Peptic ulcer disease

Question 1

Erosion of GI mucosa from HCl acid and pepsin

Answer 1

Peptic Ulcer Disease (PUD)

Question 2

superficial erosion and minimal inflammation

Answer 2

acute

Question 3

Erosion of muscular wall with formation of fibrous tissue; present continuously for long duration

Answer 3

Chronic

Question 4

two types of ulcers

Answer 4

gastric (less common) & duodenal

Question 5

gastric is felt

duodenal is felt

Answer 5

right after eating

2-5 hours after meal

Question 6

Gastric characteristics

Answer 6

increased obstruction
increase mortality
high recurrence
more in females older than 50

Question 7

Duodenal characteristics

Answer 7

35-45 y/o
High HCL secretion
occur, disappear, recur

Question 8

Risk Factors

Answer 8

a. H. pylori
i. Major risk factor
ii. 80% gastric
iii. 90% duodenal
b. Transmission
i. Oral-oral or fecal-oral
ii. Black and Hispanic
c. Long survival (activates immune response)
i. Never develops ulcer, it just lays there
d. Produce urease
e. Medication-Induced Injury
i. NSAIDs; especially with
ii. Corticosteroids or anticoagulants

Question 9

Epigastric discomfort 1 to 2 hours after meal; burning or gaseous pain; food may worsen

Answer 9

Gastric

Question 10

Burning or cramp like pain in midepigastric or back; 2 to 5 hours after meal
c. Other: bloating, nausea, vomiting, early satiety

Answer 10

Duodenal

Question 11

Diagnostic studies

Answer 11

Endoscopy-direct visualization (obtain specimens for H. pylori

Question 12

Gastric Ulcer labs

Answer 12

CBC, liver enzymes, serum amylase

Stool-blood

Question 13

Conservative care for gastric ulcers

Answer 13

i. Adequate rest, no smoking or alcohol, stress management, dietary modifications
ii. Pain management. No NSAIDs or aspirin 4 to 6 weeks unless administered with PPI, H2 receptor blocker, or misoprostol
iii. Endoscopic evaluation and follow-up; 3 to 6 months for healing

Question 14

Drug therapy for gastric ulcers

Answer 14

i. Reduce gastric acid secretion (PPI)

ii. Eliminate H. pylori (antibiotics and PPI)

Question 15

Three major complications for gastric ulcers

Answer 15

hemorrhage, perforation, gastric outlet obstruction

Question 16

Perforation s/s

Answer 16

severe abdominal pain
bowel sounds absent
respirations shallow
pulse increased & weak

Question 17

If perforation untreated

Answer 17

Bacterial peritonitis occurs

Question 18

Edema, inflammation, pylorospasm, or scar tissue cause obstruction in distal stomach and duodenum

Answer 18

Gastric Outlet Obstruction

Question 19

Gastric outlet obstruction: if residual is less than

Answer 19

200 mL after clamped for 8-12 hrs..begin oral intake

Question 20

Gastric risk factors

Answer 20

H. Pylori
NSAIDs
Bile reflux

Question 21

Duodenal etiology

Answer 21

H. Pylori

Question 22

Antibiotic Therapy

Answer 22

H. pylori 14 days of PCN; if allergic, metronidazole

Question 23

i. Protects esophagus, stomach, and duodenum

ii. Works best in low pH; give 1 to 2 hours before or after antacid

Answer 23

Sucralfate (cytoprotective drug therapy)

Question 24

acute care

Answer 24

i. NPO, NGT, IV fluids, VS, monitor for shock
ii. Gastric content analysis; check pH, blood, or bile
iii. Monitor labs
iv. Manage pain and anxiety; restful environment

Question 25

Hemorrhage acute care

Answer 25

i. Monitor VS, NG aspirate
ii. See interventions for upper GI bleeding
iii. Will have a decrease in pain bc the blood neutralizes acids in stomach

Question 26

gastric outlet treatment

Answer 26

3. Treatment: decompress with NGT; PPI or H2 receptor blocker; pain management; fluid and electrolyte replacement; surgery or balloon dilation