Peptic Ulcer Disease Flashcards
Peptic Ulcer Disease (PUD)
description
ulceration in mucosa of wall of the stomach, pylorus, duodenum or esoph.
damage may reach as deep down to muscle
PUDs are classifed as esophogreal, gastric, or duodenal
Gastric Ulcers
description
ulceration of the mucosal lining that extends to the submucosal lining of the stomach
Gastric Ulcers
RF
Stress
smoking
steroid use
NSAIDs
ETOH
past history
H. pylori infection
Gastric Ulcers
complications
hemorrhage
perforation
pyloric obstruction
Gastric Ulcers
assessment
gnawing sharp pain in or to the left of the mid-epigastric region occuring 30-60 min after a meal
hematemesis > melena
Gastric Ulcers
interventions
monitor VS and for SS of bleeding
Admin small, frequent bland feedings during active phase
admin H2 antagonists to lower acid secretion
admin antacids to lower pH
admin anticholinergics to lower motility
admin mucosal barrier protectorants 1 hr before meals
admin prostaglandins for protective antisecretory actions
Gastric Ulcers
eduction
no ETOH
avoid caffeine or chocolate products
Gastric Ulcers
interventions during active bleedings
VS closely
assess for dehydration, hypovolemia, shock, sepsis, respiratory insufficiency
NPO and give IV
I/O
monitor H/H
admin blood as prescribed
prep meds as needed for vasocontriction
Gastric Ulcers
sugical interventions
gastrectomy
vagotomy
gastric resection
Billroth I
Billroth II
Pyloroplasty
Gastrectomy
esophago-jejun-ostomy
esophago-duodun-ostomy
removal of the stomach with esoph attached to the jejunum or duodenum
Vagosomy
division of the vagus nerve to cut impulses that stim acid secretions in the stomach
gastric resection
antrectomy
removal of the lower stomach along with vagotomy
Billroth I
Gastro-duoden-ostomy
partial gastrectomy with the rest anastomosed to the duodenum
Bilroth II
Gastrojejunostomy
partial gastrostomy but anastomosed to the jejunum
Pyloroplasty
enlargement of the pylorus to prevent or decrease pyloric obstruction increasing gastric emptying
Gastric Ulcers
postoperative interventions
VS
Fowlers
Fluids for electrolytes
assess bowel sounds
monitor NG suction
NPO for 1-3 day until paristalsis returns
progressive diet from clear water onwards
monitor for postoperative complications (hemorrhage, dumping syndrome, diarrhea, hypoglycemia, B12 deficincy)
why shouldnt NG tubes be irrigated or removed following Gastric surgery unless prescribed ?
RF disruption of the Gastric sutures
monitor to prevent strain on the internal suture site
Duodenal Ulcer
description
break in the duodenal mucosa
Duodenal Ulcer
RF
H pylori infection
ETOH
smoking
Stress
caffeine
asprin/NSAIDs
steroids
Duodenal Ulcer
complications
bleeding
perforations
gastric outlet obstructions
intractable disease
Duodenal Ulcer
assessment
burning pain in mid-epigastric area 1.5-3 hours after eating and at night that wakes pt
melena > hematemesis
pain is often relieved by eating
Duodenal Ulcer
interventions
VS
small freq bland meals
adequate rest
no smoking; avoiding ETOH, caffeine, asprin, steroids, NSAIDs
H2 anatagonists or PPIs
Duodenal Ulcer
surgical interventions
only is unresponsive to meds
or if hemorrhage, perforation, obstruction occurs
dumping syndrome
description
rapid emptying of stomach contents into SI following gastric resection
dumping syndrome
assessment
SS occuring 30 min after eating
NV
abd fullness, and cramping
Diarrhea
palipations and TC
perspiration
weakness and dizziness
borborygmi (loud gurgling <=bowel hypermotility)
dumping syndrome
education
avoid sugar, salt and milk
high protein, high fat, low carb diet
small meals and avoid drinks with meals
lie down after meals
take antispasmodic meds to delay gastric emptying
