Topic 7: Peptic Ulcer Disease

Question 1

peptic ulcer disease

Answer 1

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.

Question 2

Acute peptic ulcer

Answer 2

superficial erosion, minimal inflammation, short duration, resolves when cause treated

Question 3

chronic peptic ulcer

Answer 3

erodes through the muscular wall, present continuously for years or intermittently through life, most common type of ulcers

Question 4

risk factors for peptic ulcers

Answer 4

· H. pylori
· Medication-Induced Injury (NSAIDs and Corticosteroids)
· Lifestyle factors (alcohol, smoking, stress)

Question 5

Gastric Ulcer clinical manifestations

Answer 5

· “Burning” or “gaseous” pressure in epigastrium
· Pain 1-2 hours after meals. If penetrating ulcer, aggravating of discomfort with food

Question 6

Duodenal Ulcer clinical manifestations

Answer 6

· 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

Question 7

complications of peptic ulcer disease

Answer 7

hemorrhage, perforation, gastric outlet obstruction

Question 8

hemorrhage manifestations

Answer 8

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

Question 9

perforation

Answer 9

· ulcer will penetrate the serosal surface with spillage of either gastric or duodenal contents into the peritoneal cavity

Question 10

perforation manifestations

Answer 10

o Sudden sharp pain
o Peritonitis
o Rebound tenderness
o Rigid

Question 11

Gastric outlet obstruction

Answer 11

· obstruction in the distal stomach and duodenum is the result if edema, inflammation, pylorospasm or fibrous scar tissue formation

Question 12

diagnostic assessment for peptic ulcer

Answer 12

· 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

Question 13

what diagnostic test is used for patients who cannot undergo an endoscopy and is used in the diagnosis of gastric outlet obstruction

Answer 13

barium contrast study

Question 14

acute care for peptic ulcer disease

Answer 14

· 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

Question 15

perforation interventions

Answer 15

· 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

Question 16

gastric outlet obstruction interventions

Answer 16

· 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

Question 17

conservative care for peptic ulcer disease

Answer 17

· 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

Question 18

interventons for acute exacerbation of PUD

Answer 18

· NPO
· NG suction
· Adequate rest
· IV fluid replacement

Question 19

surgical interventions for PUD

Answer 19

· 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)

Question 20

surgical complications

Answer 20

· Dumping Syndrome
· Postprandial hypoglycemia
· Bile reflux gastritis

Question 21

Dumping syndrome

Answer 21

Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia.

Question 22

postprandial hypoglycemia

Answer 22

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.

Question 23

Bile reflux gastritis

Answer 23

If the pylorus is removed bile can enter into the stomach increasing epigastric distress after meals

Question 24

patient teaching for PUD

Answer 24

· 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

Question 25

nutrition for PUD

Answer 25

· 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

Question 26

overall, what should be avoided with PUD

Answer 26

alcohol, smoking, acidic foods, aspirin and NSAIDS (4-6 weeks), stress

Question 27

antibiotic therapy for PUD is used for

Answer 27

· Eradicating H. pylori is the most important part of treating PUD

Question 28

antibiotic therapy is usually prescribed with

Answer 28

a PPI for 14 days

Question 29

what are the standard antibiotics for PUD

Answer 29

amoxicillin, bismuth compound, clarithromycin, metronidazole, tetracycline

Question 30

if a patient has a penicillin allergy what medication should be used

Answer 30

metronidazole is used instead of amoxicillin in a triple-drug regimen

Question 31

important teaching for antibiotics

Answer 31

comply and take whole antibiotic prescription

Question 32

what drug is more effective in reducing gastric ulcer secretions and promoting ulcer healing

Answer 32

PPI’s are more effective than H2 receptor blockers

Question 33

sucralfate

Answer 33

used for short-term ulcer treatment, provides mucosal protection for the esophagus, stomach and duodenum.

Question 34

when should sucralfate be given

Answer 34

Give at least 60 minutes before or after an antacid