PEPTIC ULCER DISEASE NRS452 Norhaini 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 Vomit Older 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 test Zollinger-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