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PART I

INTRODUCTION
A. BACKGROUND
Serves as a reservoir of food the stomach receives food / drinks , grinding , mixing , and
emptying into the duodenum papers . Hull which is always associated with all types of food ,
drinks and medicines will experience iritasikronik . Gastric actually protected by a layer of
mucus but because of several factors , irritants such as food , beverages , medicines and nonsteroidal anti -inflammatory ( NSAID ) , alcohol and bile which can cause defects occur
mucosal lining and back diffusion of H + ions .
Causing gasteritis acute / chronic or gastric ulcer . With the discovery of a gastric ulcer . With
the discovery of the bacteria H. pylory on gastrointestinal disorders , is currently considered
to be H. pylori is the main cause of gastric ulcers, in addition to NSAIDs , Zollinger- Ellison
syndrome aclcohol and which results in the increased production of the hormone gastrin that
HCI production are increasing .
This disease occurs with greatest frequency in indifidu between the ages of 40-60 years . The
lifetime risk of developing peptic ulcer is 10 % . In western countries the prevalence of
Helicobacter pylori inseksi about the game's age ( ie 20 % at age 20 , 30 % at age 30 , 80 % at
age 80 , etc. ) . In the United States with an estimated 4 million people have active peptic
ulcers , and approximately 350,000 new cases diagnosed each year . Four times as many
diagnosed gastric ulcer duodenal ulcer . about 3,000 per year in the United States are caused
by duodenal ulcers and gastric ulcers 3,000 .

A. THEOLOGICAL PROBLEM
1. Knowing the definition of peptic ulcer ?
2. Knowing WOC Ulkul peptic ?
3. Askep peptic ulcer ?

B. PURPOSE
1. To know the definition of peptic ulcer ?
2. To ngetehui WOC Ulkul peptic ?
3. For how Askep peptic ulcer ?

CHAPTER II
DISCUSSION
A . DEFINITIONS
According to Chris Brooker peptic ulcer is a mucosal ulceration GI ( Gastrointestinal )
caused by disruption of normal balance due to the corrosive effects of gastric fluid and gastric
mucus protekstif . Meanwhile, according to Brunner and Studarth , peptic ulcer is
Earthmoving ( perforated area ) formed in the mucosal lining of the stomach , pylorus ,
duodenum , or esophagus . Another name of one of the gastrointestinal disorder is gastric
ulcer , duodenal or esophageal which depends on the location of the affected . And lastly
according to Price and Wilson peptic ulcer is a break continuity gastric mucosal epithelium
extends below . Gastric mucosal damage which does not extend to the epithelial erosion,
although often also called ulcers .
Peptic ulcer is the excavation ( hollow area ) that form in the walls mulkosal stomach ,
pylorus , duodenum , or esophagus . Peptic ulcer also known as gastric ulcer , duodenal or
oesophageal , depending on location . ( Bruner and suddart , 2001)
Peptic ulcer is a break continuity of gastric mucosal epithelial spread to bottom . Mukosayang
damage does not extend to the bottom of epithelial called erosion , although often regarded as
the " ulcer " ( eg, ulcers due to stress . By definition , peptic ulcer can be located in any part
of the gastrointestinal tract are exposed to gastric acid sap , ie the esophagus , stomach ,
duodenum , and after gastroenterostomi , also jejenum . ( Sylvia A. Price , 2006) .
Peptic ulcer or peptic ulcers are ulcers that occur in mulkosa , submucosa and sometimes sometimes up mulkularis layer of gastrointestinitas tract that is always associated with
considerable gastric acid HCL . Including this is ulcers ( ulcers ) are found on the bottom of
the esophagus , stomach and upper duodenum (first portion of the duodenum ) . Maybe also
found that patients gastroyeyenostomy dijejenum ulcers . ( Sujono Hadi , 1999: 204 ) .
Erosive gastritis or duodenal ulceration is a condition in which the stomach erosion or
ulceration of the stomach or duodenum that has reached the vascular system darahlambung or
duodenum ; can be acute or chronic .
Gastric ulcer is gastric mucosal ulceration caused by damage to the mucosal barrier ,
allowing repeated washing hydrochloric acid . Contributing factors include treatment ( aspirin
and indomethacin ) , chemical substances ( tobacco and alcohol ) , setres , and heredity .
Duodenal ulcer is duodenal ulceration of the mucosa caused by an increase in the amount of
hydrochloric acid in the duodenum . Factors penyebabnyatermasuk heredity factors ,
psychosocial stressors , and drugs .
Ulcers of the mucous membranes under esopagus

