Pathophysiology
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Transcript Pathophysiology
NUR 120
PEPTIC ULCER
DISEASE
Pathophysiology
Normally, a physiologic balance exists
between peptic acid secretion and gastric
mucosal defense
The gastric mucosal barrier protects the
underlying tissue from gastric acids and
digestive juices
When a disruption occurs with this protective
barrier, the mucosal lining is exposed and
corroded by acid, resulting in an ulcer
Causes of PUD
H pylori bacteria
Chronic use of NSAIDS
Hypersecretion of Stomach Acid
Stress
Zollinger-Ellison Syndrome
To Test for H Pylori
Endoscopic gastric samples
Collect medication history prior
Urea breath testing
NPO prior to test
IgG serologic test can detect antibodies
Stool sample
Ulcer Classification
Location:
ulcer on stomach=Gastric Ulcer
ulcer on upper intestine=Duodenal Ulcer
ulcer on esophagus=Esophageal Ulcer
Duration:
Acute or Chronic
Signs and Symptoms
o
Symptoms vary from person to person
o
Can be confused with GERD and dyspepsia
o
Common signs and symptoms:
o
Gnawing, burning and aching in the
epigastrium, and
o
Dyspepsia that feels like heartburn
o
Bloating and nausea
o
Pain
o
Less common symptoms:
o Pyloric obstruction- vomiting after meals
o Vomiting blood that looks like coffee
grounds
o Black stools that looks like tar or that has
dark red in them
Gastric Ulcer
Duodenal Ulcer
30 to 60 min after meal
1.5 to 3 hr after meal
Rarely occurs at night
Often occurs at night
Pain worsens with food ingestion
Pain relieved by food
ingestion
o
Peptic ulcer disease can be differentiated
between gastric, duodenal, and stress ulcers.
o
Silent ulcers may occur with pts with diabetes,
NSAID users such as aspirin and ibuprofen.
o
If left untreated, complications may occur
such as bleeding, perforation, penetration or the
obstruction of the digestion tract.
Treatment of Peptic Ulcer Disease
Combination of lifestyle changes and
pharmacotherapy best
Treatment goals
Eliminate infection by H. pylori
Promote ulcer healing
Prevent recurrence of symptoms
Treatment of Peptic Ulcer
Disease (continued)
Drugs used in treatment
H2-receptor antagonists
Proton pump inhibitors
Antacids
Antibiotics and miscellaneous drugs
Treatment of H. pylori
Goals of treatment
Primary: bacteria completely eradicated
Ulcers heal more rapidly
Ulcers remain in remission longer
Very high reoccurrence when H. pylori not eradicated
Infection can remain active for life if not treated.
H2-Receptor Blockers
Slow acid secretion by stomach
Often drugs of choice in treating PUD
Cimetidine used less frequently
Drug-drug interactions are numerous.
Do not take antacids at same time as H2-receptor
blockers.
Decreases absorption
H2-Receptor Blockers
Prototype drug: ranitidine (Zantac)
Mechanism of action: acts by blocking H2-
receptors in stomach to decrease acid production
Primary use: to treat peptic ulcer disease
Adverse effects: possible reduction in number
of red and white blood cells and platelets,
impotence or loss of libido in men
H2-Receptor
Antagonist Therapy
Dysrhythmias and hypotension have occurred
with IV cimetidine
Ranitidine (Zantac) or famotidine (Pepcid)
can be administered intravenously
Assess kidney and liver function
Evaluate client’s CBC for possible anemia
during long-term use
Proton Pump Inhibitors
Prototype drug: omeprazole (Prilosec)
Mechanism of action: reduces acid secretion in
stomach by binding irreversibly to enzyme H+, K+ATPase
Primary use: for short-term, 4- to 8-week therapy for
peptic ulcers and GERD
Adverse effects: headache, nausea, diarrhea, rash,
abdominal pain
Long-term use associated with increased risk of
gastric cancer
Proton Pump Inhibitor
Therapy for PUD
Take 30 minutes prior to eating, usually
before breakfast
May be administered at same time as
antacids
Often administered in combination with
clarithromycin (Biaxin)
Antacids
Prototype drug: aluminum hydroxide (Amphojel)
Mechanism of action: neutralizes stomach acid by
raising pH of stomach contents
Primary use: in combination with other antiulcer
agents for relief of heartburn due to PUD or GERD
Adverse effects: minor; constipation
Antibiotics
Administered to treat H. pylori infections of
gastrointestinal tract
Two or more antibiotics given concurrently
Increase effectiveness
Lower potential for resistance
Regimen often includes
Proton pump inhibitor
Bismuth compounds
Inhibit bacterial growth
Prevent H. pylori from adhering to gastric
mucosa
Miscellaneous Drugs
Several additional drugs are beneficial in treating PUD
Sucralfate
Coats ulcer and protects it from further erosion
Misoprostol
Inhibits acid and stimulates production of mucus
Pirenzepine
Inhibits autonomic receptors responsible for
gastric-acid secretion
Peptic Ulcer Disease
Nursing Interventions:
•Pain Management:
•Assess location, characteristics, onset/duration, frequency, quality,
intensity or severity of pain, and precipitating factors to determine
appropriate intervention
•Provide client with optimal pain relief by using prescribed analgesics to
provide comfort.
•Use a variety of measures of relief such as pharmacologic,
nonpharmacologic, and interpersonal techniques to facilitate pain relief.
•Teach the use of nonpharmacologic techniques which include relaxation,
music therapy, guided imagery, distraction, acupressure, and massage
before after and if possible during painful activities before pain occurs or
increases.
•Relaxation helps decrease acid production and reduces pain
•Nursing Interventions cont’d:
–Treament Regimen:
•Explain the pathophysiology of the disease and how it relates to anatomy and physiology
to help the patient understand the disease.
•Discuss lifestyle changes that may be required to prevent future complications and/or
control the disease process.
•Instruct patient on which signs and symptoms to report to the health care provider to
ensure early initiation of treatment.
–Hemorrhage/Bleeding:
•Assess for evidence of hematemesis, bright red or melena stool, abdominal pain or
discomfort, symptoms of shock (decreased BP, cool/clammy skin, dyspnea, tachycardia,
decreased urine output)
•If ulcer is actively bleeding, observe NG tube aspirate or emesis for amount and color to
assess degree of bleeding.
•Take vital signs every 15-30 mins to help determine patient’s hemodynamic status and as
indicators for shock.
•Maintain IV infusion line to provide ready access for blood and fluid replacement.
•Monitor hematocrit and hemoglobin as indicators of severity of hemorrhage and need for
fluid and blood replacement.
•Nursing Interventions cont’d:
–Perforation:
•Observer for manifestations of perforation such as
sudden, severe abdominal pain; rigid, boardlike abdomen;
radiating pain to shoulders; increasing distention;
decreasing bowl sounds.
•Take vital signs every 15-30 mins.
•Maintain NG tube to suction to provide continuous
aspiration and gastric decompression.
•Administer pain medication to promote comfort and
reduce anxiety.
Dietary modifications
Avoid foods that
cause epigastric
distress.
Avoid milk, sweets,
or sugars
Small, frequent
meals rather than large
meals.
Limit the fluid intake
at one time.
Avoid
Cigarettes and
alcohol.
Avoid OTC
drugs unless
approved by
HCP.
Take all
medications as
provided.
Report any of the following:
Increased nausea and or vomiting.
Increase in epigastric pain.
Bloody emesis or tarry stools.
Encourage stress reducing activities or
relaxation strategies.