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