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Med Surg II > Exam 1: Peptic Ulcer Disease (PUD) > Flashcards

Exam 1: Peptic Ulcer Disease (PUD) Flashcards

1
Q

What is Peptic Ulcer Disease ?

A

Erosion of GI mucosa (gastric or duodenal)

It can be in the stomach or duodenum !!

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2
Q

What type of PUD tends to be more superficial/irritation ?

A

Acute

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3
Q

What type of PUD tends to be deeper/ through muscle ?

A

Chronic

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4
Q

Acute vs. Chronic PUD, depends on what ?

A

depends on mucosal involvement

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5
Q

What are causes of PUD ?

A
  • Infection (Helicobacter Pylori)

- Drugs (ASA, steroids, NSAIDS, smoking

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6
Q

What are manifestations of PUD ?

A
  • Nausea
  • Heart burn
  • Pain relieved with antacids or eating (duodenal)
  • Gnawing or burning epigastric pain
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7
Q

With GASTRIC Peptic Ulcers, the Gnawing or burning epigastric pain occurs how long after eating ?

A

1-2 hours

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8
Q

With DUODENAL peptic ulcers, the gnawing or burning epigastric pain occurs how long after eating ?

A

2-4 hours

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9
Q

How does Asparin (ASA) cause PUD ?

A

Directly irritates the lining

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10
Q

How do Steroids cause PUD ?

A

They reduce the integrity of the lining by preventing cell renewal

  • They reduce protective mechanisms of the mucosa
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11
Q

_________ & _______ Go Together! ?

hint: what 2 kinds of drug classes

A

Steroids & PPI”s

  • If we see pt’s on steroids (ex: prednisone), they will most likely also be on a PPI (ex: pantoprazole)
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12
Q

What are complications of PUD ?

A
  • Hemorrhage
  • Perforation
  • Gastric outlet obstruction
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13
Q

What are manifestations of hemorrhage ?

A
  • 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

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14
Q

Hemorrhage cause what ?

A

Low blood/ fluid volume

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15
Q

What are manifestations of perforation ?

A
  • 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)
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16
Q

What is the general Tx for perforations ?

A
  • 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)
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17
Q

What interventions should be done after surgery for a perforation ?

A
  • Bowel rest

- NG tube to low intermittent suction

18
Q

What is Gastric Outlet syndrome due to ?

A

Due to inflammation or scarring at the site where stomach contents empty into the duodenum

19
Q

What are signs & symptoms of Gastric outlet obstruction ?

A
  • Sensation of epigastric fullness
  • N & V (undigested food) - (may be projectile)
  • Electrolyte imbalance
20
Q

What is the Tx for Gastric Outlet Obstruction ?

A
  • NG tube to decompress the stomach (because it can’t empty on its own)
  • Possibly surgical intervention to remove scarring, etc.
21
Q

What is the collaborative management of PUD ?

A
  • Endoscopy
  • Electrocoagulation
  • H. pylori testing (blood test, breath test, stool)
  • Avoid foods that cause distress
  • Antibiotics if H. pylori
  • Antiemetic for nausea
22
Q

What foods should be avoided in the management of PUD ?

A
  • Caffeine
  • ETOH
  • Carbonated beverages
  • etc.
23
Q

How is H. pylori treated ?

A

2 antibiotics & 1 PPI (14 days)

24
Q

What are types of surgeries used in the management of PUD ?

A
  • Vagotomy
  • Pylorplasty
  • Billroth I
  • Billroth II
25
Q

What nerve is instrumental in gastric acid production ?

A

Vagus nerve

26
Q

What does a vagotomy involve ?

A

Severing the vagus nerve to decrease acid production

27
Q

What does a pylorplasty involve ?

A

enlarging the pyloric sphincter to improve gastric emptying

28
Q

____________ 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)

A

Billroth 1

29
Q

____________ surgery involves a subtotal gastric resection with gastrojejunostomy anastomosis (AKA: stomach attached to jejunum) ?

A

Billroth II

30
Q

What are complications of PUD surgery ?

A
  • Dumping syndrome

- Postprandial hypoglycemia

31
Q

Dumping syndrom is more common with what type of PUD surgery ?

A

Billroth II

  • B/c you know only have 1/3 of the stomach and your bypassing the duodenum and going right into the jejunum
32
Q

Dumping syndrome is caused by what ?

A

Rapid movement of food into the intestines

33
Q

True or False: Dumping syndrome is self limiting and usually resolves within several months to one year after surgery ?

A

True

34
Q

True or False: With dumping syndrome you have reduced stomach capacity ?

A

True

35
Q

What are Manifestations of Dumping Syndrome ?

A
  • Sweating
  • Vertigo
  • Tachycardia
  • Syncope
  • Pallor
  • Plapitations
  • Need to lay down
36
Q

What are pt. teaching points for Dumping syndrome ?

A
  • 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)
37
Q

What does Postprandial mean ?

A

After meals

38
Q

True or False: Postprandial Hypoglycemia is a variant of Dumping syndrome ?

A

True

39
Q

How does Postprandial Hypoglycemia develop ?

A
  1. Bolus of concentrated carbohydrate
  2. It gets dumped into the small intestine
  3. Causes hyperglycemia
  4. Causes excessive insulin release
  5. Which causes Hypoglycemia about 1-3hrs after meal
40
Q

What is the Tx for Postprandial Hypoglycemia ?

A
  • Tx the hypoglycemia
  • Diet management to prevent dumping
    - small meals
    - High protein meals
41
Q

What are symptoms of Postprandial Hypoglycemia ?

A
  • Similar to dumping syndrome*
  • sweating
  • weakness
  • palpitations
  • tachycardia
  • anxiety

Med Surg II (13 decks)

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