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Peptic Ulcer Diseae


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