Duodenal ulcer presentation

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1. DUODENAL ULCER By , Sumit dey Bsc nsg II ND YR

2. Definition Ulcers that occur in the upper area of the small intestine, which is called the duodenum, are calledduodenal ulcer.

3. Causes Helicobacter pylori
Use of anti-inflammatory drugs
Other factor-Other causes are rare. For example, the Zollinger -Ellison syndrome. In this rare condition, much more acid than usual is made by the stomach. Other factors such as smoking, stress, and drinking heavily may possibly increase the risk of having a duodenal ulcer. However, these are not usually the underlying cause of duodenal ulcers.

4. Risk factor Long term use of anti-inflammatory drugs
Liver disease
CoPD
Trauma such as sever burn,brain injury
Age (more common in people over the age of 50)
Alcohol use
Family history of

5. Sign and symptoms Abdominal distension Pain or nausea Loss of appetite Weight loss Hematemesis

6. Phathophysiology Due to etiological factor Erosion occurs which is caused by the increased concentration or activity of acid pepsin or by decreased resistance of mucosa . A damage mucosa cannot secretes enough mucus to act as a barrier against hcl Patient with duodenal ulcer disease secretes more acid then normal.

7. Cont…………….. Damage to the gastroduodenal mucosa allows for decreased resistence to bacteria. Thus infection occurs from h.pylori .

8. Dignostic evaluation Gastroscopy (endoscopy) is the test that can confirm a duodenal ulcer . In this test a doctor or nurse looks inside your stomach and the first part of your small intestine (duodenum). They do this by passing a thin, flexible telescope down your gullet (oesophagus). They can see any inflammation or ulcers.
A test to detect the H. pylori germ (bacterium) is usually done if you have a duodenal ulcer. If H. pylori is found then it is likely to be the cause of the ulcer. Briefly, it can be detected in a sample of stools (faeces), or in a breath test, or from a blood test, or from a biopsy sample taken during an endoscopy.

9. Management Physical examination ( epigastric tenderness, abdominal distention).
distention).
Endoscopy (preferred, but upper gastrointestinal [GI] barium study may be done). Acid-suppressing medication-The most common use medication is proton pump inhibitor for example- esomeprazole , lansoprazole , omeprazole , pantoprazole and rabeprazole .
If your ulcer was caused by H. pylori-Antibiotic should also be give with acid suppressing medicin

10. Surgical management If recommended, surgery is usually for intractable ulcers (particularly with Zollinger –Ellison syndrome), lifethreatening hemorrhage , perforation, or obstruction. Surgical procedures include vagotomy , vagotomy with pyloroplasty , or Billroth I or II.

11. Nursing Assessment Assess pain and methods used to relieve it; take a thorough history, including a 72hour food intake history.
If patient has vomited, determine whether emesis is bright red or coffee ground in appearance. This helps identify source of the blood.
Ask patient about usual food habits, alcohol, smoking, medication use (NSAIDs), and level of tension or nervousness.
Ask how patient expresses anger (especially at work and with family), and determine whether patient is experiencing occupational stress or family problems.
Obtain a family history of ulcer disease.
Assess vital signs for indicators of anemia (tachycardia, hypotension).
Assess for blood in the stools with an occult blood test.
Palpate abdomen for localized tenderness.

12. Nursing Diagnosis Acute Pain related to the effect of gastric acid secretion on damaged tissue
Anxiety related to coping with an acute disease
Imbalanced Nutrition related to changes in diet
Deficient Knowledge about preventing symptoms and managing the condition