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Peptic Ulcer Diseae
PUD
| Question | Answer |
|---|---|
| PUD definition | is used to describe both gastric (stomach) and duodenal ulcers. results when mucosal defense become impaired and dont protect epi. |
| Gastric- PUD pathopys | gastric ulcers |
| causative agents- gastric | acid, pepsin, H. Pylori |
| causes-gastric ulcer | when break down occurs then the acid causes injury to epithelium=decreased gastric empty=decrease blood flow contribuate to uleration. most are deep, occur at lesser curvature |
| duodenal ulcer pathophys | occur in first portion of suodenal, deep and penatrate muscle layer. |
| charteristics duodenal ulcer | increase acid secretion(increase in pH for long periods) |
| causes of acid stimulation | high protein foods, calcium, vagal stim. most cases of duodenal have + H.Pylori |
| Stress ulcer | occur with medical crisis/trauma( head injury, burns, respiratory failure, shock, sepsis) |
| what occurs with stress ulcer? | multifocal lesions, occur in proximal portion of stomach and duodenum |
| Progression of stress ulcer: | begin as ischemia, progess to erosion, to ulceration then to hemorrhage. |
| Complications of ulcers: | hemorrhage- most serious comp 15-25% of cases; vomitting-hematemesis. melana, PERFORATION- IS ER. |
| Perforations- result of ulcer: s/s | abd tender, rigid, pt in fetal postion to min. pain, paralytic ileus occurs. |
| progression of perforation: | peritonitis, then bacterial sepsis, then hypovelemia shock follows. |
| Pyloric obstruction | caused by scarring, edema, inflammation. |
| pyloric obstruction s/s: | N/V, bloating, electo imbalance (hypochlor, or hypokal) |
| Tx of pyloric obstruction: | IV fluids and electrolytes |
| Etiology of ulcers: | primarily with NSAIDs- difficult to tx b/c of reacurrence. other drugs:theophylline, caffine, and corticosteroids. Hpylori |
| assessment of ulcers:s/s | dyspepsia, pain is sharp, burning, gnawing. Gstric:upper left; duodenal:located rt and occurs 90min-3 hrs after eating) |
| DX tests: | hmg,hct= if bleeding occured; Barium=duo; EGD:most accurate means of DX. IgG for H.pylori, stool testing. |
| Interventions: | drug combos:pepto/priolsec and flagyl;zantac, nexium ect.. also cytotec with NSAIDs can be used( reduce acid secretion) |
| antiacids: | buffer gastric acid, taken 2 hr after meals; many drugs interact with so take 1-2 hr before or after. |
| teaching: | pt with Na+ restrict= avoid alumun. and Mg+.Riopan is lowest Na+ content. |
| diet therapy: | bland diet, 6 smaller meals, |
| interventions: | hypovelemic management=occurs with bleeding or vomitting; monitor I&O, electos, volume replace:NS LR, Blood, Fresh frozen plasma. |
| occlut blood: | need 3 stools all + |
| s/s oh hypovelmic shock: | hypotension, weak thready pulse, chills, diaphoresis, palpations. Tx: transfusions, H2 blockers, and NG lavage (50-200ml NS and continue untilpk returns w/o clots- postion pt on left side) |
Created by:
Rose921
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