peptic ulcer disease Flashcards
what is a peptic ulcer?
ecavation in mucosal wall of the stomach, in pylorus or duodenum
-can go through tissue into peritoneum
potential causes and risk factors?
- infection from helicobacter pylori
- excessive secretion of Hcl
- familial tendency
- ppl with type O blood
- chronic use of: NSAIDs, alcohol, excessive smoking
what is H. pylori
gram negative bacteria
may be acquired through ingestion of food and water
most infected ppl do not develop ulcers
testing is recommended ONLY if a PUD
clinical manifestations of PUD?
- many ppl hav no symptoms
- symptoms may differ depending on location of ulcer
- pain
- pyrosis
- eructation
- vomiting (rare- complication)
- bleeding (occult and/or melena)
assessments for PUD?
family history, blood, vomit, pain, med history, infection, tenderness, abd distension…. if ulcer bleeding: hyptension
diagnostics for PUD?
- testing for H. pylori (urea breath test, serology or blood antibody test, endoscopic biopsy, stool culture)
- stools for occult blood
- endoscopy
- upper GI series (barium swallow)
potential complications of PUD?
- perforation
- hemorrhage
- penetration
- pyloric obstruction
nursing diagnosis examples for PUD?
acute pain
anxiety related to acute illness
imbalanced nutrition related to changes in diet
deficient knowledge about prevention of symptoms and management of condition
gastric decompression??
proton pump inhibitors???
irreversible inhibition of the proton pump (generates gastric acid) in parietal cells
-use: gastric and duodenal ulcers, GERD, zollinger-ellison syndrome
-side effects: minimal when short term. headache, diarrhea, n/v, increase risk of fractures, pneumonia, acid rebound, cdiff, hypomangesemia, gastric cancer
considerations???
-effects can last for weeks! watch for cdiff! assess pain, signs of bleeding! one hour before meals! lowest dose short time!!
examples of PPIs?
omeprazole, esomeprazole, rabeprazole
h2 antagonists??
block h2 receptors on gastric parietal cells.
suppresses secretion of gastric acid
-decreases volume of gastric fluid and increases pH
use: GERD, gastric and duodenal ulcers, preop prep
-side effects: serious not common, headache, diarrhea, n and v, increased suscpetibility to infection
examples of H2 antagonists?
ranitidine, famotidine, cimetidine
RANITINE recently recalled at VIHA, replaced with pantoprazole (PPI)
-in peds using famotidine
antacids for PUD?
- alkaline substances used to neutralize stomach acid, may also enhance mucosal production
- relatively safe, inexpensive
- may contain: aluminum, magnesium, sodium bicarbonate, alginate, calcium
- ALUMINUM formulas contraindicated in renal failure!!!
examples of antacids??
- calcium carbonate (TUMS)
- magnesium hydroxide (MILK OF MAGNESIA)
- aluminum hydroxide (ALMAGEL)
antibiotics for PUD?
if caused by h. pylori—-> antibiotics!!
clarithromycin and amoxicillin (or metronidazole for penicillin allergies)
10-14 days!!! triple therapy!!!
2 antibiotics + PPI or H2Ra
what is zollinger-ellison syndrome?
severe petic ulcers, extreme gastric hyperacidity, gastrin-secreting benign or malignant tumors in pancreas
why are NSAIDs bad with PUD?
inhibit secretion of mucus that protects mucosa
why is pain relieved by eating?
food neutralizes the acid but once its empty the pain returns
why can stress reduction and rest help PUD?
- reduce environmental stress as hectic lifestyle may worsen symptoms
- biofeedback, hypnosis, behaviours modification, massage, acupuncture may help
dietary modifications?
- avoid extreme temps of foods
- avoid alcohol, coffee, rich in milk or cream
hemorrhage as a complication?
bright red or dark coffee grounds, large amts vomited up
assess symptoms
mostly stops on own, if recurs within 48 hours or lots of blood—> surgery
treatment of hemorrhage?
blood therapy when signs of shock IV fluids o2 sats NG lavage of saline recumbet position legs elevated to prevent hypotension, left side to prevent aspiration
perforation and penetration?
erosion of ulcer through gastric serosa into peritoneal cavity…. immediate surgery… sudden severe upper abdomen pain, vomit, collapse, extremely tender abdomen, hypotension and tachycardia—> shock
-chemical peritonitis within few hours
pyloric obstruction?
area distal to pyloric sphincter becomes scared and stenosed from spasms or edema or scar tissue, NG tube, residual of more than 400ml fluid suggests obstruction… may beed surgery
