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MS Module 2 > Peptic Ulcer Disease > Flashcards

Peptic Ulcer Disease Flashcards

1
Q

Peptic Ulcer Disease

A

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

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2
Q

Acute Peptic Ulcer Disease

A

Superficial, minimal inflammation and short duration

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3
Q

Chronic Peptic Ulcer Disease

A

Muscular wall involved, scar tissue, and longer duration

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4
Q

Gastric vs Duodenal

A

Based on location

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5
Q

Patho

A

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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6
Q

Etiology: Helicobacter pylori

A

Produces enzyme urase

-mediates inflammation making mucosa more vulnerable

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7
Q

Etiology: Aspirin and NSAIDs

A

Inhibit syntheses of prostaglandins

-Cause abnormal permeability

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8
Q

Etiology: Corticosteroids

A

Decrease rate of mucosal cell renewal

-Decrease protective effects

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9
Q

Etiology: Lifestyle factors

A

Alcohol
Smoking
Coffee

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10
Q

Etiology: stress (physiological and psychological)

A

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

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11
Q

Gastric Ulcers

A 
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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12
Q

Duodenal Ulcers

A

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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13
Q

Gastric ulcer pain

A

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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14
Q

Duodenal Ulcer pain

A

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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15
Q

3 major complications

A

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

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16
Q

Gastric Outlet Obstruction

A

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

17
Q

Diagnostic studies

A

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

18
Q

Lab analysis

A

CBC
Liver enzymes
Guaiac stool test
Serum amylase

19
Q

Medical regimen consists of:

A 
Adequate rest
Drug therapy
Elimination of smoking and alcohol
Dietary modification
Long-term follow-up care
Stress management
20
Q

Collaborative care

A

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

21
Q

Drug Therapy

A 
H2R blockers
PPI
Antibiotics
Antacids
Anticholinergics
Cytoprotective therapy
Tricyclic antidepressants
22
Q

Nutritional Therapy

A

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

23
Q

Nursing assessment

A 
Past Heatlh hx
Medication usage
Heartburn
Weight loss
Black, tarry stools
Epigastric tenderness
N/V
Abnormal lab values
24
Q

Overall goals

A

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

25
Q

Health promotion

A

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

26
Q

Acute Interventions

A

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

27
Q

Patient teaching

A

Disease
Drugs
Lifestyle changes
Regular follow up

28
Q

Surgical therapy

A 
Uncommon b/c of antisecretory agents
Indications for interventions:
-Unresponsive to medical management
-concern about gastric cancer
-perforation
29
Q

Billroth 1: gastroduodenostomy

A

Partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of gastric stump to duodenum

30
Q

Billroth 2: gastrojejunostomy

A

Partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of gastric stump to jejunum

31
Q

Surgical therapies

A 
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
32
Q

Postoperative most common complications

A

Dumping syndrome
Postprandial hypoglycemia
Bile reflux gastritis

33
Q

Dumping syndrome

A

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
34
Q

Postprandial Hypoglycemia

A

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

35
Q

Bile reflux gastritis

A

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

36
Q

Nutritional therapy postoperatively

A

Start as soon as immediate postoperative period has successfully passed
Patient should be advised to reduce drinking fluid (4oz) w/ meals

37
Q

Postoperatively diet should consist of:

A 
Small, dry feedings daily
Low carbs
Restricted sugar w/ meals
Moderate amounts of protein and fat
Rest for 30 min after each meal
38
Q

Postoperative care

A

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

MS Module 2 (13 decks)

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