ACID PEPTIC DISEASES

A peptic ulcer is an excavation

(hollowed out area) that forms in the

mucosal wall of the stomach, in the

pylorus,the duodenum or in the

esophagus resulting from the erosion

of a circumscribed area of mucus

membrane

DEFINITION

H PYLORI INFECTION

DRUGS

DIET

ENVIRONMENTAL FACTERS

ETIOLOGY AND RISKFACTORS

AGE

SEX

GENETICS

PSYCOLOGICAL AND EMOTIONAL SRESS

PATHOPHYSIOLOGICAL CONDITIONS

ETIOLOGY AND RISKFACTORS

PATHOPHYSIOLOGY

Abdominal pain, classically epigastric related with meal time

Nausea and Vomiting Pyrosis Bloating and abdominal fullness Water brash Loss of appetite and weight loss Hematemesis melena

CLINICAL MANIFESTATIONS

HEMORRHAGE

PERFORATION

GASTRIC OUTLET OBSTRUCTION

COMPLICATIONS

CONSERVATIVE THERAPY

ADEQUATE BED REST

BLAND DIET

CESSATION OF SMOKING

SRESS REDUCTION

COLLABORATIVE THERAPY

1. H2 Receptor blockers

2. Proton pumb inhibitor

3. Anticholinergics

4. Antibiotic for H pylori

5. Antacids

DRUG THERAPY

Antacids

Single substance Aluminum carbonate Aluminum phosphate Calcium carbonate Magnesium hydroxide Sodium bicarbonate

Drug therapy

Antacids

Mixtures of aluminum hydroxide and magnesium salts

Gelusil Maalox Aludrox

Antacids

Mixtures of calcium carbonate and aluminum and magnesium hydroxide

Camalox Ducon

Mixtures of calcium carbonate,magnesium carbonate and magnesium oxide

Alkets

CYTOPROTECTIVE DRUGS

Sucralfate Bismuthsubsalicylate

TRICYCLIC ANTIDEPRESSANTS Imipramine doxepine

DRUG THERAPY

Keep the patient in NPO status

Nasogastric suction

adequate rest

cessation of smoking

IV fluid replacement

Drug therapy

Treatment of acute exacerbation without complication

Intractability:Failure of the ulcer to heal or recurrence of the ulcer after therapy

History of hemorrhage or increased risk of bleeding during treatment

Prepyloric or pyloric ulcers (both have high recurrence rate)

Indications for surgery

Concurrent conditions such as severe burns, trauma or sepsis

Multiple ulcer sites

Drug induced ulcers

Possible existence of a malignant ulcer

obstruction

Indications for surgery

Vagotomy

Truncal vagotomy Selective vagotomy Proximal vagotomy

pyloroplasty

SURGICAL MANAGEMENT

GASTROENTEROSTOMY

ANTRECTOMY

BILLROTH I/ GASRODUODINOSTOMY

BILLROTH II/ GASTROJEJUNOSTOMY

SURGICALMANAGEMENT

NPO

GASTRIC DECOMPRESSION

BED REST

FLUID REPLACEMENT

BLOOD TRANSFUSION

TREATMENT OF COMPLICATIONS

ANALGESICS

STOMACH LAVAGE

BROAD SPECTRUM ANTIBIOTICS

TREATMENT OF COMPLICATION

SURGICAL THERAPY

Perfortion : simple closure with omentum graft

Gastric outlet obstruction:pyloroplasty and vagotomy

Ulcer removal or reduction: bilroth I and ll, vagotomy, pyloroplasty

TREATMENT OF COMPLICATIONS

Marginal ulcers

Hemorrhage

Dumping syndrome

Post prandial hypoglycaemia

POST OPERATIVE COMPLICATIONS

Bie reflux gastritis

Gastrojejunocoic fistula

Pyloric obstruction

Nutritional problems

POST OPERATIVE COMPLICATIONS

Purposes:

To slow the rapid passage of food in to the intestine

To control symptoms of the Dumping syndrome

Promote rebuilding of body tissue and to meet energy needs

Nutritional therapy after surgey

Diet principle

Meals are divided in to six small feedings

eliminate drinking fluid with meals, fluid should be taken between meals.

The diet should consist of small dry feedings daily that are low in carbohydrate, are restricted in refined sugars

Diet principle

Protein and fats are increased to promote rebuilding of tissues and to meet energy needs

Plan rest periods of at least 30 minutes after each meal, preferably in recumbent position.

Diet principle

Nursing diagnoses

Acute pain related to increased gastric secretions, decreased mucosal protection, and ingestion of gastric irritants as manifested by burning cramp like pain in epigastrium and abdomen.

Nursing management

Nausea related to exacerbation of disease process as manifested by episodes of nausea and vomiting

Ineffective therapeutic regimen management related to lack of knowledge of long term management

of peptic ulcer disease and consequences of not following treatment plan and un willingness to

modify lifestyle

Potential complication for hemorrhage secondary to eroded mucosal tissue

potential complication for perforation of GI mucosa secondary to impaired mucosal tissue integrity

Risk for injury, post operative complications (immediate and delayed) related to bleeding, distention and atelectasis.

Altered nutrition less than body requirement related to decreased nutrient absorption secondary to dumping syndrome

Post operative nursing diagnosis

Thank you…