Stomach Disorders: Peptic, Gastric and Duodenal Ulcers Flashcards
Where do most peptic ulcers occur?
• In the lesser curvature of the antrum
Where do most duodenal ulcers occur?
• Just after the pyloric sphincter
What is the normal pH range of the stomach?
• 1.5-3.5
Describe “erosion” of the stomach lining.
• It is a minor ulceration of the mucosal layer only and will heal on its own with care
Describe an acute ulcer of the stomach lining.
- Penetrates the mucosal layer into the submucosa
- Can reach the superficial layer of the muscularis
- Bleeding can occur and result in hematemesis or melena
What is melena?
• dark sticky feces containing partly digested blood.
Describe a chronic ulcer of the stomach lining.
- 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
What are some causes of breakdown to the gastric mucosal barrier?
- “AAA BINH”
- Acids
- Bile salts
- Aspirin
- NSAIDs
- Alcohol
- Ischemia
- H. pylori
Describe the ulceration process starting just after “breakdown of mucosal barrier”
- 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
The acid erosion of the mucosal layer triggers a histamine response. Describe it.
- 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
What are some s/s that indicate a possible gastric ulcer?
- Gnawing, sharp midepigastric pain that usually occurs 30min-1hr of eating
- Hematemesis
- N/V
- Pain relieved after vomiting
Most common risk factors for gastric ulcers are?
- H. pylori
- Alcohol
- NSAIDs
Most common risk factors for duodenal ulcers?
- H. pylori
- Autoimmune disease
- Zollinger-Ellison syndrome
What are some s/s that indicate a possible duodenal ulcer?
- Mid-epigastric pain 2-4hrs after eating
- Melena
- Pain relief by eating
What is a psychological cause of ulcers?
• Stress
Which type of ulcer is likely to wake one up at night?
• Duodenal as the pain usually comes hours after eating
Define Peptic Ulcer Disease
• Ulceration of the mucosal wall of the stomach, pylorus, duodenum or esphagus
What are the surgical interventions for severe gastric ulcers?
- Billroth I
- Billroth II
- Total gastrectomy
Prostaglandins do what to help ulcer healing but are contraindicative for who?
- They inhibit acid secretions
* They are contraindicative for pregnant women
What is the nursing care for a pt with suspected peptic ulcer disease?
- 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)
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?
- Potassium
- Magnesium
- Phosphorus
What does potassium do in the body?
• 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.
What does magnesium do in the body?
• Supports muscle and nerve function and energy production
What does phosphorus do for the body?
• 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
What will low potassium do to the body?
- 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
What will low magnesium do to the body?
- 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.
What will low phosphorus do to the body?
• Symptoms of phosphorus deficiency include loss of appetite, anxiety, bone pain, fragile bones, stiff joints, fatigue, irregular breathing, irritability, numbness, weakness, and weight change
What nursing education should be provided to help pt reduce ulcer risk?
- Avoid alcohol, caffeine, chocolate
- Smoking cessation
- Avoid aspirin/NSAIDs
- Get adequate rest
- Reduce stress
What is the peak age for gastric ulcers?
• 50-60yrs
What is the peak age for duodenal ulcers?
• 35-40yrs
With gastric ulcers, what causes hyposecretion of stomach acids?
• Destruction of parietal/chief cells
What is the relationship between gastric and duodenal ulcers and risk for cancer?
- Gastric ulcers can become cancer
* Cancer as a result of duodenal risk is rare
What types of food are good for ulcer healing or prevention?
- Avocados
- Raw honey
- Cabbage/KaleSpinach
- Brussel sprouts
- Celery
What food should be avoided for ulcer pts?
- Milk
- Alcohol
- Buttery pastries/Mayo
- Bacon
- Fries
- Red meat
What classes of drugs can cause a high risk for peptic ulcers?
- Steroids
- Biphosphonates
- NSAIDs
- Anticoagulants
- SSRIs (Selective serotonin reuptake inhibitors)
- Antiplatelets
What are bisphosphonates used for and name 4.
- Strengthen fragile bone conditions
- Fosamax
- Actonel
- Boniva
- Reclast
Name 3 NSAIDs
- Motrin
- Naproxen
- Celecoxib
What type of pts may be on anticoags?
- Post stroke
* Afib/disrythmia
Name 3 anticoags that can increase risk of peptic ulcers
- Warfarin
- Eliquis
- Pradaxa
In an urgent situation, what is important to note regarding Warfarin and Eliquis?
• Warfarin use requires blood work, Eliquis does not
What type of pts may be on SSRIs and name 4 of them.
- Psych pts
- Celexa
- Prozac
- Paxil
- Zoloft
What are 4 antiplatelets that can increase risk of peptic ulcers?
- Aspirin
- Plavix
- Ticlid
- Effient
