Podcast
Questions and Answers
Which of the following best describes the pathophysiology of gastric ulcers?
Which of the following best describes the pathophysiology of gastric ulcers?
- Direct result of H. pylori colonizing the duodenum, leading to chronic inflammation.
- Breakdown of the mucosal barrier, often occurring more in older adults, with an increased risk of cancer. (correct)
- Increased gastric acid secretion overwhelming the duodenal lining.
- An uncertain role of stress leading to increased acid production.
Which of the following locations is commonly affected by peptic ulcer disease?
Which of the following locations is commonly affected by peptic ulcer disease?
- Appendix and ileum
- Colon and rectum
- Gallbladder and pancreatic duct
- Stomach and duodenum (correct)
What is the primary mechanism by which Helicobacter pylori (H. pylori) contributes to the formation of peptic ulcers?
What is the primary mechanism by which Helicobacter pylori (H. pylori) contributes to the formation of peptic ulcers?
- Increasing the rate of gastric emptying.
- Stimulating excessive mucus production in the stomach.
- Producing an enzyme that reduces the effectiveness of the mucosal gel. (correct)
- Promoting rapid cell turnover in the stomach lining.
A patient reports experiencing epigastric pain 1 to 2 hours after meals. Eating does not relieve the pain. Which type of ulcer is most likely causing the patient's symptoms?
A patient reports experiencing epigastric pain 1 to 2 hours after meals. Eating does not relieve the pain. Which type of ulcer is most likely causing the patient's symptoms?
Which diagnostic test provides direct visualization of the esophagus, stomach, and duodenum?
Which diagnostic test provides direct visualization of the esophagus, stomach, and duodenum?
What is the rationale for using combination therapy, including antibiotics, in the treatment of peptic ulcers?
What is the rationale for using combination therapy, including antibiotics, in the treatment of peptic ulcers?
Which of the following medications is a cytoprotective agent used in the treatment of peptic ulcer disease?
Which of the following medications is a cytoprotective agent used in the treatment of peptic ulcer disease?
A patient with a peptic ulcer is advised to avoid aspirin. Which of the following explains the reasoning for this recommendation?
A patient with a peptic ulcer is advised to avoid aspirin. Which of the following explains the reasoning for this recommendation?
What is the most common complication associated with peptic ulcer disease?
What is the most common complication associated with peptic ulcer disease?
Which assessment finding is most indicative of a peptic ulcer perforation?
Which assessment finding is most indicative of a peptic ulcer perforation?
A patient diagnosed with a duodenal ulcer asks why the pain is often relieved by food. What is the best explanation?
A patient diagnosed with a duodenal ulcer asks why the pain is often relieved by food. What is the best explanation?
Which of the following lifestyle modifications is most important for a patient with peptic ulcer disease?
Which of the following lifestyle modifications is most important for a patient with peptic ulcer disease?
A patient with a history of peptic ulcer disease presents with coffee-ground emesis. What does this finding suggest?
A patient with a history of peptic ulcer disease presents with coffee-ground emesis. What does this finding suggest?
In evaluating the effectiveness of treatment for peptic ulcer disease, which outcome indicates the most successful prognosis?
In evaluating the effectiveness of treatment for peptic ulcer disease, which outcome indicates the most successful prognosis?
A patient with peptic ulcer disease is prescribed a C-urea breath test. What is the purpose of this test?
A patient with peptic ulcer disease is prescribed a C-urea breath test. What is the purpose of this test?
A patient who has been taking NSAIDs long-term is diagnosed with a gastric ulcer. Which medication is most likely to be prescribed to reduce acid secretion?
A patient who has been taking NSAIDs long-term is diagnosed with a gastric ulcer. Which medication is most likely to be prescribed to reduce acid secretion?
Which of the following conditions correlates to higher incidence of peptic ulcer disease?
Which of the following conditions correlates to higher incidence of peptic ulcer disease?
A patient experiencing nausea and vomiting is potentially experiencing which of the following complications?
A patient experiencing nausea and vomiting is potentially experiencing which of the following complications?
What intervention should be prioritized for a patient who has peritonitis?
What intervention should be prioritized for a patient who has peritonitis?
Which of the following symptoms are displayed by a patient with peptic ulcer complication caused by perforation?
Which of the following symptoms are displayed by a patient with peptic ulcer complication caused by perforation?
Flashcards
Peptic Ulcer Disease
Peptic Ulcer Disease
A chronic condition characterized by the breakdown of the mucosal lining in the GI tract. Common locations are the stomach (gastric ulcer), duodenum (duodenal ulcer), lower esophagus and jejunum.
H. pylori
H. pylori
Mucosal breakdown in PUD often results from infection by this bacteria. It spreads orally/fecally, reducing the effectiveness of mucosal gel & colonizing the stomach/duodenum.
Pathophysiology of Gastric vs. Duodenal Ulcers
Pathophysiology of Gastric vs. Duodenal Ulcers
Gastric: breakdown of mucosal barrier and an increased risk of cancer. Duodenal: increased gastric acid secretion and is more common.
