headnursing

PEPTIC ULCER DISEASE

Definition

A peptic ulcer is an excavation formed in the mucosal wall of the stomach, pylorus, duodenum or esophagus. It is frequently referred to as gastric, duodenal or esophageal ulcer depending on its location. Peptic ulcer is most likely to be in the duodenum than in the stomach. They tend to occur singly, but there maybe several present at one time. Chronic ulcer usually occurs in the lesser curvature of the stomach, near the pylorus.

Predisposing Factors
• Helicobacter pylori
• Chronic use of ASA, NSAID’s (Non steroidal anti-inflammatory drugs), Steroids
• Severe physiologic stress
• Hypersecretory states.
• Cigarette smoking and alcohol intake
• Caffeine, Fatty, spicy, highly acidic foods
• Type O blood
• Genetics

Signs and Symptoms
• Epigastric pain
• Nausea and vomiting
• Dyspepsia (bloating, belching, distention)
• Heart burn
• Chest discomfort
• Anorexia
• Weight loss
• Hematemesis or melena

Medical Management

Medications such as:
Antacids
• Neutralizes HCl
• Taken 1 to 2 hours p. c.
• Examples of drugs are: Amphogel, Basaljel., Milk of magnesia. Maalox (Magnesium based- diarrhea, Aluminum based- constipation)
Histamine (H2) receptor antagonists
• Reduces HCl secretion
• Taken with meals
• Examples are: Zantac (Ranitidine), Pepcid (Famotidine), Axid (Nizatidine), Tagamet (Cimetidine).
Side effects:
• Diarrhea
• Abdominal cramps
• Confusion
• Dizziness
• Weakness
• Cimetidine- antiandrogenic effect (gynecomastia, decrease libido, impotence)
Cytoprotective
• Coats ulcer and increases prostaglandin synthesis
• Taken on an empty stomach (30-60 minutes before meals)
• Example: Carafate (Sucralfate)
Prostaglandin analogue
• Replaces gastric prostaglandin
• Example: Cytotec (Misoprostol)
Proton Pump inhibitor
• Gastric acid secretion inhibitor
• Example : Losec (Omeprazole)
Helicobacter pylori Drug treatment
• Amoxicillin/ tetracycline-Drug of choice
• Flagyl(Metronidazole)

Surgery
Vagotomy
• Resection of vagus nerve
• Decrease cholinergic stimulation
Pyloroplasty
• Surgical dilatation of the pyloric sphincter
• Improves gastric emptying of acidic chime
Antrectomy
• Removal of 50% of the lower part of the stomach
Types:
• Billroth I (Gastroduodenostomy)
• Billroth II (Gastrojejunostomy)

Nursing Management
• Take prescribed medications as ordered
• Diet:
Liberal bland diet during exacerbation
Eat slowly and chew food properly
Small frequent feedings during exacerbation
Avoid fatty foods, coffee, tea, cola drinks, chocolate, spices, red/black pepper, alcohol.
• Quit smoking
• Stress therapy
• Regular pattern of exercise


Differentiation between Gastric and Duodenal Ulcer


Gasric Ulcer

• Poor Man’s ulcer/laborer’s ulcer
• 20% incidence
• 50 years old and above
• Malnourished
• Normal gastric secretions and normal emptying rate
• Radiates to left
• Pain appears ½ to 2 hours p. c.
• Do not relieved by food
• Nausea and vomiting, hematemesis are common
• Complications are:
Hemorrhage
Perforation
Peritonitis




















Duodenal Ulcer

• Executive’s ulcer
• 80% incidence
• 25-50 years old
• Well-nourished
• Over secretions of Hydrochloric acid
• Radiates to right
• Pain appears 3 to 4 hours p. c.
• Relieved by food
• Melena is more common
• Complications are:
Obstruction
Hemorrhage
Perforation
Peritonitis