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Questions and Answers
A peptic ulcer is best described as:
A peptic ulcer is best described as:
- A viral infection affecting the intestinal villi.
- An excavation that forms in the mucosal wall of the stomach, pylorus, duodenum, or esophagus. (correct)
- A benign tumor located exclusively by the esophagus.
- An inflammation of the gastric lining due to an allergic reaction.
Which of the following is a surgical procedure that involves the dilation of the pyloric sphincter to improve gastric emptying?
Which of the following is a surgical procedure that involves the dilation of the pyloric sphincter to improve gastric emptying?
- Pyloroplasty (correct)
- Antrectomy
- Billroth I
- Vagotomy
Which diagnostic test is typically preferred for the initial evaluation and diagnosis of peptic ulcer disease (PUD)?
Which diagnostic test is typically preferred for the initial evaluation and diagnosis of peptic ulcer disease (PUD)?
- Upper endoscopy (correct)
- Barium swallow
- Serologic testing for H. pylori antibodies
- Gastric secretory studies
Why is Misoprostol contraindicated in pregnant women?
Why is Misoprostol contraindicated in pregnant women?
Which of the following best describes the mechanism of action of antacids in the management of peptic ulcer disease?
Which of the following best describes the mechanism of action of antacids in the management of peptic ulcer disease?
A patient with a peptic ulcer reports that their pain is relieved by eating. This is most characteristic of which type of ulcer?
A patient with a peptic ulcer reports that their pain is relieved by eating. This is most characteristic of which type of ulcer?
What is the primary goal of medical management in treating peptic ulcer disease (PUD)?
What is the primary goal of medical management in treating peptic ulcer disease (PUD)?
Which of the following best describes the action of cytoprotective drugs like sucralfate in treating peptic ulcer disease?
Which of the following best describes the action of cytoprotective drugs like sucralfate in treating peptic ulcer disease?
Why are NSAIDs considered a predisposing factor for peptic ulcer disease?
Why are NSAIDs considered a predisposing factor for peptic ulcer disease?
A patient is prescribed a histamine H2-receptor antagonist for peptic ulcer disease. When is the optimal time for the patient to take this medication?
A patient is prescribed a histamine H2-receptor antagonist for peptic ulcer disease. When is the optimal time for the patient to take this medication?
Which of the following best characterizes the pain associated with a gastric ulcer?
Which of the following best characterizes the pain associated with a gastric ulcer?
What is a potential complication of gastric ulcers that requires careful monitoring?
What is a potential complication of gastric ulcers that requires careful monitoring?
Which of the following is included in the typical quadruple with bismuth for H. pylori drug treatment?
Which of the following is included in the typical quadruple with bismuth for H. pylori drug treatment?
What is the purpose of serologic testing in the context of peptic ulcer disease?
What is the purpose of serologic testing in the context of peptic ulcer disease?
Which laboratory finding suggests that a patient with a peptic ulcer is experiencing bleeding?
Which laboratory finding suggests that a patient with a peptic ulcer is experiencing bleeding?
Which of the following dietary modifications is most important for a patient with peptic ulcer disease to avoid?
Which of the following dietary modifications is most important for a patient with peptic ulcer disease to avoid?
What is a primary purpose of performing a vagotomy in the surgical treatment of peptic ulcer disease?
What is a primary purpose of performing a vagotomy in the surgical treatment of peptic ulcer disease?
A patient with blood type O is considered to have a ____________ predisposition to peptic ulcer disease.
A patient with blood type O is considered to have a ____________ predisposition to peptic ulcer disease.
Which of the following statements is likely to be true regarding a 'poor man's ulcer'?
Which of the following statements is likely to be true regarding a 'poor man's ulcer'?
Flashcards
Peptic Ulcer Disease (PUD)
Peptic Ulcer Disease (PUD)
An excavation in the mucosal wall of the stomach, pylorus, duodenum, or esophagus.
Types of Peptic Ulcers
Types of Peptic Ulcers
Gastric, duodenal, or esophageal, depending on its location.
Main Cause of Peptic Ulcers
Main Cause of Peptic Ulcers
Helicobacter pylori infection.
Predisposing Factors for PUD
Predisposing Factors for PUD
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Characteristics of Gastric Ulcers
Characteristics of Gastric Ulcers
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Characteristics of Duodenal Ulcers
Characteristics of Duodenal Ulcers
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Assessment Findings for PUD
Assessment Findings for PUD
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Goals of Medical Management
Goals of Medical Management
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Antacids
Antacids
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Histamine H2-Receptor Antagonists
Histamine H2-Receptor Antagonists
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Proton-Pump Inhibitors (PPIs)
Proton-Pump Inhibitors (PPIs)
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Cytoprotective Drugs
Cytoprotective Drugs
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Quadruple Therapy
Quadruple Therapy
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Prophylactic Therapy for NSAID Ulcers
Prophylactic Therapy for NSAID Ulcers
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Prostaglandin Analogue Function
Prostaglandin Analogue Function
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Misoprostol Contraindication
Misoprostol Contraindication
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Medical management
Medical management
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Vagotomy
Vagotomy
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Pyloroplasty
Pyloroplasty
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Billroth I
Billroth I
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Study Notes
- Peptic Ulcer Disease (PUD) is an excavation (hollowed-out area) that forms in the mucosal wall of the stomach, pylorus, duodenum, or esophagus.
