PUD - Text Flashcards

1
Q

What is a peptic ulcer?

A

an excavation that forms in mucosal wall of stomach, pylorus (opening between stomach and duodenum), in duodenum, or esophagus
• Cause = Helicobactor pylori infection
• erosion of mucous membrane, may extend into muscle or through to peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where in the stomach do chronic ulcers tend to occur?

Most common place in general?

A

Chronic ulcers tend to occur in lesser curvature near pylorus

•Most often occur in duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Esophageal ulcers often result of?

A

GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When does PUD commonly occur?

A

PUD typically occurs in ages 40-60yrs

but can be in children and infants; rare in women of childbrearing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does helicobactor pylori spread?

DO all of those infected get PUD?

A
  • In food and water, person-to-person via emesis

* Not all infected by H. Pylori have ulcers – mechanism of this is not entirely understood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk factors for PUD?

A
  • Stress, Caffeine, smoking, milk, and alcohol can lead to inc HCl production, which is turn can contribute
  • Predispositions: Type O blood (familial ties), COPD, chronic renal disease, chronic NSAID use, alcohol + smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

WHat is a stress ulcer?

A

= acute mucosal ulceration that occurs after physiological stressful event (burns, shock, sever sepsis) → not peptic ulcers, will grow in numbers until stressful event subsides, typical after sx
o Result from shock → causing ischemia, resulting in inc acid and pepsin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Patho of PUD?

A
  • Gastroduodenal mucosa can’t withstand digestive action of HCl and pepsin
  • Damaged mucosa cannot secrete enough mucus for protection
  • NSAIDs dec mucous secretion
  • Gastric ulcer = typically abn high HCl secretion; duodenal = abn low or normal levels of HCl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical manifestations of PUD?

A
  • Many ppl have no symptoms or may be intermittent
  • May disappear and reappear, last days to months
  • Perforation or hemorrhage may occur in 20-30% of those with no preceding mnfts
  • Have dull, gnawing pain or burning sensation in midepigastrium or back
  • Pain relieved by eating (or taking alkali) b/c food neutralizes acid
  • Sharply localized tenderness with pressure
  • Vomiting rare in duodenal ulcer, caused by obstruction of pyloric orifice (may not be preceded by nausea but rather bout of pain and bloating)
  • Constipation and diarrhea possible
  • Melena (tarry stools) occurs d/t bleeding – 15% of cases bleed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diagnostics in PUD?

A
  • Physical exam: pain, epigastric tenderness, or abdominal distension
  • Endoscopy preferred b/c can have visualization of lesion, biopsy taken
  • Barium study may show ulcer
  • Stools may be tested periodically
  • H Pylori found via endoscopy, histology, serology, stool antigen test, urea breath test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Medical management of PUD?

A

• Goal is to eradicate H pylori and manage gastric acidity
• Medications, lifestyle changes, and surgical intervention used
- Stress reduction
- Smoking reduction
- Dietary modifications
- Sx mangement
• Pharmacology: abx, PPI’s, H2RAs, and bismuth salts (aka Pepto Bismol) to suppress H Pylori
o Pt given rest, sedatives, and tranquilizers for comfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Possible stress reduction measures used in pt’s with IBD?

A

biofeedback, hypnosis, behavior mod & massage may be helpful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why is smoking cessation important for PUD?

A

smoking reduced bicarbonate production from pancreas (makes duodenum more acidic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dietary changes made in PUD?

A

to reduce acid production and hypermotility

Avoid consumption of extreme temp foods, meat extracts, alcohol, coffee, caffeine, milk and cream

3 regular meals; stop consumption of those foods that cause pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is surgical management used in PUD?

A

rare but recommended for those with intractable ulcers (fail to health w 12-16wks medical treatment), hemorrhage, performation, obstruction, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Assessments done for PUD pt? What kind of fundings?
When does pain typically occur?
What is it relieved by?

A

• Pain – usually occurs 2 hours after meal, awakens pt between midnight and 3AM
–> Relieved by antacids, vomiting, eating

  • Qualities of emesis, tarry stool?
  • Describe food habits
  • Smoking, alcohol, NSAID use
  • Vitals – tachycardia and hypotension possibl from GI bleed
  • Palpation of abdomen for tenderness
  • Stool sample
17
Q

Typical nursing diagnoses related to PUD?

A
  • Acute pain r/t effects of gastric acid secretion on damaged tissue
  • Imbalanced nutrition r/t changes in diet
  • Anxiety r/t acute illness
  • Deficient knowledge about prevention of symptoms and management of condition
18
Q

Possible PUD complications?

A

hemorrhage, perforation, penetration, pyloric obstruction

19
Q

Primary nursing interventions for PUD?

A

1) Pain relief
2) Reducing anxiety
3) Maintain optimal nutritional status (assess for malnutrition and weight loss)
4) Monitoring and managing potential complications

20
Q

What interventions are possible for pain relief in PUD?

A

give meds

avoid aspirin, caffeine, decaf coffee

relaxation techniques

21
Q

What complication is most common in pUD?

A

Hemorrhage (10-20% of cases)

22
Q

How might hemm be seen in PUD?

A

• Seen as hematemesis or melena (may vomit bright red or coffee grounds)

  • Assess for faintness, dizziness, nausea
  • Look for tachycardia, hypotension, tachypnea
  • Monitor HCt, Hb
  • Stool tests for frank or occult blood
  • Hourly urinary output (look for anuria or oliguria)
23
Q

What is important to determine if pt seems to be hemorrhaging?

A
  • Important to identify extent of bleeding – can be fatal!

* High blood loss or recurrence likely requires sx

24
Q

Interventions if hemorrhage in occurring?

A

• Insert peripheral IV for LR, NS, or blood products

  • NG tube inserted to differentiate fresh blood and coffee grounds, aid in removal of clots and acid, prevent nausea and vomiting
  • Possible urinary catheter + monitor output
  • O2 sats
  • Positioning pt: recumbent for hypotension, on side if vomiting
  • Treating hemorrhagic shock
  • Possible endoscopic repair or selective embolization (inserting clot to prevent bleeding)
25
Q

What is perforation with PUD?

What is penetration?

How serious is this?

A

erosion of ulcer through gastric serosa into peritoneal cavity w/o warning

erosion of ulcer through gastric serosa into adjacent structures such as pacreas, biliary tract, or omentum

26
Q

S&S of perforation and penetration in PUD?

A

sudden severe upper abdominal pain, may refer to shoulders d/t irritation of phrenic nerve;
vomiting
collapse
extremely tender and rigid abdomen, hypotension, tachycardia (d/t shock)
o Chemical peritonitis develops within few hours, followed by bacterial peritonitis

27
Q

How serious is perforation in PUD?

A

o Is medical emergency, requires immediate sx

28
Q

How is penetration treated?

A

o Usually requires sx

**Pain not relieved by previously successful measures (such as meds)

29
Q

What is a pyloric obstruction?

Aka?

A

• Aka gastric outlet obstruction (GOO) = area distal to pyloric sphinctor becomes scarred and stenosed from spasm or edema or from scar tissue that forms when ulcer heals and breaks down

30
Q

S&S of pyloric obstruction?

Tx?

A
  • Pt has nausea, vomiting, epigastric fullness, anorexia, weight loss
  • Stomach drained by NG tube (>400ml strongly suggests obstruction)
  • Endoscopy performed, possible sx