jejenum

B. Etiology
Mucus production decline as a cause of ulcers
Most ulcers occur when the cells of the intestinal mucosa does not produce adequate
mucus production as protection against stomach acid . Causes decrease mucus production can
include anything that decreases blood flow to the intestine , causing mucosal lining hypoxia
and injury or death of mucus -producing cells . Ulcers of this kind is called ischemic ulcers .
Decreased blood flow occurs in all types of shock . A special type of ischemic ulcers that
occur after severe burns called ulcers Curling ( Curling Ulcer ) .
The decrease mucus production in the duodenum may also occur as a result of inhibition
of mucus-secreting glands in the duodenum , which is called Brunner glands . Brunner gland
activity is inhibited by sympathetic stimulation . Sympathetic stimulation increases in a state
of chronic stress that there is a relationship between chronic stress and ulcer formation .
The main cause of the decline in production of mucus associated with H. pylori infection
bacterium colonizing the mucus -producing cells in the stomach and duodenum , thereby
reducing the ability of cells to produce mucus . Approximately 90 % of patients with
duodenal ulcer and 70% of gastric ulcers showed H. pylori infection . H. pylori infection is
endemic in several developing countries . Infection occurs by means of ingestion of
microorganisms .
The use of some medications , especially anti - inflammatory non - steroidal ( NSAIDs ) ,
are also associated with an increased risk of developing ulcers . Aspirin causes irritation of
mucous walls , as well as with other NSAIDs and glucocorticosteroids . These drugs cause
ulcers by inhibiting prostaglandin protection systemically or in the intestinal wall .
Approximately 10 % of patients taking NSAIDs experience active ulcer with a high
percentage to experience less serious erosion . Stomach or intestinal bleeding can occur due
to NSAIDs . The elderly are particularly vulnerable to injury due to NSAID GI . Other drugs
or foods associated with the development of ulcers include caffeine , alcohol , and nicotine .
These drugs seem to also injure the mucous layer of protection .
Excess acid as a cause of ulcers in stomach acid Formation important to activate the
digestive enzymes of the stomach . Hydrochloric acid ( HCl ) is produced by the parietal cells
in response to certain foods , hormones ( including gastrin ) , histamine , and parasympathetic
stimulation . Food and drugs such as caffeine and alcohol stimulates parietal cells to produce
acid . Some individuals showed perietalnya cells overreact to food or substances , or maybe
they have a number of parietal cells more than normal to produce more acid . Aspirin is
acidic , which can directly irritate or erode lapisanlambung .
Gastrin hormone also stimulates gastric acid production , so anything that can increase the
secretion of gastrin can cause excessive acid production . The main example of this condition
is Zollinger - Ellison syndrome , a disease characterized by the growth of tumors in the
endocrine cells producing gastrin . Other causes excess acid include excessive vagal
stimulation on parietal cells was seen after an injury or trauma to the brain . Ulcers that
develop in these circumstances called Cushing ulcer .

Excessive stimulation of the vagus during psychological setres also can cause excessive
production of HCl .
Increased Distribution of Acid as causes of displacement duodenum ulcer of stomach
contents into the duodenum too quickly can aggravate the protective mucus layer in the
duodenum .
This occurs in the stomach irritation by certain foods or microorganism, and gastrin
secretion of excessive or abnormal distension . Movement of gastric contents into the
intestine too quickly also occurs in the so-called dumping syndrome or syndrome affluent .
Affluent syndrome occurs when the stomach 's ability to resist and slowly pull out kimus into
the duodenum disturbed . One cause affluent syndrome is surgical removal of most of the
stomach . Affluent syndrome not only result in rapid displacement of gastric contents into the
intestine , but also can cause cardiovascular hypotension . Hypotension occurs due to
displacement of a wide variety of food particles into the intestine all at one time resulted
largely moved to the circulation of water in the intestine through the process of osmosis .