- A peptic ulcer can be referred to as a gastric, duodenal, or esophageal ulcer, depending on its location.
- Peptic ulcers are caused by erosion of a circumscribed area of mucosa, which extends as deep as the muscle layers or to the peritoneum.
- Helicobacter pylori infection is a cause of peptic ulcers.
Pathophysiology
- An increase in secretion due to stress or stimulants, damages the mucous membrane, leading to PUD.
- A decrease in secretion due to decreased blood flow or irritants, damages the mucous membrane, leading to PUD.
Predisposing Factors
- Stress
- Smoking
- Alcohol
- Caffeine
- Drugs: ASA, NSAIDs
- Zollinger-Ellison Syndrome
- Irregular, hurried meals
- Fatty, spicy, highly acidic foods
- Type A personality (stress personality)
- Blood type O
- Genetics
Gastric Ulcer Vs. Duodenal Ulcer
- Gastric Ulcer:*
- "Poor man's" ulcer
- Typically occurs in individuals aged 50 and above
- Has a lower incidence, accounting for 20% of cases
- Pain radiates to the left side of the abdomen.
- Pain occurs ½ to 1 hour after a meal or during meals.
- Pain is not relieved by food intake.
- Symptoms include nausea/vomiting and hematemesis.
- Can lead to complications such as hemorrhage, perforation, and peritonitis.
- Duodenal Ulcer:*
- "Executive" ulcer
- More common in individuals aged 30-60
- Has a higher incidence, accounting for 80% of cases
- Pain radiates to the right side of the abdomen
- Pain occurs 2-3 hours after a meal (12 am-3 am).
- Pain is relieved by eating.
- Symptoms include melena.
- Can lead to complications such as obstruction.
Assessment Findings
- Pain
- Epigastric tenderness
- Abdominal distention
Diagnostic Tests
- Upper Endoscopy: the preferred diagnostic procedure
- Histology: measures for detecting H. pylori
- Serologic testing: checks for antibodies against H. pylori antigen
Laboratory Tests
- CBC: Detects the extent of blood loss.
- Fecalysis: Checks for the presence of occult blood.
- Gastric Secretory Studies: Used to diagnose Zollinger-Ellison Syndrome (ZES).
Medical Management
- The goals are to eradicate H. pylori as indicated and to manage gastric acidity.
- Methods include medications, lifestyle changes, and surgical intervention.
Medical Management - Medications
- Antacids:*
- Examples: Amphogel, Maalox, Calcium Carbonate (Tums), Magnesium hydroxide, Gaviscon
- Neutralizes HCl and is best taken 1-2 hours after a meal.
- Histamine H2-Receptor Antagonists:*
- Examples: Cimetidine, famotidine, ranitidine
- Reduces HCl acid secretion and is best taken at bedtime.
- Proton-Pump Inhibitors:*
- Examples: Esomeprazole 40mg daily, Pantoprazole 40mg daily, Lansoprazole 30mg daily, Omeprazole 20mg daily/AC
- Suppress gastric acid secretion.
- Cytoprotective Drugs:*
- Sucralfate coats the ulcer and is given 30 minutes to 1 hour before meals.
H. Pylori Drug Treatment
- Quadruple therapy with bismuth subsalicylate 525 mg qid, plus tetracycline 500 mg qid, plus metronidazole 500 mg bid, plus a PPI daily for 10–14 days (Efficacy: 85%)
Prophylactic Therapy for NSAID Ulcers
- PPIs and Misoprostol 100-200mcg qid prevent recurrent ulceration.
- Prostaglandin analogues suppress the secretion of gastric HCl.
- Misoprostol should not be taken by pregnant women.
Additional Medical Management
- Smoking Cessation
- Dietary Modification
- Surgical Management
- Follow-up Care
Surgical Procedures for PUD
- Vagotomy: Resection of the vagus nerve.
- Pyloroplasty: Surgical dilation of the pyloric sphincter.
- Antrectomy*
- Billroth I (Gastroduodenostomy): Anastomosis of the gastric stump to the duodenum.
- Billroth II (Gastrojejunostomy): Anastomosis of the gastric stump to the jejunum; the duodenum is bypassed but not removed.
Nursing Interventions
- Relieving pain
- Reducing Anxiety
- Maintaining Optimal Nutritional Status
- Monitoring and Managing potential complications
What To Avoid
- Fatty foods, coffee, tea, chocolate, cola, spices, and alcohol, as they are irritants and stimulants.
- Bedtime snacks
- Binge eating
- Large quantities of milk
- Smoking
- Stressors
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