Peptic Ulcer Disease Flashcards
What is Peptic Ulcer Disease?
- Erosion of GI mucosa from HCL acid and pepsin
- Susceptible areas of GI tract; lower esophagus, stomach, duodenum, post-op gastrojejunal anastomosis.
What are the types of Peptic Ulcer Disease?
Acute
Chronic
Describe acute peptic ulcer disease.
Superficial erosion and minimal inflammation.
Describe chronic peptic ulcer disease.
Erosion of muscular wall with formation of fibrous tissue; present continuously for long duration
What is gastric: antrum?
- More prevalent in females older than 50
- Increased obstruction
- Risk factors: H. pylori, NSAIDs, Bile reflux
- Increased mortality
- High recurrence
What is a duodenal ulcer?
- 1 to 2 cm
- Prevalent ages 35-45
- Etiology - H. Pylori
- High HCL secretion
- High risk : COPD. Cirrhosis, Pancreatitis, hyperparathyroidism, Zollinger-Ellison syndrome, CRF.
- Occur, disappear, recur
How can we tell if it is a gastric ulcer?
- Epigastric discomfort 1 to 2 hours after meal
- Burning or gaseous pain; food may worsen it
- Perforation is first symptom in some patients
How can we tell if a patient has a duodenal ulcer?
- Burning or cramp like pain in mid-epigastric or back; 2 to 5 hours after meal.
- Bloating, nausea, vomiting, early satiety,
- May be silent in older adults and NSAIDs.
What is our best way to see if there is an ulcer?
- Endoscopy - direct visualization.
Obtain specimens for H. pylori (urease)
What tests can we use to check for PUD?
- Noninvasive H. pylori - breath test
- CBC, Liver enzymes, Serum amylase
- Stool - Occult blood
What should we check for on a patient coming back from endoscopy?
Gag reflex especially before giving food to make sure they can swallow.
What is the goal of treating PUD?
- Decreasing acidity and enhance mucosal defense.
- No NSAIDs or aspirin for 4 to 6 weeks unless with a ppi
What does a PPI do?
- To prevent ulcers
Who do we not give misoprostol to?
Patients who are pregnant, may be pregnant, or are trying to get pregnant.
This is the drug given for abortions.
What 3 drugs do we give to treat a peptic ulcer caused by H. pylori?
- Antibiotics
- H2 receptor blocker, or PPI
- Sucralfate
What does sucralfate do?
- Protects esophagus, stomach, and duodenum
What types of antibiotics do we give for H. pylori?
Bismuth alone or with tetracycline, and metronidazole (flagille)
When do we give sucralfate?
1 to 2 hours before or after antacid
What medicines does sucralfate bind with?
Digoxin Warfarin Phenytoin Tetrcycline Need to monitor these drug therapies to make sure they are working when taken in combination.
What are the 3 major complications of PUD?
- Hemorrhage - most common
- Perforation - most lethal
- Gastric outlet obstruction
What are symptoms of PUD complications?
- Sudden, severe abdominal pain
- Radiates to back and shoulders; no relief with food or antacids
- ABDOMEN RIGID/BOARDLIKE
- Bowel sounds absent
- Nausea and vomiting
- Respirations shallow, pulse increased and weak.
- Intensity proportional to amount and duration of spillage
What would make someone abdomen boardlike/rigid?
- Blood accumulating in the stomach, this is a serious situation.
What happens if a perforation goes untreated?
Bacterial peritonitis occurs in 6-12 hours
What is the immediate focus of a perforation?
Stop the spillage and restore blood volume.
Why is a NGT used for perforations?
Aspiration and gastric decompression
What would we give a person with a perforation?
IV fluids
Blood
Broad spectrum antibiotics
What are small perforations?
Self-healing
Monitor for obstruction (vomiting is a sign)
What are large perforations?
Surgery for closure and suctioning of peritoneal cavity.
What is a gastric outlet obstruction?
- When the stomach fills and dilates, causing discomfort and pain; worse at end of day; may be visible dilated.
- Vomiting and belching may provide some relief; constipation and anorexia.
How do we treat gastric outlet obstruction?
- Decompress with NGT
- PPI or H2 receptor blocker
- Fluid and electrolyte replacement
- Surgery or balloon dilation
What are symptoms of a gastric outlet obstruction?
- Inflammation
- Edema
- Pylorospasm
- Vomiting
What complications do we monitor for?
- Hemorrhage Monitor VS, NG aspirate See interventions for upper GI bleeding - Perforation Notify HCP, Frequent VS, No oral or NG intake, IV fluids, Pain management, Antibiotics, Prep for surgery
When can we feed someone with a gastric outlet obstruction?
When gastric residual is less than 200mL after clamped for 8 to 12 hours, begin oral intake, progress to solids.
What do we do if there is no relief or recurrence of gastric outlet obstruction?
Surgical intervention.
What are some gerontologic considerations for PUD?
- Increased morbidity and mortality
- Frequent use of NSAIDS (for arthritis)
- First symptom may be GI bleed or decreased Hct
- Treatment plan is similar with emphasis on teaching and prevention
What is dumping syndrome?
- Gastric chyme enters small intestine as large hypertonic bolus; pulls fluid into bowel lumen causing decreased plasma volume, distention of bowel lumen, and rapid transit within 15 to 30 minutes of eating
- Lasts about 1 hour
- Reduced with rest after eating
How do we prevent dumping syndrome?
- Eating less carbohydrates in a meal
- Resting after eating a meal
What is postprandial hypogylcemia?
- Variant of dumping syndrome
- Happens about 2 hours after eating
What is Bile reflux gastritis?
- Bile reflux causes damage to gastric mucosa, chronic gastritis and PUD.
- Temporarily relieved with vomiting,
- Administer cholestyramine - binds bile salts.
What is pernicious anemia?
Loss of intrinsic factor, needed for absorption of cobalamin in terminal ileum, essential for RBCs.
What do we administer cobalamin with?
- Multivitamins with folate
- Calcium
- Vitamin D
- Iron
TAKEN FOREVER STOMACH LINING DOES NOT GROW BACK
What do we give patients to improve wound healing?
- Vitamin C
- Potassium
- Vitamin D
- Vitamin K
- B-complex
What nutritional therapy do we give for patients post surgery?
- Small frequent meals
- No fluids with meals, chew thoroughly
- Avoid simple sugars and fried foods
- Avoid extreme food temperatures
