Week 5 - Peptic Ulcer Disease Flashcards
what is peptic ulcer disease
- condition characterized by erosion of the gastric or duodenal mucosa resulting from the digestive action of HCl and pepsi
what are 2 types of ulcer
- gastric
- duodenal
what can cause PUD (3)
circumstances that cause the mucosal barrier to be impaired
- drugs
- stress
- bacteria
what kind of bacteria commonly causes PUD
- H. pylori
what types of drugs can cause PUD (3)
- NSAIDs
- asa
- corticosteroids
are gastric or duodenal ulcers more common
- duodenal
describe the difference in gastric secretion in a gastric vs duodenal ulcer
- gastric = normal to decreased
- duodenal = increased
what sex is a gastric ulcer more common in? duodenal?
- gastric = women
- duodenal [ men
what is the peak age of a gastric ulcer vs duodenal
- gastric = 50-60 years
- duodenal = 35-45 years
describe pain in a gastric ulcer
- burning or gaseous pressure in high left epigastrium, back, upper abdomen
describe pain in a duodenal ulcer
- burning, cramping, pressure-like pain across midepigastrium and upper abdomen
- pain is periodic and episodic
- pain in midmorning, midafternoon, and middle of night
describe how pain changes after meals in a gastric vs duodenal ulcer
- gastric = pain 1-2 hour after meal
- duodenal = pain 2-4 hours after meal
describe the impact of food on a gastric vs duodenal ulcer
- gastric = pain aggravted by food
- duodenal = relieved by food (and antacid)
what are 3 complications of PUD
- hemorrhage
- perforation
- gastric outlet obstruction
what is the most common complication of PUD
- hemorrhage
how does PUD cause hemorrhage
- develops from erosion of the granulation tissue, or erosion thru a major blood vessel
what type of ulcer accounts for a greater percentage of uper GI bleeds
- duodenal
what will you see during hemorrhage of PUD (3)
same as GI bleed
- melena, hematemesis, coffee group emesis
- signs of hypovolemic shock
- abdominal pain
what are some interventions for hemorrhage of PUD (6)
same as GI bleed
- monitor VS
- endoscopic therapy
- monitor fluid and electrolytes
- monitor I&O
- monitor for shock
- monitor lab studies
- etc.
what is the most lethal complication of PUD
- perforayion
when does perforation of PUD occur
- when ulcer penetrates the serosal surface
what does perforation of PUD cause
- spillage of gastric or duodenal contents into the peritoneal cavity
what are manifestations of perforation of PUD (7)
- sudden, severe upper abdominal pain that quickly spreads throughout whole abdomin
- shoulder pain (if irritates phrenic nerve)
- rigid, boardlike abdomen
- shallow, rapid resp
- absent BS
- NV sometimes
- distension
what is the goal of interventions for perforation of PUD(3)
- monitor for hypovolemic shock
- treat
- stop the spillage of gastric or duodenal contents into peritoneal cavity
how can PUD perforation be treated/interventions for it (5)
- maintain NG for gastric decompression (get rid of whats spilling)
- antibiotics
- replace circulating blood volume (lose fluids from the vascular and interstitsal space)
- surgery if perforation fails to seal sponatenously
- VS
if the mucosa is perforated, what should the nurse not do?
