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NS 313- Med Surg Exam 2 > Peptic Ulcer Disease > Flashcards

Peptic Ulcer Disease Flashcards

1
Q

What is peptic ulcer disease (PUD)?

Where can this occur?

A

Open Sores caused by Erosion of GI mucosa resulting from digestive action of HCl and Pepsin

-Can either be acute or chronic

  • Lower Esophagus
  • Stomach
  • Duodenum
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2
Q

Describe Acute PUD

Describe Chronic PUD

A

Acute: Superficial Erosion, Minimal Inflammation

Chronic: Muscular wall erosion with formation of fibrous tissue,
Present continuously for many months or intermittently

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3
Q

What has to occur for a peptic ulcer to develop?

A

HCl freely enters mucosa when barrier is broken –> Results in cellular destruction and inflammation –> Histamine is released –> Vasodilation –> Further Acid Secretion

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4
Q

What type of drugs can cause PUD and how?

A

Corticosteroid decreases rate of mucosal barrier cell renewal thereby decrease protective effects

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5
Q

What are some manifestations of Gastric Ulcers?

What are some manifestations of Duodenal Ulcers?

A

Gastric Ulcers:

  • Mid Epigastric Pain 1-2 hours after food
  • Burning, GASSY Feeling
  • Aggravation with Food

Duodenal Ulcers:

  • Pain Slightly Lower 4-5 hours after eating
  • Burning, CRAMPING Feeling
  • Pain Relief with food and antacids
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6
Q

What are 3 major complications of Peptic Ulcer Disease (PUD)?

A

Hemorrhage- Most common
Develops from Erosion

Perforation- Most Lethal Complication
Sudden, Dramagic Onset
Spillage of gastric or duodenal contents into peritoneal cavity

Gastric Outlet Obstruction- Duodenum Predisposes to Obstruction
Increased contractile force needed to empty stomach results in hypertrophy of stomach wall
Results in Dilation and Atony

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7
Q

What is the goal of Peptic Ulcer Disease Treatment?

A
  • Decrease degree of gastric acidity
  • Enhance mucosal defense mechanisms
  • Minimize harmful effects on mucosa
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8
Q

What are some nutritional therapies for Peptic Ulcer Disease (PUD)?

A
  • Hot, spicy foods and beverages (tea, coffee, broth)
  • Food high in roughage (undigestable) irritates an inflamed mucosa
  • Increase Protein Intake for neutralizing food
  • Milk can neutralize gastric acidity and protect GI mucosa
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9
Q

What are general treatments for PUD acute complications?

A

NG tube

Fluid and Electrolytes are replaced by IV infusion

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10
Q

What are treatments for PUD if Bleeding occurs?

A

(Similar for upper GI bleeding)

  • Blood may be administered
  • Careful monitoring of vital signs, I and O, and impending shock
  • Endoscopic Evaluation
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11
Q

What are treatments for PUD if Perforation occurs?

A
  • Immediate focus to stop spillage of gastric or duodenal contents into peritoneal cavity and restore blood volume
  • NG tube placed into stomach as near to perforation site as possible to facilitate decompression
  • Lactated Ringer’s and Albumin Solutions administered to replace blood volume
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12
Q

What is indicative of a malignant gastric outlet obstruction?

A

Short duration of pain or absence of pain

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13
Q

What are common complications of gastric outlet obstruction from PUD?

A

Recurrent Vomiting
Constipation
Dehydration
Lack of roughage in diet

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14
Q

What are some acute complications of PUD?

A

Bleeding
Increased Pain and Discomfort
N/V

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15
Q

What treatments for PUD if Gastric Outlet Obstruction occurs?

A

Decompress stomach with NG tube inserted into stomach

  • Results in stomach regaining normal muscle tone
  • Inflammation and EDEMA subside

IV fluids and electrolytes to correct dehydration and electrolyte imbalance from vomiting

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16
Q

What are some signs of a Hemorrhage from PUD?

A

Increased amount of redness of aspirate signals massive upper GI bleeding

Increased amount of blood in gastric contents and decreases pain because blood neutralizes acidic gastric contents

17
Q

What are some indications of Perforation of the bowel possibly from PUD?

A

Rigid, Board-Like Abdomen

Shallow, Grunting Respiration

Sudden, Severe abdominal pain unrelated in intensity and location to pain that brought patient to hospital

18
Q

What are some nursing action bowel perforation possibly from PUD?

A

Antibiotic therapy started

Surgical closure may be necessary if not spontaneously closed

19
Q

What are some nursing actions for a gastric outlet obstruction possibly from PUD?

A

Constant NG aspiration of stomach contents

Regular irrigation of NG tube

20
Q

Where are gastric outlet obstructions usually located?

A

Near pylorus sphincter

21
Q

What is a Bilroth I surgery and what is another name for it?

What is a Bilroth II surgery and what is another name for it?

A 
Partial gastrectomy (keep upper 2/3) with re-connection to DUODENUM
- Gastroduodenostomy
Partial Gastrectomy (keep upper 2/3) with re-connection to Jujenum
- Gastrojujenostomy
22
Q

What is a Vagotomy?

What is a Pyloroplasty?

A

Vagotomy- Cuts or “de-nerve” the vagus nerve on all or part of the stomach to reduce the rate of gastric secretions, usually to treat PUD

Pyloroplasty- Repair (expand) the pyloric opening (fixes gastric outlet obstruction)

23
Q

What does a combination of a Vagotomy with either a Bilroth I or II do?

A

Remove the Ulcer (Bilrtoh I or II) and the stimulus for additional secretions (Vagotomy decreases HCl, which would then less likely to cause PUD)

24
Q

What is one side effect of a direct removal of a large portion of the stomach and pyloric sphincter and what does it cause?

A

Dumping Syndrome- food moves from your stomach to your bowels too quickly
- Liquid Stools (Absorption is a Problem)

Decreased Calories
Weight Loss
Vitamin B12 deficiency because intrinsic factor is required

25
Q

What are some ways to minimize effects of Dumping Syndrome?

A
  • Smaller and more frequent meals
  • Avoid Bulk
  • Avoid fluid with meals
  • Avoid High Carbohydrate Diet
26
Q

What is Postprandial Hypoglycemia?

What do you do to treat it?

A

Posprandial Hypoglycemia- Release of excessive amounts of insulin into circulation (variant of dumping syndrome)

Treat with Bolus of fluid High in Carbs into Small Intestines

NS 313- Med Surg Exam 2 (14 decks)

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