Peptic Ulcer Disease Flashcards
Peptic Ulcer Disease
Erosion of GI mucosa resulting from digestive action of HCl acid and pepsin
Acute Peptic Ulcer Disease
Superficial, minimal inflammation and short duration
Chronic Peptic Ulcer Disease
Muscular wall involved, scar tissue, and longer duration
Gastric vs Duodenal
Based on location
Patho
Defects in gastric or duodenal mucosa that extends through muscularis mucosa
Develop only in presence of gastric acid
Excess gastric acid may not be necessary
Etiology: Helicobacter pylori
Produces enzyme urase
-mediates inflammation making mucosa more vulnerable
Etiology: Aspirin and NSAIDs
Inhibit syntheses of prostaglandins
-Cause abnormal permeability
Etiology: Corticosteroids
Decrease rate of mucosal cell renewal
-Decrease protective effects
Etiology: Lifestyle factors
Alcohol
Smoking
Coffee
Etiology: stress (physiological and psychological)
Burns, Surgery, Sever medical illness, sepsis, traumatic injuries
Cushing ulcers
Gastric Ulcers
Occurs in any portion of stomach Less common than duodenal ulcers Prevalent in women, older adults Peaking incidence >50 years of age Risk factors: H. pylori, medications, smoking, bile reflux
Duodenal Ulcers
Occur at any age and in anyone
-Increase between ages 35-45
Account for 80% 0f all peptic ulcers
Familial tendency
-Blood group O increased risk
Associated with increased HCl acid secretion
-Alcohol, cigarette smoking
H. pylori is found in 90% - 95% of patients
Increased risk:
-COPD, cirrhosis of liver, chronic pancreatitis, hyperparathyroidism, chronic kidney disease
Zollinger-Ellison syndrome
Gastric ulcer pain
Pain high in epigastrium
- 1-2 hrs after meals
- Burning or gaseous
- Food aggravates pain as ulcer has eroded through gastric mucosa
Duodenal Ulcer pain
Midepigastric region beneath xiphoid process
Back pain: if ulcer is located in posterior aspect
2-5 hrs after meals
Burning of cramplike
intermittent
3 major complications
Hemorrhage (most common)
Perforation
Gastric outlet obstruction (treatment)
*All considered emergency situations!
Gastric Outlet Obstruction
Both acute and chronic can result in this
Predisposition: ulcers located in antrum and pre-pyloric and pyloric areas of stomach/duodenum
Occurs due to:
-edema, inflammation, pyloro-spasm, fibrous scar tissue formation
Diagnostic studies
Endoscopy w/ biopsy
Tests for H. pylori:
-Urea breath test & stool antigen test
-biopsy and testing for urease (GOLD STANDARD)
Barium contrast study
Radioloy
Gastric analysis
Lab analysis
CBC
Liver enzymes
Guaiac stool test
Serum amylase
Medical regimen consists of:
Adequate rest Drug therapy Elimination of smoking and alcohol Dietary modification Long-term follow-up care Stress management
Collaborative care
Complete healing may take 3-9 weeks
-Should be assessed by means of x-rays or endoscopic examination
Aspirin and nonselective NSAIDs may be stopped for 4-6 weeks
Smoking cessation
Drug Therapy
H2R blockers PPI Antibiotics Antacids Anticholinergics Cytoprotective therapy Tricyclic antidepressants
Nutritional Therapy
Dietary modifications
-Food and beverages irritating to patient are avoided or eliminated
Bland diet may be recommended
Six small meals a day during symptomatic phase
Nursing assessment
Past Heatlh hx Medication usage Heartburn Weight loss Black, tarry stools Epigastric tenderness N/V Abnormal lab values
Overall goals
Comply w/ prescribed therapeutic regimen
Experience a reduction in or absence of discomfort
Exhibit no signs of GI complications
Have complete healing
Make lifestyle changes to prevent recurrence
Health promotion
Identify patients at risk
Provide early detection and treatment
Encourage patients to take ulcerogenic drugs w/ food or milk
Teach patient to report to health care provider symptoms r/t gastric irritation
Acute Interventions
NPO, possibly NG tube
IV Hydration
Explain treatment measures to patient/family
Provide regular mouth care
Cleanse and lubricate nares if NG tube is in place
Patient teaching
Disease
Drugs
Lifestyle changes
Regular follow up
Surgical therapy
Uncommon b/c of antisecretory agents Indications for interventions: -Unresponsive to medical management -concern about gastric cancer -perforation
Billroth 1: gastroduodenostomy
Partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of gastric stump to duodenum
Billroth 2: gastrojejunostomy
Partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of gastric stump to jejunum
Surgical therapies
Vagotomy -Severing of vagus nerve -can be total or selective -done to decrease gastric acid secretion Pyloroplasty -enlargement of pyloric sphincter -commonly done AFTER vagotomy (increases gastric emptying) -decrease gastric motility and emptying
Postoperative most common complications
Dumping syndrome
Postprandial hypoglycemia
Bile reflux gastritis
Dumping syndrome
Decrease ability of stomach to control amount of gastric chyme entering small intestine
- Large bolus of hypertonic fluid enters intestine
- Increases hypertonic fluid draw into bowel lumen
- Results in sudden decrease in plasma volume
Postprandial Hypoglycemia
Like dumping syndrome
Result of uncontrolled gastric emptying of a bolus of fluid high in carbs into small intestine
Bolus causes increase blood glucose and release of excessive amounts of insulin into circulation
Symptoms: sweating, weakness, mental confusion, palpitations, tachycardia, anxiety. Occur usually 2 hours after eating
Bile reflux gastritis
Can result in reflux of bile into stomach
Prolonged contact of bile, especially bile salts, causes damage to gastric mucosa, chronic gastritis, and recurrence of PUD
Vomiting relieves distress temporarily.
Continuous epigastric distress increases after meals if main symptom
Nutritional therapy postoperatively
Start as soon as immediate postoperative period has successfully passed
Patient should be advised to reduce drinking fluid (4oz) w/ meals
Postoperatively diet should consist of:
Small, dry feedings daily Low carbs Restricted sugar w/ meals Moderate amounts of protein and fat Rest for 30 min after each meal
Postoperative care
NG suction must be in working order and patency maintained
Observe for signs of decreased peristalsis and lower abdominal discomfort
Monitor VS
Encourage ambulation
Long term complication: pernicious anemia
