alcohol and smoking
• Chronic reflux of pancreatic secretions and
bile into the stomach
PATHOPHYSIOLOGY
Causative factors
Gangrenous mucosa
Edematous & hyperemic
Superficial erosion hemorrhage
Decreased secretion of gastric juice (less acid but much
mucus)
CLINICAL MANIFESTATIONS
1. Reducing Anxiety
• Offers supportive therapy
• Prepare patient for additional diagnostic
studies
• Use calm approach in assessing patient
and answering questions
• Explain all procedures
2. Promoting Optimal Nutrition
• No foods or fluids by mouth until acute
symptoms subside
• Monitor I/O and serum electrolyte
levels
• Ice chips then clear liquid then solid
foods
• Discourage caffeinated beverages,
alcohol and smoking
3. Promoting Fluid Balance
• Monitor I/O and electrolytes
• Monitor for hemorrhagic gastritis
(inform AP immediately)
• Hematemesis
• Tachycardia
• Hypotension
4. Relieving Pain
• Avoid irritating foods
• Correct use of medications
END