Peptic ulcer disease Flashcards
Erosion of GI mucosa from HCl acid and pepsin
Peptic Ulcer Disease (PUD)
superficial erosion and minimal inflammation
acute
Erosion of muscular wall with formation of fibrous tissue; present continuously for long duration
Chronic
two types of ulcers
gastric (less common) & duodenal
gastric is felt
duodenal is felt
right after eating
2-5 hours after meal
Gastric characteristics
increased obstruction
increase mortality
high recurrence
more in females older than 50
Duodenal characteristics
35-45 y/o
High HCL secretion
occur, disappear, recur
Risk Factors
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
Epigastric discomfort 1 to 2 hours after meal; burning or gaseous pain; food may worsen
Gastric
Burning or cramp like pain in midepigastric or back; 2 to 5 hours after meal
c. Other: bloating, nausea, vomiting, early satiety
Duodenal
Diagnostic studies
Endoscopy-direct visualization (obtain specimens for H. pylori
Gastric Ulcer labs
CBC, liver enzymes, serum amylase
Stool-blood
Conservative care for gastric ulcers
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
Drug therapy for gastric ulcers
i. Reduce gastric acid secretion (PPI)
ii. Eliminate H. pylori (antibiotics and PPI)
Three major complications for gastric ulcers
hemorrhage, perforation, gastric outlet obstruction
Perforation s/s
severe abdominal pain
bowel sounds absent
respirations shallow
pulse increased & weak
If perforation untreated
Bacterial peritonitis occurs
Edema, inflammation, pylorospasm, or scar tissue cause obstruction in distal stomach and duodenum
Gastric Outlet Obstruction
Gastric outlet obstruction: if residual is less than
200 mL after clamped for 8-12 hrs..begin oral intake
Gastric risk factors
H. Pylori
NSAIDs
Bile reflux
Duodenal etiology
H. Pylori
Antibiotic Therapy
H. pylori 14 days of PCN; if allergic, metronidazole
i. Protects esophagus, stomach, and duodenum
ii. Works best in low pH; give 1 to 2 hours before or after antacid
Sucralfate (cytoprotective drug therapy)
acute care
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
Hemorrhage acute care
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
gastric outlet treatment
- Treatment: decompress with NGT; PPI or H2 receptor blocker; pain management; fluid and electrolyte replacement; surgery or balloon dilation
