Peptic Ulcer Disease Flashcards
What is peptic ulcer disease (PUD)?
Where can this occur?
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
Describe Acute PUD
Describe Chronic PUD
Acute: Superficial Erosion, Minimal Inflammation
Chronic: Muscular wall erosion with formation of fibrous tissue,
Present continuously for many months or intermittently
What has to occur for a peptic ulcer to develop?
HCl freely enters mucosa when barrier is broken –> Results in cellular destruction and inflammation –> Histamine is released –> Vasodilation –> Further Acid Secretion
What type of drugs can cause PUD and how?
Corticosteroid decreases rate of mucosal barrier cell renewal thereby decrease protective effects
What are some manifestations of Gastric Ulcers?
What are some manifestations of Duodenal Ulcers?
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
What are 3 major complications of Peptic Ulcer Disease (PUD)?
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
What is the goal of Peptic Ulcer Disease Treatment?
- Decrease degree of gastric acidity
- Enhance mucosal defense mechanisms
- Minimize harmful effects on mucosa
What are some nutritional therapies for Peptic Ulcer Disease (PUD)?
- 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
What are general treatments for PUD acute complications?
NG tube
Fluid and Electrolytes are replaced by IV infusion
What are treatments for PUD if Bleeding occurs?
(Similar for upper GI bleeding)
- Blood may be administered
- Careful monitoring of vital signs, I and O, and impending shock
- Endoscopic Evaluation
What are treatments for PUD if Perforation occurs?
- 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
What is indicative of a malignant gastric outlet obstruction?
Short duration of pain or absence of pain
What are common complications of gastric outlet obstruction from PUD?
Recurrent Vomiting
Constipation
Dehydration
Lack of roughage in diet
What are some acute complications of PUD?
Bleeding
Increased Pain and Discomfort
N/V
What treatments for PUD if Gastric Outlet Obstruction occurs?
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
What are some signs of a Hemorrhage from PUD?
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
What are some indications of Perforation of the bowel possibly from PUD?
Rigid, Board-Like Abdomen
Shallow, Grunting Respiration
Sudden, Severe abdominal pain unrelated in intensity and location to pain that brought patient to hospital
What are some nursing action bowel perforation possibly from PUD?
Antibiotic therapy started
Surgical closure may be necessary if not spontaneously closed
What are some nursing actions for a gastric outlet obstruction possibly from PUD?
Constant NG aspiration of stomach contents
Regular irrigation of NG tube
Where are gastric outlet obstructions usually located?
Near pylorus sphincter
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?
Partial gastrectomy (keep upper 2/3) with re-connection to DUODENUM - Gastroduodenostomy
Partial Gastrectomy (keep upper 2/3) with re-connection to Jujenum - Gastrojujenostomy
What is a Vagotomy?
What is a Pyloroplasty?
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)
What does a combination of a Vagotomy with either a Bilroth I or II do?
Remove the Ulcer (Bilrtoh I or II) and the stimulus for additional secretions (Vagotomy decreases HCl, which would then less likely to cause PUD)
What is one side effect of a direct removal of a large portion of the stomach and pyloric sphincter and what does it cause?
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
