PEPTIC ULCER PEPTIC ULCER DISEASEDISEASE

PEPTIC ULCER PEPTIC ULCER DISEASEDISEASE

NRS452NRS452Norhaini MajidNorhaini Majid

Introduction• PUD ,a break in a mucous lining of

GI tract• Duodenal - most common, age 30

-55• Gastric Ulcer – affect older age 55

- 70

Risk Factors• H.pylori infection – how?• Use of NSAIDs• Cigarette smoking• Family history of PUD• Other possible risks – physiological

stress, alcohol /caffeine consumption

Pathophysiology• Normal gastric mucosa• Disruption of mucosal barrier• Inflammatory process• Erosion and ulcer formation

» Refer page 682-683, Med/Surg Nsg

Manifestation of PUD

• Classic symptom?• Typically described as …….• Occurs

– Stomach– 3 – 4 hours after meal– midnight

Manifestation of PUD (cont…)

• Heartburn• VomitOlder adult• Chest pain• Dysphagia• Weight loss• Anemia

Manifestation of PUD complications

• Hemorrhage

• Obstruction

• Perforation

Hemorrhage• Occult blood in stool• Hematemesis• Fatigue• Weakness, dizziness• Orthostatic hypotension• Hypovolemic shock

Obstruction• Sensations of epigastric fullness• Nausea & vomiting• Electrolyte imbalances• Metabolic alkalosis

Perforation • Severe upper abdominal pain – shoulder• Rigid, boardlike abdomen• Absence of bowel sounds• Diaphoresis• Tachycardia• Rapid, shallow respiration• Fever

Zollinger-Ellison Syndrome

• PUD cause by gastrinoma or gastrin-secreting tumor (pancreas, stomach, or intestine

• Gastrin ?• Affect stomach, duodenum,

esophagus and jejunum

Zollinger-Ellison Syndrome

Characteristic• Ulcer-like pain

• Diarrhea

• Steatorrhea

Zollinger-Ellison Syndrome

Complication

• Perforation• Bleeding • Fluid & electrolyte imbalances

Diagnostic Tests• Barium Swallow• Gastroscopy• Biopsy• Serologic test• Urea breath testZollinger-Ellison Syndrome• Gastric Analysis

Medications• Combination therapy

• Two antibiotics + proton pump inhibitors (e.g omeperazole, metronidazole and clarithromycin)

Treatments• Dietary mx• Surgery• Rx of complications

Treatment of Peptic Ulcer Disease

Goals of Treatment

•Relieve pain •Prevent complications (bleeding, perforation, penetration, obstruction) •Minimize recurrences •Reduce financial costs

Nursing Care?

• Student Activity– Identify nursing problem and solve it

using nursing process approach – Discuss