PUD Clinical Manifestations: Pain
PUD Clinical Manifestations: Pain
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Esophagogastroduodenoscopy (EGD)
Esophagogastroduodenoscopy (EGD)
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Medical management goals for PUD
Medical management goals for PUD
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Medications to Eliminate H. pylori
Medications to Eliminate H. pylori
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Nursing Interventions for PUD
Nursing Interventions for PUD
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Name the 3 major complications of PUD:
Name the 3 major complications of PUD:
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Signs of Perforation
Signs of Perforation
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Study Notes
- Peptic Ulcer Disease (PUD) involves breakdown of the mucosal lining in the GI tract.
- PUD can occur in the stomach (gastric ulcer), duodenum (duodenal ulcer), lower esophagus, and jejunum.
Etiology and Incidence
- Mucosal breakdown can occur secondary to infection.
- H. pylori infection is a common cause of mucosal breakdown.
- 1 in 6 patients with H. pylori develop PUD.
- NSAIDs, smoking, and stress are also risk factors.
- PUD is more common in men.
- Diseases that alter gastric secretion such as COPD, Crohn's, and cancer, are risk factors
- Diet is not a major factor, but caffeine/alcohol can exacerbate PUD.
Helicobacter pylori (H. Pylori)
- H. pylori is spread through oral-oral or fecal-oral routes.
- H. pylori produces an enzyme that diminishes the effectiveness of mucosal gel.
- H. pylori colonizes the stomach and duodenum.
- H. pylori infection may be asymptomatic.
- 80-90% of ulcers are caused by H. pylori.
- Antibiotics are used for treatment (1-2 drugs for 2 weeks).
Pathophysiology
- Gastric ulcers involve the breakdown of the mucosal barrier.
- Gastric ulcers are more common in older adults.
- Gastric ulcers have an increased risk of cancer.
- Duodenal ulcers involve increased gastric acid secretion and are the most common type.
- The role of stress ulcers is uncertain.
Clinical Manifestations
- PUD may be asymptomatic.
- Pain is common when the stomach is empty.
- Gastric ulcer pain occurs 1 to 2 hours after eating and is unrelieved by eating.
- Duodenal ulcer pain occurs 2 to 4 hours after eating and is relieved by food.
- Other clinical manifestations include bloating, belching, nausea and vomiting (less common), anemia, and weight loss.
- Guaiac positive stools (melena) give stools a "roof tar" appearance.
Diagnostic and Laboratory Tests
- Esophagogastroduodenoscopy (EGD) provides direct visualization.
- H. Pylori antibodies are tested in blood.
- C-urea breath test detects an enzyme produced by H. pylori, which breaks urea down into ammonia and carbon dioxide.
Medical Management Goals
- Allow ulcer to heal
- Reduce acid secretion.
Medications for Management
- Antibiotics, such as tetracycline, clarithromycin, amoxicillin, and metronidazole are used in combination therapy to eradicate H. pylori.
- Histamine2-receptor antagonists (H2 blockers) such as ranitidine and famotidine reduce acid secretion.
- Proton Pump Inhibitors (PPIs), such as omeprazole and pantoprazole help reduce acid secretion.
- Cytoprotective agents like sucralfate bind to the ulcer base and form a protective paste/barrier.
Interventions
- Rule out pain from cardiac-related disorders.
- Maintain good nutrition and eliminate foods that cause discomfort.
- Decrease stress and encourage smoking cessation.
- Avoid Aspirin ASA and NSAIDs, and limit alcohol and caffeine intake.
- Explain potential complications.
Complications
- Hemorrhage is a potential complication.
- Obstruction is a potential complication.
- Perforation is a potential complication.
Complications: Hemorrhage
- Hemorrhage is the most common complication.
- Symptoms depend on the rapidity of blood loss.
- Blood transfusions and maintenance of fluid/electrolyte balance may be necessary.
- Lab and diagnostic tests include CBC, endoscopy, and guaiac stool.
Complications: Obstruction
- Obstruction can results in nausea and vomiting.
- Obstruction can results in a sensation of epigastric fullness.
- Obstruction can results in electrolyte and acid/base imbalances.
Complications: Perforation (peritonitis)
- Perforation is the most lethal complication.
- Perforation causes sudden, dramatic upper abdominal pain that quickly spreads throughout the abdomen.
- The abdomen becomes rigid and board-like.
- Bowel sounds are decreased or absent.
- Respirations become shallow and rapid.
- The pulse becomes rapid and weak.
- Blood pressure drops causing hypotension.
Complications: Perforation (peritonitis) Diagnosis and Treatment
- Diagnosis involves identifying peritoneal signs such as rebound tenderness, guarding, rigidity, absent bowel sounds, and severe upper abdominal pain.
- Treatment involves stopping spillage into the peritoneal cavity, restoring blood volume, preventing infection, and performing emergency surgery.
Prognosis and Evaluation
- Most ulcers heal in 3-8 weeks.
- Monitor for reports of decreased pain, maintenance of adequate nutrition, adherence to medication regimen, and demonstration of lifestyle modifications.
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