- have the pt swallow anything or put anything down the NG tubes –> would just contribute to peritonitis and irritation
what is gastric outlet obstruction
- narrowing of the pylorus from inflammation and scar tissue
what are signs of gastric outlet obstruction (4)
- ulcer-like pain that progresses and becomes worse towards end of day as stomach fills and dilates
- swelling of upper abdomen
- projectile vomitting
- loud peristalsis
describe the vomit during gastric outlet obstruction (2)
- contains undigested food particles
- poor odour
what can the projectile vomitting in gastric outlet obstruction lead (3)
- weight loss
- complains of thirst
- complains of unpleasant taste in mouth
what are interventions of gastric outlet obstruction (3)
- decompress with NG tube
- IV fluid and electrolyte replacement
- surgery to open obstruction and remove scar tissue
what can be used to diagnose PUD (4)
- similar to those for upper GI bleed*
- endoscopy
- tests to confirm H. pylori
- barium contrast studies
- lab analysis
what tests can be done to test for H. pylori (3)
- breath test
- blood test
- biopsy during endoscopy
what is the con to barium contrast studies
- not accurate in identifying shallow, superficial ulcers
what are barium studies specifically useful for
- diagnosing gastric outlet obstruction
what are the different types of treatment for PUD
- conservative therapy
- drug therapy
list whats included in conservative therapy for PUD (6)
- rest (physical and emotional)
- quiet, calm enviro
- eliminate or reduce stress (to decrease HCl)
- absence from smoking
- bland diet
- meds
what are 6 types of meds used for treatment of PUD
- H2R blockers
- PPIs
- antibiotics for H pylori
- antacids
- anticholinergics
- cytoprotective drugs
describe pt teaching r/t meds for PUD (3)
- strict adherence imp (d/t frequent recurrence of ulcers)
- maintain lifestyle changes along w meds
- no other drugs, unless prescribed by HCP, should be taken
what do H2R blockers do
- block action if histamine on H2R = decreased HCl secretion
what is an example of H2R receptor blocker (2)
- famotidine (pepsid)
- rantidine (zantac)
what are 2 examples of PPIs
- omeprazole (losec)
- pantoprazole (pantoloc)
are PPIs or H2R blockers more effective in reducing gastric acid secretion and promoting ulcer healing?
- PPIs
why are ab used for PUD treatment
- to eradicate H. pylori
what are 2 types of ab used for h. pylori
- amoxicillin
- metronidazole (flagyl)
what do antacids do (2)
- neutralize the acid = increased pH
- prevents further breakdown
what are some examples of antacids (3)
- sodium bicarb
- magnesium hydroxide (milk of mg)
- calcium carbonate (tums)
how do anticholinergic meds help treat PUD
- decrease cholinergic (vagal) stimulation of HCl secretion
what is a type of cytoprotective drug
- sulcrafate bismol subsalicyclate (pepto bismol)
what do cytoprotective drugs do
- protects mucosal lining
what nutritional therapy is done for a pt with PUD (4)
dietary mod:
- bland duet w 6 small meals/day if symptomatic
- avoid alcohol and caffeine
- avoid irritating foods: spicy foods, acidic foods
- combo of protein, carbs, and fats
describe acute interventions for acute exac of an ulcer (6)
- NPO status for few days
- IV fluid and electrolyte replacement
- connected to intermittent suction
- cleaning and lubrication of nares
- vitals to detect and treat shock if needed
- physical and emotional rest
describe discharge teaching for a pt with PUD (8)
- explain dietary mods (avoid irritating food, small, frequent meals, avoid alcohol)
- explain smoking avoidance
- avoid OTC meds, unless approved by HCP
- take all meds as precribed
- signs to report
- explain need to reduce stress
- need for long term follow ups
- encourgae pt to share concerns about lifestyle changes and living w chronic illness
why should pts with PUD avoid OTC med
- many contain ingredients, like asa
what symptoms should a pt with PUD report (4)
- bloody emesis
- tarry stools
- increased epigastric pain
- increased NV
what are some surgical procedures used for treatment of PUD (4)
- gastroduodenostomy (billroth 1)
- gastrojejunostomy (billroth2)
- vagotomy
- pyloroplasty
what is a gastroduodenostomy (billroth 1)
- partial gastrectomy
- with removal of the distal 2/3 of the stomach
