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Adult Health 1 Exam 3 Fall 2022 > Peptic Ulcer Disease > Flashcards

Peptic Ulcer Disease Flashcards

1
Q

What is Peptic Ulcer Disease?

A
  • Erosion of GI mucosa from HCL acid and pepsin

- Susceptible areas of GI tract; lower esophagus, stomach, duodenum, post-op gastrojejunal anastomosis.

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2
Q

What are the types of Peptic Ulcer Disease?

A

Acute

Chronic

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3
Q

Describe acute peptic ulcer disease.

A

Superficial erosion and minimal inflammation.

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4
Q

Describe chronic peptic ulcer disease.

A

Erosion of muscular wall with formation of fibrous tissue; present continuously for long duration

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5
Q

What is gastric: antrum?

A
  • More prevalent in females older than 50
  • Increased obstruction
  • Risk factors: H. pylori, NSAIDs, Bile reflux
  • Increased mortality
  • High recurrence
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6
Q

What is a duodenal ulcer?

A
  • 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
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7
Q

How can we tell if it is a gastric ulcer?

A
  • Epigastric discomfort 1 to 2 hours after meal
  • Burning or gaseous pain; food may worsen it
  • Perforation is first symptom in some patients
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8
Q

How can we tell if a patient has a duodenal ulcer?

A
  • 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.
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9
Q

What is our best way to see if there is an ulcer?

A
  • Endoscopy - direct visualization.

Obtain specimens for H. pylori (urease)

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10
Q

What tests can we use to check for PUD?

A
  • Noninvasive H. pylori - breath test
  • CBC, Liver enzymes, Serum amylase
  • Stool - Occult blood
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11
Q

What should we check for on a patient coming back from endoscopy?

A

Gag reflex especially before giving food to make sure they can swallow.

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12
Q

What is the goal of treating PUD?

A
  • Decreasing acidity and enhance mucosal defense.

- No NSAIDs or aspirin for 4 to 6 weeks unless with a ppi

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13
Q

What does a PPI do?

A
  • To prevent ulcers
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14
Q

Who do we not give misoprostol to?

A

Patients who are pregnant, may be pregnant, or are trying to get pregnant.
This is the drug given for abortions.

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15
Q

What 3 drugs do we give to treat a peptic ulcer caused by H. pylori?

A
  • Antibiotics
  • H2 receptor blocker, or PPI
  • Sucralfate
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16
Q

What does sucralfate do?

A
  • Protects esophagus, stomach, and duodenum
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17
Q

What types of antibiotics do we give for H. pylori?

A

Bismuth alone or with tetracycline, and metronidazole (flagille)

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18
Q

When do we give sucralfate?

A

1 to 2 hours before or after antacid

19
Q

What medicines does sucralfate bind with?

A 
Digoxin
Warfarin
Phenytoin
Tetrcycline
Need to monitor these drug therapies to make sure they are working when taken in combination.
20
Q

What are the 3 major complications of PUD?

A
  • Hemorrhage - most common
  • Perforation - most lethal
  • Gastric outlet obstruction
21
Q

What are symptoms of PUD complications?

A
  • 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
22
Q

What would make someone abdomen boardlike/rigid?

A
  • Blood accumulating in the stomach, this is a serious situation.
23
Q

What happens if a perforation goes untreated?

A

Bacterial peritonitis occurs in 6-12 hours

24
Q

What is the immediate focus of a perforation?

A

Stop the spillage and restore blood volume.

25
Q

Why is a NGT used for perforations?

A

Aspiration and gastric decompression

26
Q

What would we give a person with a perforation?

A

IV fluids
Blood
Broad spectrum antibiotics

27
Q

What are small perforations?

A

Self-healing

Monitor for obstruction (vomiting is a sign)

28
Q

What are large perforations?

A

Surgery for closure and suctioning of peritoneal cavity.

29
Q

What is a gastric outlet obstruction?

A
  • 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.
30
Q

How do we treat gastric outlet obstruction?

A
  • Decompress with NGT
  • PPI or H2 receptor blocker
  • Fluid and electrolyte replacement
  • Surgery or balloon dilation
31
Q

What are symptoms of a gastric outlet obstruction?

A
  • Inflammation
  • Edema
  • Pylorospasm
  • Vomiting
32
Q

What complications do we monitor for?

A 
- 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
33
Q

When can we feed someone with a gastric outlet obstruction?

A

When gastric residual is less than 200mL after clamped for 8 to 12 hours, begin oral intake, progress to solids.

34
Q

What do we do if there is no relief or recurrence of gastric outlet obstruction?

A

Surgical intervention.

35
Q

What are some gerontologic considerations for PUD?

A
  • 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
36
Q

What is dumping syndrome?

A
  • 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
37
Q

How do we prevent dumping syndrome?

A
  • Eating less carbohydrates in a meal

- Resting after eating a meal

38
Q

What is postprandial hypogylcemia?

A
  • Variant of dumping syndrome

- Happens about 2 hours after eating

39
Q

What is Bile reflux gastritis?

A
  • Bile reflux causes damage to gastric mucosa, chronic gastritis and PUD.
  • Temporarily relieved with vomiting,
  • Administer cholestyramine - binds bile salts.
40
Q

What is pernicious anemia?

A

Loss of intrinsic factor, needed for absorption of cobalamin in terminal ileum, essential for RBCs.

41
Q

What do we administer cobalamin with?

A
  • Multivitamins with folate
  • Calcium
  • Vitamin D
  • Iron
    TAKEN FOREVER STOMACH LINING DOES NOT GROW BACK
42
Q

What do we give patients to improve wound healing?

A
  • Vitamin C
  • Potassium
  • Vitamin D
  • Vitamin K
  • B-complex
43
Q

What nutritional therapy do we give for patients post surgery?

A
  • Small frequent meals
  • No fluids with meals, chew thoroughly
  • Avoid simple sugars and fried foods
  • Avoid extreme food temperatures

Adult Health 1 Exam 3 Fall 2022 (8 decks)

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