Peptic Ulcer Disease Overview

Peptic Ulcer Disease

• Peptic ulcer disease (PUD) is characterized by erosion of the GI mucosa due to the digestive action of HCl acid and pepsin.
• Peptic ulcers form in the mucosal wall of the stomach, pylorus, duodenum, or esophagus.
• Peptic ulcers are classified by location (gastric, duodenal, esophageal) and by their severity and duration.
• Acute ulcers are superficial erosions with minimal inflammation and resolve quickly.
• Chronic ulcers are long-lasting, eroding deeply into the muscular wall and forming fibrous tissue.

Etiology and Pathophysiology of Peptic Ulcers

• The pathogenesis of peptic ulcers involves a disturbance in the balance between gastric acid and pepsin secretion and the mucosal barrier.
• H. pylori infection is a major cause of peptic ulcers.
• Other causes include NSAID use, smoking, alcohol consumption, stress, and certain medical conditions.

Clinical Manifestations of Peptic Ulcers

• Gastric Ulcers:
  • Pain located in the high left epigastric area, radiating to the back and upper abdomen.
  • Pain described as dull, aching, and gnawing.
  • Vomiting is common.
  • Hemorrhage is more likely.
  • Hematemesis is more common.
• Duodenal Ulcers:
  • Pain located to the right of the midline epigastric region, radiating to the back
  • Pain described as burning, cramping, pressure-like pain
  • Vomiting is uncommon.
  • Hemorrhage is less likely.
  • Melena is more common.

Diagnostic Evaluation of Peptic Ulcers

• Endoscopy is the preferred diagnostic procedure, allowing direct visualization of duodenal mucosa.
• Cytological brushings and biopsies are performed to obtain samples.
• Serial stool specimens can detect occult blood.
• Gastric acid secretion test and serum gastric level test may be ordered.
• Serum test for H. pylori antibodies may be positive.

Management of Peptic Ulcers

• Pharmacotherapy:
  • H2 receptor antagonists (cimetidine, ranitidine) inhibit histamine action, reducing gastric acid.
  • Proton pump inhibitors (PPIs) inhibit HCl production.
  • Cytoprotective drugs protect the ulcer.
  • Acid-neutralizing agents (antacids) provide symptom relief.
  • Antibiotics (tetracycline, Flagyl) in combination with bismuth are used to eradicate H. pylori.
• Principles of Medical Treatment:
  • Eradicate H. pylori.
  • Reduce and neutralize acid secretion.
  • If NSAID-induced ulcers, discontinue NSAIDs and treat as above.

Nursing Process for Patients with Peptic Ulcers

• Assessment:
  • Determine location, character, and radiation of pain, factors aggravating or relieving pain, duration, and timing.
  • Assess eating patterns, regularity, types of food, and eating circumstances.
  • Obtain social history of alcohol consumption and smoking.
  • Assess medication use (aspirin, anti-inflammatory drugs, steroids).
  • Determine if GI bleeding has been experienced.
  • Take vital signs, including lying, standing, and sitting blood pressures and pulses to assess for orthostasis.
• Nursing Diagnoses:
  • Fluid volume deficit related to hemorrhage.
  • Pain related to epigastric distress.
  • Diarrhea related to GI bleeding or antacid therapy.
  • Altered Nutrition, Less Than Body Requirements.
  • Knowledge Deficit related to physical, dietary, and pharmacologic treatment.
• Nursing Interventions:
  • Fluid Volume Deficit: Monitor intake and output, observe stools for occult blood, monitor hemoglobin and hematocrit and electrolytes, administer IV fluids and blood replacement, insert NG tube and monitor drainage, administer medications through NG tube, prepare for saline lavage, observe for signs of shock.
  • Pain Relief: Encourage bed rest, provide small, frequent meals, teach about factors that increase gastric acidity, advise about irritating drug effects, administer prescribed medication.
  • Decreasing Diarrhea: Monitor elimination patterns, monitor vital signs and watch for signs of hypovolemia, restrict foods/fluids that promote diarrhea, administer antidiarrheal medication, watch for signs of impaired skin integrity.
  • Achieving Adequate Nutrition: Eliminate foods that cause pain or distress, provide small, frequent feedings, advise patient to avoid caffeinated beverages, carbonated drinks, and hot or cold foods, advise patient to chew thoroughly and eat leisurely, administer parenteral nutrition if needed.

Patient Education for Peptic Ulcers

• Modify lifestyle to prevent recurrences: Rest periods, stress management, avoid fatigue.
• Dietary modifications: Avoid extremes of temperature, overstimulation from meat extracts, alcohol, coffee, and diets rich in milk and cream.
• Take antacids one hour after meals, at bedtime, and when needed.

Abdominal Hernia

• An abnormal protrusion of an organ or structure through a weakness or tear in the abdominal wall.

Etiology of Abdominal Hernias

• Weakness in the abdominal wall.
• Increased intra-abdominal pressure (coughing, straining, heavy lifting, obesity, pregnancy, poor wound healing).
• Indirect Hernias: Defect of structural closure.
• Direct Hernias: Weakness in the abdominal wall, usually at old incisional sites.

Types of Abdominal Hernias

• Inguinal Hernias: Hernia of abdominal cavity contents through the inguinal canal, usually seen in males.
• Umbilical Hernias: Defect in the ventral abdominal fascia at or near the umbilicus, seen in obese women and children.
• Ventral (Incisional) Hernias: Weakness in the abdominal wall following abdominal surgery.
• Epigastric Hernias: Lumps or bulges in the upper part of the belly between the breastbone and the belly button.

Clinical Manifestations of Abdominal Hernias

• Abnormal bulging in the affected area, especially when straining or coughing.
• Discomfort due to tension on surrounding tissues, feeling of fullness.
• Herniation may disappear when lying down.
• Reducible Hernia: Intestinal mass easily returns to the abdominal cavity.
• Incarcerated Hernia: Adhesions or edema prevent the hernia from being reduced.

Diagnostic Evaluation of Abdominal Hernias

• Physical examination.
• Imaging studies (ultrasound, CT scan).

Management of Abdominal Hernias

• Non-Surgical Management:
  • Truss: A supportive device used to hold the hernia in place.
  • Lifestyle modifications: Weight loss, avoiding heavy lifting, and straining.
• Surgical Management:
  • Hernia repair: Surgical procedure to close the hernia defect and reinforce the abdominal wall.

Nursing Process for Patients with Abdominal Hernias

• Assessment:
  • Assess for abdominal bulge, pain, discomfort, reducibility of the hernia, and any associated symptoms.
  • Assess for risk factors such as obesity, pregnancy, and history of surgery.
  • Obtain a complete medical history and review medications.
• Nursing Diagnoses:
  • Acute Pain related to hernia.
  • Impaired Skin Integrity related to hernia or surgery.
  • Risk for Infection related to hernia or surgery.
• Nursing Interventions:
  • Pain Management: Provide pain medication as prescribed, educate patient on pain management techniques, provide comfort measures.
  • Skin Integrity: Monitor skin around the hernia for signs of breakdown, provide wound care as needed.
  • Infection Prevention: Monitor for signs of infection, educate patient on proper wound care and infection prevention measures.
• Patient Education:
  • Educate patient on the nature of the hernia, risk factors, and treatment options.
  • Provide post-operative instructions, including wound care, activity restrictions, and dietary guidelines.

This quiz covers the essential aspects of peptic ulcer disease (PUD), including its characteristics, classification, etiology, and pathophysiology. Participants will learn about the various types of peptic ulcers, their causes, and clinical manifestations. Test your understanding of this common gastrointestinal condition.