Pain high in epigastrium - 1-2 hrs after meals - Burning or gaseous - Food aggravates pain as ulcer has eroded through gastric mucosa

Peptic Ulcer Disease Flashcards by Jamie Gronewold

Peptic Ulcer Disease

Erosion of GI mucosa resulting from digestive action of HCl acid and pepsin

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Acute Peptic Ulcer Disease

Superficial, minimal inflammation and short duration

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Chronic Peptic Ulcer Disease

Muscular wall involved, scar tissue, and longer duration

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Gastric vs Duodenal

Based on location

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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

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Etiology: Helicobacter pylori

Produces enzyme urase

-mediates inflammation making mucosa more vulnerable

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Etiology: Aspirin and NSAIDs

Inhibit syntheses of prostaglandins

-Cause abnormal permeability

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Etiology: Corticosteroids

Decrease rate of mucosal cell renewal

-Decrease protective effects

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Etiology: Lifestyle factors

Alcohol
Smoking
Coffee

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Etiology: stress (physiological and psychological)

Burns, Surgery, Sever medical illness, sepsis, traumatic injuries
Cushing ulcers

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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

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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

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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

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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

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3 major complications

Hemorrhage (most common)
Perforation
Gastric outlet obstruction (treatment)
*All considered emergency situations!

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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