peptic ulcer disease

Question 1

what is a peptic ulcer?

Answer 1

ecavation in mucosal wall of the stomach, in pylorus or duodenum
-can go through tissue into peritoneum

Question 2

potential causes and risk factors?

Answer 2

• infection from helicobacter pylori
• excessive secretion of Hcl
• familial tendency
• ppl with type O blood
• chronic use of: NSAIDs, alcohol, excessive smoking

Question 3

what is H. pylori

Answer 3

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

Question 4

clinical manifestations of PUD?

Answer 4

• many ppl hav no symptoms
• symptoms may differ depending on location of ulcer
• pain
• pyrosis
• eructation
• vomiting (rare- complication)
• bleeding (occult and/or melena)

Question 5

assessments for PUD?

Answer 5

family history, blood, vomit, pain, med history, infection, tenderness, abd distension…. if ulcer bleeding: hyptension

Question 6

diagnostics for PUD?

Answer 6

• 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)

Question 7

potential complications of PUD?

Answer 7

• perforation
• hemorrhage
• penetration
• pyloric obstruction

Question 8

nursing diagnosis examples for PUD?

Answer 8

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??

Question 9

proton pump inhibitors???

Answer 9

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!!

Question 10

examples of PPIs?

Answer 10

omeprazole, esomeprazole, rabeprazole

Question 11

h2 antagonists??

Answer 11

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

Question 12

examples of H2 antagonists?

Answer 12

ranitidine, famotidine, cimetidine
RANITINE recently recalled at VIHA, replaced with pantoprazole (PPI)
-in peds using famotidine

Question 13

antacids for PUD?

Answer 13

• 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!!!

Question 14

examples of antacids??

Answer 14

• calcium carbonate (TUMS)
• magnesium hydroxide (MILK OF MAGNESIA)
• aluminum hydroxide (ALMAGEL)

Question 15

antibiotics for PUD?

Answer 15

if caused by h. pylori—-> antibiotics!!
clarithromycin and amoxicillin (or metronidazole for penicillin allergies)
10-14 days!!! triple therapy!!!
2 antibiotics + PPI or H2Ra

Question 16

what is zollinger-ellison syndrome?

Answer 16

severe petic ulcers, extreme gastric hyperacidity, gastrin-secreting benign or malignant tumors in pancreas

Question 17

why are NSAIDs bad with PUD?

Answer 17

inhibit secretion of mucus that protects mucosa

Question 18

why is pain relieved by eating?

Answer 18

food neutralizes the acid but once its empty the pain returns

Question 19

why can stress reduction and rest help PUD?

Answer 19

• reduce environmental stress as hectic lifestyle may worsen symptoms
• biofeedback, hypnosis, behaviours modification, massage, acupuncture may help

Question 20

dietary modifications?

Answer 20

• avoid extreme temps of foods

- avoid alcohol, coffee, rich in milk or cream

Question 21

hemorrhage as a complication?

Answer 21

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

Question 22

treatment of hemorrhage?

Answer 22

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

Question 23

perforation and penetration?

Answer 23

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

Question 24

pyloric obstruction?

Answer 24

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