PUD Flashcards
PUD Risk factors (6)
- Helicobacter pylori infection
- NSAIDS
- excessive gastric secretion
- no evidence for spicy foods, caffeinated drinks or milk
- familial hx, blood type O
- chronic pulmonary or kidney disease
SKIP CARD
SKIP
What is the best post meal (2-4 h) position for the GERD client?
high fowlers
Risk factors of GERD
- obesity and diabetes
- alcohol, tobacco, very hot beverages
- smoking
- position 1-4 hours after meals delaying stomach emptying
Most common risk factor for PUD
-H. pylori infection –> contaminated food, water, close contact with infected patients or emesis
ex of NSAIDS, who is at a higher incidence of PUD
- ASA, ibuprofen
- geriatric population at higher incidence
what can cause excessive gastric acid secretion?
smoking and alcohol use
Stress ulcers –> physiologic stress, what can cause it? (4)
- disease process
- burns
- shock
- sepsis
Are stress ulcers different from PUD? do they spread quickly? Are they reversible?
yes they are different, they do spread quickly, they are reversible
PUD clinical manifestations (7)
- dull, gnawing pain or burning sensation
- mid epigastric or back pain (referred)
- relief after eating *****
- Pyrosis: heartburn
- vomiting
- diarrhea, consitapation
- GI Bleed
Why does PUD cause vomiting?
due to gastric outlet obstruction –> pyloric spasm, scarring or swelling from inflammation
In PUD, s/s GI bleed? (5)
increased BUN, bloody vomitus or stool, sensation of fullness, hypotension, tachycardia
PUD assessment and diagnostic findings (4)
- physical exam: epigastric pain and tenderness
- upper endoscopy: direct visualization and biopsy
- biopsy test, urea breath test, still antigen (H. pylori)
- CBC, VS, FOBT
Collaborative Management PUD
- antibiotics –> H. pylori
- manage gastric acidity (medications, lifestyle changes, surgery)
PUD Antibiotics (3)
- metronidazole
- amoxicillin
- clarithromycin
PUD PPIs (2), what do they do?
- pantoprazole
- omeprazole
-decrease gastric acid
H2 receptor blockers (2), what disease process are these not sued for?
- famotidine
- ranitidine
-not for H. pylori
Cimetidine is contraindicated for patients on _____.
NSAIDs (decrease gastric acid)
what do antacids do? When do you use them?
decrease acidity …. used after meals
PUD conservative therapy (8 therapies) (1 goal)
- cytoprotective: misoprostol, sucralfate (coats mucosa, give 30 minutes before meals)
- avoid NSAIDs
- follow prescribed regimen
- maintenance H2 receptor blockers dosage
- smoking cessation
- diet change: avoid extreme temperatures, alcohol, caffeinated beverages, decaf coffee
- 3 regular meals
- eat tolerated foods
- goal: avoid over secretion of acid
GERD 2016
patients of PPIs were 32% more likely to have a decline in kidney function, 28% more likely to develop chronic kidney disease and 96% more likely to develop kidney failure compared to H2 blockers
GERD 2018
-older adults on PPIs more at risk for GI infections (gut microbiome changes), PNA, and depression
GERD 2020
N-nitrosodimethylamine (probable human carcinogen) use in manufacturing ranitidine
PUD complications (4)
- hemorrhage: bright red, dark coffee-ground like
- perforation: sudden severe pain **, board-like abdomen, absent BS, changes in VS, bacterial peritonitis
- peritonitis
- gastric obstruction due to scarring, abcesses
