Peptic ulcer disease-2 (1) abdullah-2 (1).pptx

Peptic ulcer disease

1. PEPTIC ULCER DISEASE(PUD) 1

2. Contents Defination of Peptic Ulcer and its Types 01 Etiology and Pathophysiology of PUD 02 Signs and symptoms of PUD 03 Complications Assessment of PUD Drug Therapy and Treatment of PUD 04 05 06 Surgical Management 07 Nursing Diagnosis of patient of PUD 08 2

3. Peptic Ulcer- Defination ● Peptic Ulcer Disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. ● An ulcer in the stomach is called a gastric ulcer while one in the first part of the intestines is duodenal ulcer. ● Together, ulcers of the stomach and duodenum are referred to as peptic ulcer . r 3

4. Anatomy of Stomach and Duodenum 4

5. Anatomy of Stomach 5

6. Gastric Glands 6

7. Gastric Glands Gastric glands contains three types of exocrine gland cells. Exocrine cells Chief cells: Secretes pepsinogin and gastric lipase Parietal cells: Secrets HCL and intrinsic factor Mucous neck cells: Secretes the mucous Enteroendocrine cells G cells: It is mainly located in pyloric antrum. It secretes the gastrin hormone which stimulates the gastric activity. 7

8. Location of Peptic Ulcer Peptic Ulcer may be found in: ● Stomach ● Duodenum ● Esophagus ● GE Junction 8

9. Etiology of Peptic Ulcer Disease H Pylori infection 90% have this bacterium Passed from person to person (fecal-oral route or oral-oral route Age Duodenal 30-40 Gastric over 50 Gender Duodenal: are increasing in older women Genetic Factors More likely if family member has Hx Lifestyle Smoking Acidic Drinks Medications 9

10. Factors that can increase the risk of ulcers ● Use of NSAIDs ( such as aspirin, naproxen, ibuprofen and many other prescribtion medicine; even safety-coated aspirin and aspirin in powder form can cause ulcer ● Excess Acid production from gastrinomas (tumors of acid producing cells) ● Stress ● Serious illness ● Radiation treatment of the area 10

11. Pathophysiology of PUD Due to Drugs (NSAIDs), alocohol, coffee, or tea Excessive secretion of HCL and decreased mucous secretion Breakdown mucous membrane of stomach Acid enters into gastric mucosa Gastric Ulcers 11

12. Pathophysiology of PUD Due to fasting Stimulation of vagus nerve Increase gastric secretion HCL secretion level increase Duodenal Ulcers 12

13. Signs and symptoms of PUD ● Pain or discomfort in the upper part of your abdomen, anywhere between your belly button and breastbone ● Feeling full too soon while eating a meal ● Feeling uncomfortably full after eating a meal ● Nausea and vomiting ● Bloating 13

14. Comparison between gastric and duodenal ulcers Gastric Ulcer Duodenal Ulcer More common in Old age i.e more than 50 More common between 30-40 Normal Hypo-secretion of gastric acid(HCL) Hyper-Secretion of gastric acid(HCL) Pain 1-2 hrs pc meal Pain 2-4 hrs pc meal Food aggravates pain Food may relieve pain Vomiting common Vomiting Not common More likely to hermorrhage- manifests as hematemasis Less likely to hemorrhage, but if occurs likely to manifest as malena Weight Loss Weight gain 14

15. Complications of PUD ● Perforation leading to peritonitis ● Haemorrhage by erosion of vessel in base ● pyloric Obstruction (by scarring) - ● Cancer - rare event in true peptic ulcer 15

16. Assessment and investigation of PUD To establish the diagnosis of peptic ulcer, the following assessment and laboratory studies should be performed: ● Physical examination . A physical examination may reveal pain, epigastric tenderness, or abdominal distention. ● Barium x ray : A barium study of the upper GI tract may show an ulcer. 16

17. ● Endoscopy . Endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. ● Occult blood . Stools may be tested periodically until they are negative for occult blood. ● Carbon 13 (13C) urea breath test . Reflects activity of H. pylori. 17

18. Drug therapy and treatment of PUD Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. pylori bacterium if present, eliminating or reducing use of NSAIDs if possible, and helping your ulcer to heal with medication. Medications can include: ● Antibiotic medications to kill H. pylori . If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium.These may include amoxicillin ( Amoxil ), clarithromycin ( Biaxin ), metronidazole ( Flagyl ), tinidazole ( Tindamax ), tetracycline and levofloxacin. 18

19. ● Medications that block acid production and promote healing . Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole ( Prevacid ), rabeprazole ( Aciphex ), esomeprazole ( Nexium ) and pantoprazole ( Protonix ). ● Medications to reduce acid production . Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing. 19

20. Available by prescription or over the counter, acid blockers include the medications famotidine (Pepcid AC), cimetidine (Tagamet HB) and nizatidine ( Axid AR). ● Antacids that neutralize stomach acid . Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients. ● Medications that protect the lining of your stomach and small intestine . In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine. Sucralfate (Carafate) and misoprostol ( Cytotec ). 20

21. Surgical Management Surgical management of peptic ulcer disease (PUD) is typically considered when conservative treatments fail or when complications like bleeding, perforation, or obstruction occur . ● Vagotomy . This is the surgical procedure cutting the vagus nerve to reduce the stomach secretion. ● Anterectomy . Remove the lower part of the stomach ( antrum ). ● Pyloroplasty . Opening in to the deodenum and small intestine (food freely pass from the stomach). 21

22. Nursing management Assessment and monitoring. Monitor vital sign. Assessment for abdominal pain. Assessment of the charesterstitics of vomiting. medication. Medication administration as per doctor prescription. 22

23. Dietry management. Elimination of acid food. E.g. spicy food, cofee etc. It can cause heart burning Eat small meal and don’t lies down 2-3 hours after eating. Elevate bed on 30 degree to decrease reflux . Patient education. Avoid spicy food, Alchol , smoking and managing stress. 23

24. References PMC pub med central https://www.google.com/search?q=pubmed+central&oq=pub+med&gs_lcrp=EgZjaHJvbWUqCQgCEAAYChiABDIGCAAQRRg5MgkIARAAGAoYgAQyCQgCEAAYChiABDIHCAMQABiABDIJCAQQABgKGIAEMgcIBRAAGIAEMgkIBhAAGAoYgAQyCQgHEAAYChiABDIJCAgQABgKGIAEMgkICRAAGAoYgATSAQoxMDg5MGowajE1qAIJsAIB&sourceid=chrome&ie=UTF-8 Pub Med google scholar 25.strand DS, kim D peura DA.25 years of proton pump inhibitors: A compherensive review. 24

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