peptic ulcer disease nrs452 norhaini majid. introduction pud,a break in a mucous lining of gi tract...
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PEPTIC ULCER PEPTIC ULCER DISEASEDISEASE
PEPTIC ULCER PEPTIC ULCER DISEASEDISEASE
NRS452NRS452Norhaini MajidNorhaini 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• VomitOlder 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 testZollinger-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
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