Peptic Ulcer Disease

Peptic Ulcer Disease

1. Interventions

   • Nursing Care
     • Acute Exacerbation
       • NPO
       • NG tube [Cleanes Nares]
       • Regular Mouth care
       • IV hydration
       • VS hourly
       • Monitor I&O
       • Physical & Emotional Rest
       • Sedatives can Mask symptoms of Shock
     • Preforation
       • NG tube
       • Continuous Aspiration
       • CVP line [Monitor Hourly]
       • Indwelling Catheter [Montior Hourly]
       • ECG
       • Broad Spectrum antibiotics
       • Open Laproscopic
       • Decompress Stomach
       • Stop Oral
       • IV fluids Replaced
     • Hemorrhage
       • Increase Redness Aspirate
       • Increase Blood in gastric Contents
       • Pain Decrease [Blood Neutralizes Acid]
       • Change in VS
       • maintain Patency
   • Drugs
     • Histamine Blocker
       • Therapeutic Effect last up to 12hrs  Decrease HCl acid Conversian Decreasing Pepsinogen to pepsin Increase Ulcer Healing
     • Proton pump Inhibitor
       • Block ATPase Enzyme Important for secreting HCl 
     • Antibiotics
       • 7-14days
     • Antacids
       • Empty stomach 20-30min With a meal 3-4hrs
     • Anticholinergics
     • Cytoprotective Therapy
   • Nutritional
     • Avoid Irritating Foods
       • Hot/Spicy
       • Carbonated Beverages
       • Caeffine
       • Alcohol
       • Meat Extract [Broth]
     • 6 Small meals a day during Symptomatic Phase
     • Bland Diet May be Recommended

2. Signs & Symptoms

   • Diagnostics
     • Breath Test
     • Stool Test
       • Black Tarry Stools
     • Endoscopy with Biopsy
       • Allow for direct viewing of Mucosa. Determine if treatment is working for healing.  *R/O  H. Pylori and gastric Cancer.  [Biopsy]
     • Whole body Antibody Test
     • Barium Swallow Test
       • Reserved for Patients who cannot tolerate Endoscopy  *cannot detect shallow ulcers.  Used to diagnose Gastric Outlet Obstruction
     • x ray
       • Cannot disatinguish between peptic Ulcer and  Malignant Tumor. Does not show Degree of Healing
     • Gastric Analysis
       • Analysis of Gastric contents for acidity HCl and Volume *NG tube Inserted and Gastric Contents Aspirated
     • CBC
       • Anemia [Hemorrhage]
     • Liver Enzymes
       • Need to Know any liver problems to complicate ulcer treatment. 
     • Serum Amaylase
       • Penetration to Pancreatic suspected.
   • Gastric Ulcers
     • Pain high in Epigastrium
     • 1-2hrs after a meal
     • "Burning or Gaseous"
     • Food Aggravates pain as ulcer has eroded through Gastric Mucosa
   • Duodenal Ulcers
     • Pain Midepigastric xiphoid process or back pain
     • 2-5hrs after meals
     • "Burning or Cramping"
     • Tendency to Occur than disappear than occur again
   • Silent Peptic Ulcers more common in Older Adults and those Taking NSAID's
   • Presence/Absence of symptoms do not relate to size of ulcer or degree of healing.

3. Causes

   • Corticosteroids
   • H. Pylori
   • Aspirin & NSAIDs
   • Alcohol, Coffee, Smoking
   • Stress/ Depression

4. Types

   • Peptic
   • Duodenal
   • Stress Related

5. Complications

   • Hemorrhage
     • Most common Duodenal Ulcer  Ulcer is through a major Blood Vessel 
   • Preforation
     • 1.) Sever upper abd. pain spread Throughout the abd. pain radiates to back Shoulder pain not relieved by foods or Anacids  2.) Initial 0-2hrs after preforation: Tachycardia, weak pulse, Rigid Board Like abdominal Muscles to protect from further injury 3.) Shallow Respirations 4.) Bowel sounds absent  5.) N&V
   • Gastric Obstruction
     • 1.) pain toward end of day [as stomach fills and dilates] 2.)Bleching  3.) Vomiting [often projectile/Emesis contains particles ingested hours or days before 4.) Constipation due to  Dehydration and decreased dietary intake.  5.) Increased upper abd. swelling [happens over time]