PUD (Class)

Question 1

Causes/risk factors for PUD?

Answer 1

• Infection from Helicobacter pylori
• Excessive secretion of HCL (r/t stress (life, hospitilization, sepsis), milk, caffinated beverages, smoking, ETOH

Chronic use of:
     -NSAID’s
     -ETOH
     -Excessive smoking
? Familial tendency
? People with Type O blood

Question 2

In which population does PUD NOT generally occur?

Answer 2

Women of childbearing age

Question 3

How does NSAIDs contribute to formation of PUD?

Answer 3

-NSAID inhibit the secretion of mucous to protect the gastric mucosal layer.

Question 4

How is H pylori spread?

Answer 4

Food + water

-Can also be caused through person-person transmission of the bacteria (close contact and exposure to emesis)

Question 5

Do all of those infected with H Pylori get ulcers?

Answer 5

NO

• more than 50% of the worlds’ population harbor H. Pylori in their upper GI tract
  
  • 80% of people are asymptomatic (?may play a role in natural stomach ecology)
• It is not known why HP infection does not cause ulcers in all people
  
  • most likely, predisposition to ulcer formation depends on certain factors like type of HP

Question 6

WHere in the world is infection with H pylori more prevalent?

Answer 6

in developing countries

Question 7

How does a urea breath test work?

Answer 7

-based upon the ability of HP to convert urea to ammonia and CO2; pt swallow urea labelled with an uncommon isotope (radioactive carbon-14 or non-radioactive carbon-13  10-30 minutes: detection of isotope-labelled CO2 in breath indicates the urea was split  indicates that urease (enzyme that HP uses to metabolize urea) is present in the stomach  HP bacteria are present

Question 8

How is PUD treated?

Answer 8

Treatment: one week “triple therapy” consisting of PPI (omeprazole); and antibiotics clarithromycin and amoxicillin (or metronidazole for pen allergies)

Question 9

Clinical manifestations of PUD?

Answer 9

• Symptoms may differ depending on the location of the ulcer (duodenal vs gastric)
• Pain (or not, dull or burning)
• Pyrosis (heartburn)
• Eructation (burping)
• Vomiting
• Constipation
• Diarrhea
• Bleeding (occult and/or melena)

Question 10

Assessments for pt with PUD?

Answer 10

Does the patient have any history of potential causes/risk factors? RQRST related to pain? Medications (prescribed and OTC)

• describe pain and methods to relieve pain
• characteristics of vomitus (?red; ?coffee grounds)
• 24hour diet record/food habits
• lifestyle habits (?smoking; ?NSAID’s; ?stress)
• palpate for localized tenderness

Question 11

What would you potentially find or not during the physical assessment?

Answer 11

-Episgastric tenderness, abdo distention; tachycardia/hypotension (?anemia from GI bleeding)

Question 12

Labs important in PUD?

Answer 12

Hgb for bleeding (platelets, ptt PTINR)

Na, K, renal function for vomiting/diarrhea ,decreased oral intake, medication use

Question 13

Key aspects of medical management of PUD?

What meds, lifestyle changes, sx

Answer 13

Medications: antibiotics, proton pump inhibitors, bismuth salts, histamine 2 receptor antagonists (adherence to regime important)

Lifestyle changes: stress reduction, dietary changes, smoking cessation

Surgical intervention: for intractable ulcers, life threatening haemorrhage, perforation or obstruction

Question 14

4 main potential problems for PUD?

Answer 14

hemmorrhage

• perforation
• penetration
• pyloric obstruction

Question 15

Key planning/goals for nursing intervention in PUD?

Answer 15

• relief of pain
• reduce anxiety
• maintenance of nutritional requirements
• knowledge about management and prevention of ulcer recurrence
• absence of complications

Question 16

Goals in changing diet with pUD?

Answer 16

• Avoid over-secretion of acid

- Minimize hypermotility

Question 17

What ending indicates a proton pump inhibitor?

Answer 17

-prazole

Pantoprazole (Pantoloc)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Omeprazole (Losec)
Rabeprazole (Pariet EC)

Question 18

PPIs
New or old?
What are they used for?
What do they do?

Answer 18

Relatively new

Widely used for the treatment of PUD and GERD

Block the gastric proton pump found in the gastric parietal cells  targets the terminal step in acid production

Example: Omeprazole (Losec)

Question 19

H2RA

How do they work?
When are they used?

Answer 19

H2 receptors are responsible for increasing acid secretion in the stomach

Effective at suppressing the volume/acidity of stomach acid

Also used pre-operatively

Example: Ranitidine (Zantac)

Question 20

H2RA
What kind of dietary consideration is required for these drugs?
Other adverse effects?

Answer 20

can cause Vitamin B12 deficiency (stomach acid helpful in absorption)

• MS changes in elderly
• can also cause UTOX to come back positive for amphetamines!

Question 21

Antacids
What are they made from?
Examples?

Answer 21

Made from: aluminum/magnesium/calcium/potassium/sodium hydroxide or bicarbonate

Example: Maalox; MOM; TUMS
Maalox = Aluminum bicarbonate
MOM = Magnesium hydroxide
Tums = Calcium carbonate

Question 22

Pink Lady – Maalox and viscous xylocaine Why use it?

Answer 22

used for GERD in an acute pain episode, not given routinely.

xylocaine = lidocaine = anesthetic

Question 23

Who are antacids contraindicated in? Which are less harmful in this regard?

Answer 23

-contraindicated for people with renal failure (aluminum may accumulate to toxic levels)
–calcium based formulas pose less risk

Question 24

What antibiotics are used in PUD?

Answer 24

Carithromycin and amoxicillin (or metronidazole for penicillin allergies)

Question 25

Why are two antibiotics used in tx of PUD?

Answer 25

so resistance doesn’t develop to one (?)- says on slides

Question 26

Your patient tells you that his previous medication, ranitidine (Zantac) is cheaper than what the doctor has prescribed. What is the advantage of PPI over H2 Antagonists?

Answer 26

More effective at reducing gastric secretions

Question 27

Why does a patient routinely receive an H2 antagonist or PPI post-op or while in hospital with an acute medical problem?

Answer 27

Decrease risk of stress ulcers