Exam 1: Peptic Ulcer Disease (PUD) Flashcards
What is Peptic Ulcer Disease ?
Erosion of GI mucosa (gastric or duodenal)
It can be in the stomach or duodenum !!
What type of PUD tends to be more superficial/irritation ?
Acute
What type of PUD tends to be deeper/ through muscle ?
Chronic
Acute vs. Chronic PUD, depends on what ?
depends on mucosal involvement
What are causes of PUD ?
- Infection (Helicobacter Pylori)
- Drugs (ASA, steroids, NSAIDS, smoking
What are manifestations of PUD ?
- Nausea
- Heart burn
- Pain relieved with antacids or eating (duodenal)
- Gnawing or burning epigastric pain
With GASTRIC Peptic Ulcers, the Gnawing or burning epigastric pain occurs how long after eating ?
1-2 hours
With DUODENAL peptic ulcers, the gnawing or burning epigastric pain occurs how long after eating ?
2-4 hours
How does Asparin (ASA) cause PUD ?
Directly irritates the lining
How do Steroids cause PUD ?
They reduce the integrity of the lining by preventing cell renewal
- They reduce protective mechanisms of the mucosa
_________ & _______ Go Together! ?
hint: what 2 kinds of drug classes
Steroids & PPI”s
- If we see pt’s on steroids (ex: prednisone), they will most likely also be on a PPI (ex: pantoprazole)
What are complications of PUD ?
- Hemorrhage
- Perforation
- Gastric outlet obstruction
What are manifestations of hemorrhage ?
- Melena, occult blood in stool (black/tarry stool)
- Obvious bleeding
- Coffee-ground vomitus
- Tachycardia
- Thready pulse
- Fatigue
- Weakness
- Dizziness
- Orthostatic Hypotension
- Syncope
- Decreased H & H
Manifestions d/t hemorrhaging into larger blood vessels
Hemorrhage cause what ?
Low blood/ fluid volume
What are manifestations of perforation ?
- Severe upper abdominal pain radiating to the shoulder
- Rigid, board-like abdomen
- Absence of bowel sounds
- Diaphoresis
- Tachycardia
- Rapid shallow respirations
- Fever (b/c stomach contents have left the GI tract and invaded the peritoneal space)
What is the general Tx for perforations ?
- IV lactated ringers
- IV albumin (protein) (to restore fluid by pulling fluid into the bloodstream) (*Albumin causes a fluid shift)
- Packed RBC’s
- Some type of surgical intervention (to repair the perforated bowel)
What interventions should be done after surgery for a perforation ?
- Bowel rest
- NG tube to low intermittent suction
What is Gastric Outlet syndrome due to ?
Due to inflammation or scarring at the site where stomach contents empty into the duodenum
What are signs & symptoms of Gastric outlet obstruction ?
- Sensation of epigastric fullness
- N & V (undigested food) - (may be projectile)
- Electrolyte imbalance
What is the Tx for Gastric Outlet Obstruction ?
- NG tube to decompress the stomach (because it can’t empty on its own)
- Possibly surgical intervention to remove scarring, etc.
What is the collaborative management of PUD ?
- Endoscopy
- Electrocoagulation
- H. pylori testing (blood test, breath test, stool)
- Avoid foods that cause distress
- Antibiotics if H. pylori
- Antiemetic for nausea
What foods should be avoided in the management of PUD ?
- Caffeine
- ETOH
- Carbonated beverages
- etc.
How is H. pylori treated ?
2 antibiotics & 1 PPI (14 days)
What are types of surgeries used in the management of PUD ?
- Vagotomy
- Pylorplasty
- Billroth I
- Billroth II
What nerve is instrumental in gastric acid production ?
Vagus nerve
What does a vagotomy involve ?
Severing the vagus nerve to decrease acid production
What does a pylorplasty involve ?
enlarging the pyloric sphincter to improve gastric emptying
____________ surgery involves a subtotal gastric resection with gastroduodenostomy anastomosis ?
(generally 2/3 of the stomach is taken out and then rest is attached to the small intestine)
Billroth 1
____________ surgery involves a subtotal gastric resection with gastrojejunostomy anastomosis (AKA: stomach attached to jejunum) ?
Billroth II
What are complications of PUD surgery ?
- Dumping syndrome
- Postprandial hypoglycemia
Dumping syndrom is more common with what type of PUD surgery ?
Billroth II
- B/c you know only have 1/3 of the stomach and your bypassing the duodenum and going right into the jejunum
Dumping syndrome is caused by what ?
Rapid movement of food into the intestines
True or False: Dumping syndrome is self limiting and usually resolves within several months to one year after surgery ?
True
True or False: With dumping syndrome you have reduced stomach capacity ?
True
What are Manifestations of Dumping Syndrome ?
- Sweating
- Vertigo
- Tachycardia
- Syncope
- Pallor
- Plapitations
- Need to lay down
What are pt. teaching points for Dumping syndrome ?
- Eat small frequent meals
- Avoid high carbohydrate intake (high carbs will dump more quickly)
- Avoid concentrated sweets (can cause dizziness & diarrhea)
- Drink liquids only between meals
- Lie down or rest after eating
- Good foods to eat = High protein foods! (Will breakdown slower)
What does Postprandial mean ?
After meals
True or False: Postprandial Hypoglycemia is a variant of Dumping syndrome ?
True
How does Postprandial Hypoglycemia develop ?
- Bolus of concentrated carbohydrate
- It gets dumped into the small intestine
- Causes hyperglycemia
- Causes excessive insulin release
- Which causes Hypoglycemia about 1-3hrs after meal
What is the Tx for Postprandial Hypoglycemia ?
- Tx the hypoglycemia
- Diet management to prevent dumping
- small meals
- High protein meals
What are symptoms of Postprandial Hypoglycemia ?
- Similar to dumping syndrome*
- sweating
- weakness
- palpitations
- tachycardia
- anxiety
