Peptic ulcer

peptic ulcer, stress ulcer, classification, risk factors, sign and symptom, complications, medical and surgical treatment, nursing interventions.

1. Peptic ulcer Prepared by Mehwish Jamil

2. Objectives At the end of this presentation students will be able to: Define peptic ulcer Describe pathophysiology of peptic ulcer Enlist sign and symptom of peptic ulcer Discuss complications of peptic ulcer Describe medical management of peptic ulcer Describe nursing diagnosis and nursing intervention of peptic ulcer

3. Peptic ulcer Definition: A peptic ulcer is an excavation (hollowed-out area) that forms in the mucosal wall of the stomach, in the pylorus (the opening between the stomach and duodenum), in the duodenum (the first part of the small intestine), or in the esophagus. A peptic ulcer may be referred to as a gastric, duodenal, or esophageal ulcer, depending on its location. Peptic ulcers are more likely to occur in the duodenum than in the stomach.

4. Classification Chronic gastric ulcers tend to occur in the lesser curvature of the stomach, near the pylorus . Esophageal ulcers occur as a result of the backward flow of HCl from the stomach into the esophagus (gastro esophageal reflux disease [GERD ]) Duodenal ulcer. Peptic ulcers are more likely to occur in the duodenum than in the stomach

5. Pathophysiology Peptic ulcer gastro duodenal mucosa gastric acid (HCl) and pepsin . resistance of mucosa OR activity of acid–pepsin erosion damaged mucosa cannot secrete enough mucus to act as a barrier against HCl. Infection from H. pylori bacteria resistance to bacteria Damage to the gastro duodenal mucosa

6. Conti…

7. NOTE: Patients with duodenal ulcers secrete more acid than normal, whereas patients with gastric ulcers tend to secrete normal or decreased levels of acid.

8. Risk factors/ Causes Greatest frequency in people between 40 and 60 years of age . uncommon in women of childbearing age, but it has been observed in children and even in infants . stress and anxiety gram-negative bacteria H.pylori excessive secretion of HCl ingestion of milk and caffeinated beverages Smoking alcohol patients with tumors that cause secretion of excessive amounts of the hormone gastrin Zollinger-Ellison syndrome (ZES)

9. Conti… Stress and eating spicy foods may make peptic ulcers worse People with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB. chronic use of NSAIDs

10. Sign and symptom patient with an ulcer complains of dull, gnawing pain or a burning sensation in the midepigastrium or the back. localized tenderness pyrosis (heartburn ) vomiting constipation or diarrhea Bleeding Heartburn is often accompanied by sour eructation, or burping, which is common when the patient’s stomach is empty . Fifteen percent of patients with peptic ulcer experience bleeding

11. Complications Hemorrhage. Hemorrhage, the most common complication, occurs in 10% to 20% of patients with peptic ulcers in the form of hematemesis or melena. Perforation and penetration. Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning, while penetration is the erosion of the ulcer through the gastric serosa into adjacent structures. Pyloric obstruction . Pyloric obstruction occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.

12. Assessment and diagnostic findings A physical examination may reveal pain, epigastric tenderness, or abdominal distention barium study endoscopy is the preferred diagnostic procedure serologic testing for antibodies against the H. pylori antigen stool antigen test urea breath test

13. Medical management The goals are to eradicate H.pylori and to manage gastric acidity. Methods used include: medications lifestyle changes , and surgical intervention.

14. CONTI… the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics ( eg , metronidazole [ Flagyl ] or amoxicillin [ Amoxil ] and clarithromycin [ Biaxin ]) plus a proton pump inhibitor ( eg , lansoprazole [ Prevacid ], omeprazole [Prilosec ], or rabeprazole [ Aciphex ]) OR quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine againstH . pylori

15. Conti… Histamine-2 (H2) receptor antagonists and proton pump inhibitors Patients at risk for stress ulcers ( eg , patients with head injury or extensive burns) may be treated prophylactically with IV H2 receptor antagonists and cytoprotective agents ( eg , misoprostol, sucralfate ) because of the risk of upper GI tract hemorrhage . ZES______ Sandostatin ( octreotide )

16. Surgical management Vagotomy, with or without Pyloroplasty (transecting nerves that stimulate acid secretion and opening the pylorus ) antrectomy

17. Nursing diagnosis • Acute pain related to the effect of gastric acid secretion on damaged tissue • Anxiety related to an acute illness • Imbalanced nutrition related to changes in diet • Deficient knowledge about prevention of symptoms and management of the condition

18. Nursing interventions Relieving Pain Pain relief can be achieved with prescribed medications. The patient should avoid aspirin, foods and beverages that contain caffeine, and decaffeinated coffee. Reducing Anxiety Maintaining Optimal Nutritional Status Monitoring and Managing Complications