ACID PEPTIC DISEASES

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DEFINITION
A peptic ulcer is an excavation (hollowed out area) that forms in the mucosal wall of the stomach, in the pylorus,the duodenum or in the esophagus resulting from the erosion of a circumscribed area of mucus
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ETIOLOGY AND RISKFACTORS H PYLORI INFECTION

DRUGS DIET ENVIRONMENTAL

FACTERS

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ETIOLOGY AND RISKFACTORS

AGE

SEX GENETICS PSYCOLOGICAL

AND EMOTIONAL SRESS

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PATHOPHYSIOLOGY

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CLINICAL MANIFESTATIONS
Abdominal pain, classically epigastric related with meal time Nausea and Vomiting Pyrosis Bloating and abdominal fullness Water brash Loss of appetite and weight loss Hematemesis melena

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COMPLICATIONS
HEMORRHAGE PERFORATION GASTRIC

OUTLET OBSTRUCTION

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COLLABORATIVE THERAPY

CONSERVATIVE THERAPY ADEQUATE BED REST BLAND DIET CESSATION OF SMOKING SRESS REDUCTION

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DRUG THERAPY
1.

H2 Receptor blockers Proton pumb inhibitor Anticholinergics Antibiotic for H pylori Antacids

2.

3.

4.

5.

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Drug therapy
Antacids

Single substance Aluminum carbonate Aluminum phosphate Calcium carbonate Magnesium hydroxide Sodium bicarbonate

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Antacids

Mixtures of aluminum hydroxide and magnesium salts

Gelusil Maalox Aludrox

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Antacids
Mixtures

of calcium carbonate and aluminum and magnesium hydroxide

Camalox Ducon
Mixtures

of calcium carbonate,magnesium carbonate and magnesium oxide

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Alkets

DRUG THERAPY
CYTOPROTECTIVE Sucralfate Bismuthsubsalicylate TRICYCLIC Imipramine doxepine
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DRUGS

ANTIDEPRESSANTS

Treatment of acute exacerbation without complication

Keep the patient in NPO status suction

Nasogastric adequate cessation IV

rest of smoking

fluid replacement
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Indications for surgery

Intractability:Failure of the ulcer to heal or recurrence of the ulcer after therapy of hemorrhage or increased risk of bleeding during treatment or pyloric ulcers (both have high recurrence rate)

History

Prepyloric

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Indications for surgery

Concurrent

conditions such as severe burns, trauma or sepsis ulcer sites

Multiple Drug

induced ulcers existence of a malignant ulcer

Possible

obstruction
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SURGICAL MANAGEMENT

Vagotomy

Truncal vagotomy Selective vagotomy Proximal vagotomy

pyloroplasty

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SURGICALMANAGEMENT
GASTROENTEROSTOMY ANTRECTOMY BILLROTH

I/ GASRODUODINOSTOMY II/ GASTROJEJUNOSTOMY

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BILLROTH

TREATMENT OF COMPLICATIONS
NPO GASTRIC BED

DECOMPRESSION

REST REPLACEMENT TRANSFUSION

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FLUID

BLOOD

TREATMENT OF COMPLICATION
ANALGESICS STOMACH BROAD

LAVAGE

SPECTRUM ANTIBIOTICS

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TREATMENT OF COMPLICATIONS
SURGICAL

THERAPY

Perfortion : simple closure with omentum graft outlet obstruction:pyloroplasty and vagotomy removal or reduction: bilroth I and ll, vagotomy, pyloroplasty
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Gastric

Ulcer

POST OPERATIVE COMPLICATIONS

Marginal

ulcers

Hemorrhage Dumping Post

syndrome

prandial hypoglycaemia
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POST OPERATIVE COMPLICATIONS

Bie

reflux gastritis fistula

Gastrojejunocoic Pyloric

obstruction problems
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Nutritional

Nutritional therapy after surgey Purposes:

To

slow the rapid passage of food in to the intestine control symptoms of the Dumping syndrome rebuilding of body tissue and to meet energy needs
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To

Promote

Diet principle
Diet

principle

Meals

are divided in to six small feedings drinking fluid with meals, fluid should be taken between meals. The diet should consist of small dry feedings daily that are low in 4/22/12 carbohydrate, are restricted in

eliminate

Diet principle
Protein

and fats are increased to promote rebuilding of tissues and to meet energy needs rest periods of at least 30 minutes after each meal, preferably in recumbent position.
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Plan

 Nursing Acute

Nursing management
diagnoses

pain related to increased gastric secretions, decreased mucosal protection, and ingestion of gastric irritants as manifested by burning cramp like pain in epigastrium and abdomen.

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Nausea related to exacerbation of disease process as manifested by episodes of nausea and vomiting

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therapeutic regimen management related to lack of knowledge of long term management of peptic ulcer disease and consequences of not following treatment plan and un willingness to modify lifestyle

Ineffective

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Potential

complication for hemorrhage secondary to eroded mucosal tissue

potential

complication for perforation of GI mucosa secondary to impaired mucosal tissue integrity

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Post operative nursing diagnosis Risk for injury, post operative

complications (immediate and delayed) related to bleeding, distention and atelectasis.
Altered

nutrition less than body requirement related to decreased nutrient absorption secondary to dumping syndrome

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u o y nk a Th

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