Topic 7: Peptic Ulcer Disease Flashcards
peptic ulcer disease
Condition characterized by erosion if the GI mucosa from the digestive action of HCl acid and pepsin
-Any part of the GI tract that is in contact with gastric secretions is susceptible to ulcer development.
Acute peptic ulcer
superficial erosion, minimal inflammation, short duration, resolves when cause treated
chronic peptic ulcer
erodes through the muscular wall, present continuously for years or intermittently through life, most common type of ulcers
risk factors for peptic ulcers
· H. pylori
· Medication-Induced Injury (NSAIDs and Corticosteroids)
· Lifestyle factors (alcohol, smoking, stress)
Gastric Ulcer clinical manifestations
· “Burning” or “gaseous” pressure in epigastrium
· Pain 1-2 hours after meals. If penetrating ulcer, aggravating of discomfort with food
Duodenal Ulcer clinical manifestations
· Burning, cramping, pressure-like pain across mid epigastrium and upper abdomen.
· Back pain with posterior ulcers
· Pain 2-5 hours after meals and midmorning, midafternoon, middle of the night
· Periodic and episodic
· PAIN RELIEF with antacids and food
complications of peptic ulcer disease
hemorrhage, perforation, gastric outlet obstruction
hemorrhage manifestations
o Changes in VS and increase in the amount and redness of aspirate often signal massive upper GI bleed
o Hematemesis, melena stool; perform EGD, IV access, O2
perforation
· ulcer will penetrate the serosal surface with spillage of either gastric or duodenal contents into the peritoneal cavity
perforation manifestations
o Sudden sharp pain
o Peritonitis
o Rebound tenderness
o Rigid
Gastric outlet obstruction
· obstruction in the distal stomach and duodenum is the result if edema, inflammation, pylorospasm or fibrous scar tissue formation
diagnostic assessment for peptic ulcer
· Hx and physical exam
· Upper GI endoscopy with biopsy
· Endoscopic ultrasound
· H. Pylori testing of breath, urine, blood, tissue, CBC
· Liver enzymes
· Serum amylase
· Stool testing for blood
what diagnostic test is used for patients who cannot undergo an endoscopy and is used in the diagnosis of gastric outlet obstruction
barium contrast study
acute care for peptic ulcer disease
· Patient may be NPO for a few days
· NG tube connected to an intermittent suction
· IV fluid replacement
· Regular mouth care relieves the dry mouth
· Cleaning and lubricating the nares facilitate breathing and decrease soreness
· Physical and emotional rest is helpful to ulcer healing; environment should be quiet and restful
perforation interventions
· Notify HCP immediately
· Take VS promptly and record them every 15-30minutes Temporarily stop all oral or NG drugs and feedings
· Give IV fluid as ordered to replace the depleted plasma volume
· Give pain meds to provide comfort
· Confirmed perforation: will start antibiotic therapy
gastric outlet obstruction interventions
· Constant NG aspiration of stomach contents can relieve symptoms (this allows edema and inflammation to subside and permits normal flow of gastric contents through the pylorus
· Irrigate NG tube with a normal saline solution
· Maintain accurate I&Os, especially gastric aspirate
· To check for ongoing obstruction; clamp the NG tube intermittently and measure the gastric residual volume
conservative care for peptic ulcer disease
· Adequate rest (physical and emotional)
· Drug therapy
· Smoking cessation
· Dietary modifications (if needed)
· Long term follow-up care
· Aspirin and nonselective NSAIDs are stopped for 4-6 weeks
· Avoiding alcohol
interventons for acute exacerbation of PUD
· NPO
· NG suction
· Adequate rest
· IV fluid replacement
surgical interventions for PUD
· Partial gastrectomy (diseased part of the stomach is removed), Vagotomy (part/all of vagus nerve is removed), Pyloroplasty (enlarge pyloric sphincter to facilitate movement of content from stomach)
surgical complications
· Dumping Syndrome
· Postprandial hypoglycemia
· Bile reflux gastritis
Dumping syndrome
Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia.
postprandial hypoglycemia
an unusual drop in blood glucose that follows a meal and is accompanied by symptoms such as anxiety, rapid heartbeat, and sweating; also called reactive hypoglycemia.
Bile reflux gastritis
If the pylorus is removed bile can enter into the stomach increasing epigastric distress after meals
patient teaching for PUD
· Avoid foods that cause epigastric distress, such as acidic foods
· Avoid cigarettes
· Reduce or eliminate alcohol use
· Avoid OTC drugs unless approved by HCP
· Do not interchange brands of PPIs, antacids, or H2 receptor clockers that you can buy OTC without checking with the HCP
· Take all medications as prescribed
· REPORT: increase N/V, epigastric pain, bloody emesis or tarry stools
· Stress can be related to s/s of PUD, learn stress management techniques
nutrition for PUD
· Foods that may cause gastric irritation include; pepper, carbonated beverages, broth (meat extract), hot, spicy food, caffeine-containing beverages
Teach to avoid alcohol because it can delay healing
overall, what should be avoided with PUD
alcohol, smoking, acidic foods, aspirin and NSAIDS (4-6 weeks), stress
antibiotic therapy for PUD is used for
· Eradicating H. pylori is the most important part of treating PUD
antibiotic therapy is usually prescribed with
a PPI for 14 days
what are the standard antibiotics for PUD
amoxicillin, bismuth compound, clarithromycin, metronidazole, tetracycline
if a patient has a penicillin allergy what medication should be used
metronidazole is used instead of amoxicillin in a triple-drug regimen
important teaching for antibiotics
comply and take whole antibiotic prescription
what drug is more effective in reducing gastric ulcer secretions and promoting ulcer healing
PPI’s are more effective than H2 receptor blockers
sucralfate
used for short-term ulcer treatment, provides mucosal protection for the esophagus, stomach and duodenum.
when should sucralfate be given
Give at least 60 minutes before or after an antacid
