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z_NUR411_Medsurge: UNIT 2 > Stomach Disorders: Peptic, Gastric and Duodenal Ulcers > Flashcards

Stomach Disorders: Peptic, Gastric and Duodenal Ulcers Flashcards

1
Q

Where do most peptic ulcers occur?

A

• In the lesser curvature of the antrum

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2
Q

Where do most duodenal ulcers occur?

A

• Just after the pyloric sphincter

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3
Q

What is the normal pH range of the stomach?

A

• 1.5-3.5

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4
Q

Describe “erosion” of the stomach lining.

A

• It is a minor ulceration of the mucosal layer only and will heal on its own with care

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5
Q

Describe an acute ulcer of the stomach lining.

A
  • Penetrates the mucosal layer into the submucosa
  • Can reach the superficial layer of the muscularis
  • Bleeding can occur and result in hematemesis or melena
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6
Q

What is melena?

A

• dark sticky feces containing partly digested blood.

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7
Q

Describe a chronic ulcer of the stomach lining.

A
  • Penetrates to all layers of the stomach lining destroying all mucosal protective and parietal acid producing cells
  • Will cause scarring at the muscularis layer
  • If not treated, can progress to penetrate the serosal layer and cause stomach acid to leak into the peritoneum
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8
Q

What are some causes of breakdown to the gastric mucosal barrier?

A
  • “AAA BINH”
  • Acids
  • Bile salts
  • Aspirin
  • NSAIDs
  • Alcohol
  • Ischemia
  • H. pylori
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9
Q

Describe the ulceration process starting just after “breakdown of mucosal barrier”

A
  • Breakdown → acid diffusion into mucosa → destruction of mucosal cells → triggers increase of acid and pepsin release
  • This causes the feedback loop that causes deeper erosion over time until tx
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10
Q

The acid erosion of the mucosal layer triggers a histamine response. Describe it.

A
  • Histamine response triggers an increase to acid/pepsin release which feeds into the ulceration process
  • Histamine also triggers vasodilation and capillary permeability leading to loss of plasma into the gastric lumen and mucosal edema results
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11
Q

What are some s/s that indicate a possible gastric ulcer?

A
  • Gnawing, sharp midepigastric pain that usually occurs 30min-1hr of eating
  • Hematemesis
  • N/V
  • Pain relieved after vomiting
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12
Q

Most common risk factors for gastric ulcers are?

A
  • H. pylori
  • Alcohol
  • NSAIDs
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13
Q

Most common risk factors for duodenal ulcers?

A
  • H. pylori
  • Autoimmune disease
  • Zollinger-Ellison syndrome
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14
Q

What are some s/s that indicate a possible duodenal ulcer?

A
  • Mid-epigastric pain 2-4hrs after eating
  • Melena
  • Pain relief by eating
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15
Q

What is a psychological cause of ulcers?

A

• Stress

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16
Q

Which type of ulcer is likely to wake one up at night?

A

• Duodenal as the pain usually comes hours after eating

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17
Q

Define Peptic Ulcer Disease

A

• Ulceration of the mucosal wall of the stomach, pylorus, duodenum or esphagus

18
Q

What are the surgical interventions for severe gastric ulcers?

A
  • Billroth I
  • Billroth II
  • Total gastrectomy
19
Q

Prostaglandins do what to help ulcer healing but are contraindicative for who?

A
  • They inhibit acid secretions

* They are contraindicative for pregnant women

20
Q

What is the nursing care for a pt with suspected peptic ulcer disease?

A
  • Monitor VS
  • Small, freq, bland meals
  • Monitor for s/s of active bleeding
  • NPO (until dx is clear)
  • IV for fluids
  • Monitor I/O
  • Blood work (may determine blood xfusion need)
  • Monitor for s/s of hypovolemia (result of histamine reaction)
21
Q

Volume expansion due to the inflammation of the histamine reaction to the ulceration process can cause hypovolemia. What key electrolytes do we want to monitor?

A
  • Potassium
  • Magnesium
  • Phosphorus
22
Q

What does potassium do in the body?

A

• Potassium helps carry electrical signals to cells in your body. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells.

23
Q

What does magnesium do in the body?

A

• Supports muscle and nerve function and energy production

24
Q

What does phosphorus do for the body?

A

• The main function of phosphorus is in the formation of bones and teeth. It plays an important role in how the body uses carbohydrates and fats

25
Q

What will low potassium do to the body?

A
  • Deficiency typically occurs when your body loses a lot of fluid.
  • Common signs and symptoms of potassium deficiency include:
  • Weakness and fatigue
  • Muscle cramps/aches/stiffness
  • Tingles and numbness
  • Heart palpitations
  • Dyspnea
  • Digestive symptoms
  • Mood changes
26
Q

What will low magnesium do to the body?

A
  • Symptoms of magnesium deficiency include:
  • N/V
  • Fatigue
  • Muscle contractions, weakness.
  • Extreme or severe magnesium deficiency is a medical emergency and can cause life-threatening arrhythmias.
27
Q

What will low phosphorus do to the body?

A

• Symptoms of phosphorus deficiency include loss of appetite, anxiety, bone pain, fragile bones, stiff joints, fatigue, irregular breathing, irritability, numbness, weakness, and weight change

28
Q

What nursing education should be provided to help pt reduce ulcer risk?

A
  • Avoid alcohol, caffeine, chocolate
  • Smoking cessation
  • Avoid aspirin/NSAIDs
  • Get adequate rest
  • Reduce stress
29
Q

What is the peak age for gastric ulcers?

A

• 50-60yrs

30
Q

What is the peak age for duodenal ulcers?

A

• 35-40yrs

31
Q

With gastric ulcers, what causes hyposecretion of stomach acids?

A

• Destruction of parietal/chief cells

32
Q

What is the relationship between gastric and duodenal ulcers and risk for cancer?

A
  • Gastric ulcers can become cancer

* Cancer as a result of duodenal risk is rare

33
Q

What types of food are good for ulcer healing or prevention?

A
  • Avocados
  • Raw honey
  • Cabbage/KaleSpinach
  • Brussel sprouts
  • Celery
34
Q

What food should be avoided for ulcer pts?

A
  • Milk
  • Alcohol
  • Buttery pastries/Mayo
  • Bacon
  • Fries
  • Red meat
35
Q

What classes of drugs can cause a high risk for peptic ulcers?

A
  • Steroids
  • Biphosphonates
  • NSAIDs
  • Anticoagulants
  • SSRIs (Selective serotonin reuptake inhibitors)
  • Antiplatelets
36
Q

What are bisphosphonates used for and name 4.

A
  • Strengthen fragile bone conditions
  • Fosamax
  • Actonel
  • Boniva
  • Reclast
37
Q

Name 3 NSAIDs

A
  • Motrin
  • Naproxen
  • Celecoxib
38
Q

What type of pts may be on anticoags?

A
  • Post stroke

* Afib/disrythmia

39
Q

Name 3 anticoags that can increase risk of peptic ulcers

A
  • Warfarin
  • Eliquis
  • Pradaxa
40
Q

In an urgent situation, what is important to note regarding Warfarin and Eliquis?

A

• Warfarin use requires blood work, Eliquis does not

41
Q

What type of pts may be on SSRIs and name 4 of them.

A
  • Psych pts
  • Celexa
  • Prozac
  • Paxil
  • Zoloft
42
Q

What are 4 antiplatelets that can increase risk of peptic ulcers?

A
  • Aspirin
  • Plavix
  • Ticlid
  • Effient

z_NUR411_Medsurge: UNIT 2 (25 decks)

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