& anastomosis of the gastric stump to the duodenom
what is a gastrojejunostomy (billroth 2)
- partial gastrectomy
- removal of distal 2/3 of stomach and anastomosis of gastric stump to jejunum
what procedure is preferred for duodenal ulcers and why
- bill roth 2 –> bc duodenom is bypassed
what is a vagotomy
- severing of the vagus nerve
= eliminates stimulus to secrete HCl
what is a pyloroplasty
- surgical enlargement of the pyloric sphincter
what does a pyloroplasty result in
- facilitates easy passage of contents from the stomach
list 3 post-op complications for surgery for PUD
- dumping syndrome
- postprandial hypoglycemia
- bile reflux gastritis
what causes dumping syndrome
- result of removal of large portion of the stomach and the pyrloric sphincter (billroth 1&2)
describe what dumping syndrome is
- normally, gastric chyme enters the small intestine in small amounts and shifts in fluid from the extracellular space are minimal
- but after surgery, the stomach has no control over the amt of gastric chyme entering the large intestine
= large bolus of hypertonic fluid enters intestine & fluid drawn into bowel
= decrease in plasma volume
= distension of bowel lumen = urge to defecate
what are symptoms of dumping syndrome (8)
- epigastric fullness
- weakness
- sweating
- palpitations
- tachycardia
- dizziness
- abdominal cramping
- borborygmi
- urge to defecate
signs of hypovolemia
what are interventions / treatment for dumping syndrome (6)
- small, dry feedings daily
- avoid fluids w meals (already have too much)
- low carb (bc already concentrated)
- moderate protein & fat
- restrict sugar
- rest after meals
describe the onset of symptoms of dumping syndrome
- 15-30 min after eating
- usually last no longer than 1 hr after mea
what can you teach a pt regarding dumping syndrome
- body eventually adjusts and the symptoms go away
what is postprandial hypoglycemia
- variant of dumping syndrome
- where hyperglycemia releases insulin, resulting in secondary hypoglycemia
what causes postprandial hypoglycemia after PUD surgery
- result of the uncontrolled gastric emptying of a bolus high in carb = hypergylcemia
when do symptoms of postprandial hypoglycemia occur
- ~2 hr after eating
what are symptoms of post prandial hypoglycemia (6)
symptoms of hypoglycemia
- sweating
- weakness
- mental confusion
- palpitations
- tachy
- anxiety
what are interventions for post prandial hypoglycemia after PUD surgery (3)
- immediate ingestion of sugar when hypoglycemia
- prevent rebound hyperglycemia by limiting amt of sugar consumed with each meal
- eat small, frequent meals
what causes bile reflux gastritis
- occurs with gastric surgery involving the pylorus
= back up of bile into stomach
what are symptoms of bile reflux gastritis (2)
- epigastric distress that increases after meals
- vomitting
what are interventions of bile reflux gastritis (2)
- cholestyramine before or w meals
- can administer antacid
describe postop care for PUD (13)
- will have NG tube to decompress stomach & decrease P on suture line
- observe gastric aspirate
- ensure patency of NG tube (irrigations)
- monitor BS and for abdominal discomfort (may indicate intestinal obstruction)
- remove NG tube when peristalsis returns
- I&O
- VS q4h
- frequent position change
- pain meds
- encourage DB&C with splinting
- care of abdominal incision
- encourage ambulation to increase peristalsis
- IV fluids with K+ and vitamin replacement
what should monitor regarding gastric aspirate postop
- color and amt
- bright red at first
- gradual darkening withing first 24 hr
- changes to yellow/green in 36-48 hho
how can the pt splint during DB&C exercises? why should they splint?
- protects abdominal suture line from rupturing,
- splint area w pillow
why si DB&C imp post op
- prevents pulmonary complication
what should monitor regarding the abdominal incision (2)
- signs of infection (odor, drainage)
- signs of bleeding
before the NG tube is removed, what must be done
- pt must be started on oral feedings of clear liquid to determine tolerance
- aspirate stomach 1-2 h after to assess amt remaining, color, consistency
what is a long-term complication of PUD surgery? why?
- pernicuous anemia
- d/t loss of IF
what are interventions for pernicuous anemia
- injections of cobalamin (vit. B12)
