Peptic Ulcer Disease Flashcards
Ulceration of the gastric mucosa, duodenum, and rarely the lower esophagus and jejunum
Peptic Ulcer Disease
Most common PUD
Gastric and Duodenal
Types of PUD
Gastric Ulcers
Duodenal Ulcers
Stress Ulcers
resulted from stressful condition such as major surgery, sepsis, extensive burn injuries and hypoxia. Mostly involving the antrum of the stomach or duodenum causing hypoperfusion or ischemia to stomach lining
Curling’s Ulcer
resulted from a traumatic head injury, stroke, brain tumor, brain surgery causing increased ICP that overstimulate the vagus nerve and increase HCL production
Cushing’s Ulcer
removal of the stomach with attachment of the esophagus to the jejunum or duodenum (esophagojejunostomy)
Total Gastrectomy
surgical division of the vagus nerve to eliminate the vagal impulses that stimulate HCL acid secretion in the stomach
Vagotomy
removal of the lower half of the stomach (Antrectomy + Vagotomy)
Gastric Resection
partial gastrectomy with remaining segment anastomosed to the duodenum (Vagotomy+ Antrectomy + Duodenum)
Gastroduodenostomy (Billroth I)
partial gastrectomy with remaining segment anastomosed to the jejunum (Vagotomy+ Antrectomy + Jejunum)
Gastrojejunostomy (Billroth II)
enlargement of the pyloric sphincter to prevent or decrease pyloric obstruction and enhancing gastric emptying
Pyloroplasty
Rapid emptying of the gastric contents into the small intestine, occurs following gastric resection
Dumping Syndrome
Complications: PUD
Hemorrhage
Perforation
Pyloric obstruction
Intractable disease
Early signs of Dumping Syndrome (within 30 minutes after feeding)
Vertigo
Tachycardia
Syncope
Pallor
Desire to lie down
Late signs of Dumping Syndrome (1hr 30 minutes - 3hrs after feeding)
Dizziness
Light-headedness
Palpitations
Diaphoresis
Confusion
Stress, irregular hurried meals, smoking and alcoholism, caffeinated, fatty, spicy, acidic foods
Ulcerogenic medications, GI disorders - gastritis, Zollinger-Ellison Syndrome
Type A personality
Type O blood
Peptic Ulcer Disease
Assessment: Peptic Ulcer Disease
Alcohol and tobacco use
Use of corticosteroids, NSAIDS, aspirin
Epigastric tenderness, rigid, board like abdomen with rebound tenderness
Diminishing hyperactive bowel sounds, dyspepsia, vomiting
Peptic Ulcer Disease
Drug Therapy: PUD
- Triple Therapy (most successful regimen)
- Hyposecretory Drugs
- Mucosal Barrier Fortifiers
Drug Therapy
Lowers gastric secretion and increases resistance of mucosa to injury
Contraindication: Pregnancy
Misoprostol (cytotec)
Drug Therapy
Action - forms a seal over the ulcer, protecting it from irritation
Instruction - take 1hr before meals and at bedtime
Side effect - constipation
Sucralfate (carafate)
Management for Hypovolemia: PUD
- Monitor VS
- Monitor serum electrolytes
- Administer isotonic solutions
- If active bleeding - administer fresh frozen plasma
Management for Bleeding: PUD
- Signs of shock
- Perform gastric decompression or lavage
- Avoid NSAIDS to minimize GI bleeding
- Vasopressin (pitressin) - vasoconstricting drug
Management: Dumping Syndrome
- Small frequent feeding
- Do not take fluids with meals
- High protein, high fat, low to moderate carbohydrate diet
- Administer Pectin
Endoscopic Therapy: PUD
- Thermal conduct
- Inject bleeding site with diluted epinephrine
- Laster therapy
- Mechanical clip
Endoscopic Therapy: PUD
heater probe or multi-electrocoagulation
Thermal contact
Management for Dumping Syndrome
Diet
High protein, high fat, low to moderate carbohydrate diet
Management for Dumping Syndrome
Medication to prevent the syndrome
Pectin
