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Kultur Dokumente
DISEASE
By
Mrs. Sharmila P. Ghodke
Tutor, INE, Mumbai
MSc. Nursing (Med-Surg Nursing - CVTN)
INTRODUCTION
Peptic ulcer is a condition in which a person experience
severe abdominal pain, especially around the inner part
of the stomach. In this disease, mucous membrane
around the digestive organs gets weakens.
Prevalence
• 4-10/1000 population in India
• Higher prevalence in developing countries
– H. Pylori is sometimes associated with socioeconomic status and poor hygiene
TYPES
BASED ON DURATION OF
MUCOSAL INVOLVEMENT BASED ON LOCATION
ACUTE CHRONIC
• Superficial erosion • Long duration
• Minimal inflammation • Eroding through the muscular
• Short duration wall with the formation of
• Resolve quickly when cause is fibrous tissue
identified & removed. • More common than acute
erosion
COMPARISON OF GASTRIC & DUODENAL ULCERS
Assessment data Gastric ulcer Duodenal ulcer
Lesion Superficial, smooth margins, round, oval or Penetrating
cone shaped
Location Predominantly antrum, also in body & fundus First 1-2 cm of duodenum
Acid secretion Normal to decreased Increased
Sr. pepsinogen Normal Increased
Incidence Greater in women Greater in men, but increasing in women
Peak age- 50-60 yrs (postmenopausal)
More common in low socio-economic status Peak age- 35-yrs
Increases with smoking, drug use (aspirin, Associated with psychological stress
NSAIDs) & alcohol Increases with smoking, drug use (aspirin, NSAIDs)
Increases with incompetent pyloric sphincter & alcohol
& bile reflux Associated with other diseases (COPD,
Hyperparathyroidism, pancreatic disease, Zollinger-
Ellison syndrome, CRF)
Clinical Burning or gaseous pressure in high left Burning, cramping, pressure like pain across
manifestations epigastrium, back & upper abdomen midepigastrium & upper abdomen. Back pain with
Pain 1-2 hour after meal. If penetrating ulcer, posterior ulcers
aggravation of discomfort with food. Pain 2-4 hours after meal & midmorning,
Occasional nausea & vomiting. midafternoon & midnight. Periodic & episodic.
Weight loss. Relief with antacid & food.
Occasional nausea & vomiting.
Recurrence rate High High
Blood group No difference Most frequently type o
Associated gastritis Common and Increased None
Nutritional status Probably Malnourished Usually well Nourished
Malignancy potential Occurs in approximately 10% of clients Rare, no increase in incidence
Bleeding Pattern Hematemesis more common than Melena Melena more common than hematemesis
PEPTIC ULCERS: GASTRIC &
DUODENAL
ETIOLOGY
• History & PE
• Upper GI endoscopy with biopsy
• H. pylori testing of breath, urine, blood & tissue
• CBC
• Sr. electrolytes
• Liver enzymes
• Sr. amylase
• GI tract x-ray: shows presence of air or gas in peritoneal
cavity in case of ulcer perforation.
• Stool for occult blood
COMPLICATIONS
• Hemorrhage
• Perforation
• Gastric outlet obstruction
• Perforation & Penetration—into pancreas, liver and retroperitoneal
space
• Peritonitis
• Bowel obstruction
• Bleeding--occurs in 25% to 33% of cases and accounts for 25% of
ulcer deaths.
• Gastric CA
MANAGEMENT
TREATMENT PLAN: H. PYLORI
• Medications: Triple therapy for 14 days is considered the treatment of
choice.
– Proton Pump Inhibitor + clarithromycin and amoxicillin
• Omeprazole (Prilosec): 20 mg PO bid for 14 d or
Rabeprazole (Aciphex): 20 mg PO bid for 14 d plus
Clarithromycin (Biaxin): 500 mg PO bid for 14 and
Amoxicillin (Amoxil): 1 g PO bid for 14 d
– In the setting of an active ulcer, continue proton pump inhibitor
therapy qds for additional 2 weeks.
• Goal: complete elimination of H. Pylori. Once achieved reinfection rates
are low.
TREATMENT PLAN: NOT H.
PYLORI
• Medications—treat with Proton Pump Inhibitors or H2 receptor
antagonists to assist ulcer healing
• Adequate rest
• Cessation of smoking
• Drugs
• Nutritional therapy
• Stress management
CONSERVATIVE THERAPY
CONT…
• Drugs:
– H2 receptor blockers
• Promote ulcer healing
• Reduce amount of stomach acid secretion into digestive tract
– Antacids
• Increase gastric pH by neutralizing the HCl acid
• Aluminum hydroxide: bind the bile salts, thus decreasing damage to gastric
mucosa
CONSERVATIVE THERAPY
CONT…
• Drugs:
– Cytoprotective drug therapy
• Sucralfate: provides cytoprotection
• Misoprostol: protective & antisecretory effect, given in gastric ulcer
caused by NSAIDs & Aspirin
– Other drugs
• Tricyclic antidepressants: reduces acid secretion & pain
• Anticholinergics: chlorpromazine, antipsychotics
CONSERVATIVE THERAPY
CONT…
• Nutritional therapy:
– No specific recommendations
– Eat & drink foods & fluids that do not cause any distressing
symptoms.
– Avoid caffeine containing beverages
– Eliminate alcohol
– Avoid hot, spicy foods, pepper, carbonated beverages & broth
(meat extract)
THERAPEUTIC DIET
NAME OF DIET INGREDIENTS
1.Sippy`s diet and its Hourly feeds of milk, cream and olive
modification by hurst. oil with antacids medication.
• Surgical procedures
– Billroth I (Gastroduodenostomy)
– Billroth II (Gastrojejunostomy)
– Total gastrectomy
– Vagotomy (Truncal or selective)
– Pyloroplasty
Antrectomy - remove the
lower part of the stomach
(antrum), which produces a
hormone that stimulates the
stomach to secrete
digestive juices. A
vagotomy is usually done
in conjunction with an
antrectomy.
Pyloroplasty - the opening into
the duodenum and small
intestine (pylorus) are enlarged,
enabling contents to pass more
freely from the stomach. May
be performed along with a
vagotomy.
VAGOTOMY
Hyperglycemia
Reflex hypoglycemia
BILE REFLUX GASTRITIS
Chronic gastritis
Recurrence of PUD
NURSING DIAGNOSIS
INTERVENTION:-
Maintain NG tube
Monitor for complication
Promote comfort
Monitor the sign and symptoms hemorrhage such as
haematemesis and melena
Monitor vitals signs.
Monitor hematocrit and hemoglobin level as ordered
3.Imbalanced nutrition less than body required related to
decrease nutrient absorption. secondary to dumping syndrome.
INTERVENTION:-
INTERVENTION:-
• Help client to realize that healing takes place rapidly when irritating
effect is removed.