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1

Peptic Ulcer Disease

Erosion of GI mucosa resulting from digestive action of HCl acid and pepsin

2

Acute Peptic Ulcer Disease

Superficial, minimal inflammation and short duration

3

Chronic Peptic Ulcer Disease

Muscular wall involved, scar tissue, and longer duration

4

Gastric vs Duodenal

Based on location

5

Patho

Defects in gastric or duodenal mucosa that extends through muscularis mucosa
Develop only in presence of gastric acid
Excess gastric acid may not be necessary

6

Etiology: Helicobacter pylori

Produces enzyme urase
-mediates inflammation making mucosa more vulnerable

7

Etiology: Aspirin and NSAIDs

Inhibit syntheses of prostaglandins
-Cause abnormal permeability

8

Etiology: Corticosteroids

Decrease rate of mucosal cell renewal
-Decrease protective effects

9

Etiology: Lifestyle factors

Alcohol
Smoking
Coffee

10

Etiology: stress (physiological and psychological)

Burns, Surgery, Sever medical illness, sepsis, traumatic injuries
Cushing ulcers

11

Gastric Ulcers

Occurs in any portion of stomach
Less common than duodenal ulcers
Prevalent in women, older adults
Peaking incidence >50 years of age
Risk factors: H. pylori, medications, smoking, bile reflux

12

Duodenal Ulcers

Occur at any age and in anyone
-Increase between ages 35-45
Account for 80% 0f all peptic ulcers
Familial tendency
-Blood group O increased risk
Associated with increased HCl acid secretion
-Alcohol, cigarette smoking
H. pylori is found in 90% - 95% of patients
Increased risk:
-COPD, cirrhosis of liver, chronic pancreatitis, hyperparathyroidism, chronic kidney disease
Zollinger-Ellison syndrome

13

Gastric ulcer pain

Pain high in epigastrium
-1-2 hrs after meals
-Burning or gaseous
-Food aggravates pain as ulcer has eroded through gastric mucosa

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Duodenal Ulcer pain

Midepigastric region beneath xiphoid process
Back pain: if ulcer is located in posterior aspect
2-5 hrs after meals
Burning of cramplike
intermittent

15

3 major complications

Hemorrhage (most common)
Perforation
Gastric outlet obstruction (treatment)
*All considered emergency situations!

16

Gastric Outlet Obstruction

Both acute and chronic can result in this
Predisposition: ulcers located in antrum and pre-pyloric and pyloric areas of stomach/duodenum
Occurs due to:
-edema, inflammation, pyloro-spasm, fibrous scar tissue formation

17

Diagnostic studies

Endoscopy w/ biopsy
Tests for H. pylori:
-Urea breath test & stool antigen test
-biopsy and testing for urease (GOLD STANDARD)
Barium contrast study
Radioloy
Gastric analysis

18

Lab analysis

CBC
Liver enzymes
Guaiac stool test
Serum amylase

19

Medical regimen consists of:

Adequate rest
Drug therapy
Elimination of smoking and alcohol
Dietary modification
Long-term follow-up care
Stress management

20

Collaborative care

Complete healing may take 3-9 weeks
-Should be assessed by means of x-rays or endoscopic examination
Aspirin and nonselective NSAIDs may be stopped for 4-6 weeks
Smoking cessation

21

Drug Therapy

H2R blockers
PPI
Antibiotics
Antacids
Anticholinergics
Cytoprotective therapy
Tricyclic antidepressants

22

Nutritional Therapy

Dietary modifications
-Food and beverages irritating to patient are avoided or eliminated
Bland diet may be recommended
Six small meals a day during symptomatic phase

23

Nursing assessment

Past Heatlh hx
Medication usage
Heartburn
Weight loss
Black, tarry stools
Epigastric tenderness
N/V
Abnormal lab values

24

Overall goals

Comply w/ prescribed therapeutic regimen
Experience a reduction in or absence of discomfort
Exhibit no signs of GI complications
Have complete healing
Make lifestyle changes to prevent recurrence

25

Health promotion

Identify patients at risk
Provide early detection and treatment
Encourage patients to take ulcerogenic drugs w/ food or milk
Teach patient to report to health care provider symptoms r/t gastric irritation

26

Acute Interventions

NPO, possibly NG tube
IV Hydration
Explain treatment measures to patient/family
Provide regular mouth care
Cleanse and lubricate nares if NG tube is in place

27

Patient teaching

Disease
Drugs
Lifestyle changes
Regular follow up

28

Surgical therapy

Uncommon b/c of antisecretory agents
Indications for interventions:
-Unresponsive to medical management
-concern about gastric cancer
-perforation

29

Billroth 1: gastroduodenostomy

Partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of gastric stump to duodenum

30

Billroth 2: gastrojejunostomy

Partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of gastric stump to jejunum