Pathophysiology
Peptic ulcer occurs in gastroduodenal mucosa because these networks can not withstand
stomach acid digestion work ( hydroxide acid and pepsin ) . Erosion is associated with an
increase in concentration and work peptin acid , or with respect to a decrease in the normal
defenses of the mucosa . Damaged mucosa secrete mucus that can not quite act as a barrier
against hydrochloric acid .
Class of drugs NSAIDs ( aspirin ) , alcohol , bile salts , and other drugs that damage the
gastric mucosa , change the epithelial barrier permeability , allowing back diffusion of
hydrochloric acid to the breakdown of tissue ( mucosa ) and in particular the blood vessels .
Hi This resulted in histamine release . Histamine stimulates the secretion of acid and pepsin
from pepsinogen increase . This will lead to histamine was also an increase in capillary
vasodilation kapilerm so that the membrane becomes permeable to proteins , resulting in a
number of protein lost and the mucosa becomes Adema .
Increased acid stimulates cholinergic nerves and sympathetic nerves . Stimulation of the
cholinergic will result in an increase in motility , causing pain , whereas stimulation of the
sympathetic nerves can lead to esophageal spasm reflex causing acid regurgitation Hcl that
trigger the onset of pain in the form of violent heats containing diagnosis .
In addition , stimulation of the nerve sympatik can also result in ongoing pilorospasme
pilorustenosis resulting into further food from the stomach can not get to the next channel .
Therefore, in patients with peptic ulcer after eating experience nausea , anorexia , bloating
and sometimes vomiting . The risk of nutritional deficiencies can occur as a manifestation of
these symptoms . In patients with gastric ulcer increased pepsin from pepsinogen . Pepsin
causes mucus degradation factor merupakansalah the stomach . Therefore, there was a
decrease in barrier function resulting in the destruction of capillaries and small veins . If this
continues to be able to bring complications such as bleeding .
Bleeding peptic ulcers can occur in any place , but the most common is the posterior
wall of duodenal bulb , because it is close to arterigastroduodenalis or pancreaticoduodenal
artery . Mild and chronic blood loss can lead to iron deficiency anemia . Besides, it can also
display symptoms of bleeding hemateneses and melena . In acute bleeding due to peptic ulcer
can lead to a lack of fluid volume .
Peptic ulcer process continues, in addition to resulting in bleeding may also result in
the continued perforasi.perforasi can penetrate the surrounding organs , including the
peritoneum . When the ulcer has to diperitonium peritonitis may occur as a result of infasi
germs . Obstruction is one of the complications of peptic dariulkus . Obstruction is usually
found in areas pylorus , which is caused by inflammation , edema , presence pilorusplasme
and scarring that occurs in the process of ulcer healing . Due to the obstruction can be
symptoms of anorexia , nausea , bloating and vomiting after eating .

A. COMPLICATIONS OF CLINICAL
Most ulcers can be healed without further complications .
But in some cases , peptic ulcer can cause life-threatening complications , such as penetration
, perforation , bleeding and blockage .
1. Penetration .
An ulcer can penetrate the muscular wall of the stomach or duodenum , and to the other
adjacent organs , such as liver or pancreas . This will cause a sharp pain that is severe and
settling , which can be felt outside the affected area ( for example in the back , because it has
penetrated pancreatic duodenal ulcer ) . Pain will increase if patients change posisinya.Jika
drug administration failed to address this situation , surgery may be necessary .
2. Perforation .
Ulcers on the front surface of the duodenum or ( more rarely ) in the stomach can penetrate
walls and forming an open hole into the abdominal cavity . Pain felt a sudden , very severe
and continuous , and soon spread throughout the abdomen . Patients may also feel pain in one
or both shoulders , which will gain weight if the patient sighed . Change of position will
worsen the pain , so people often try to lay still . When pressed , stomach ache. Fever
indicates infection in the stomach . If not addressed shock can occur . This situation requires
immediate surgery and intravenous antibiotics .
3 Bleeding .
Bleeding is the most common complication . Symptoms of bleeding due to ulcer are :
a. Vomiting fresh blood or clots reddish brown from the partly digested food , which
resembles coffee grounds .
b . Black stools or bloody stools .
With endoscopic cauterization done ulcers . If the source of bleeding can not be found and
the bleeding is not great , given the treatment with H2 antagonists and antacids - . Patients
also fasted and infused , so that the digestive tract can beristirahat.Bila severe bleeding or
settled , the endoscope can be injected substance that can cause clotting . If this fails , surgery
is required .
4. Blockage .
Swelling or inflamed tissue around the ulcer or ulcer scar tissue because previously , could
narrow hole at the end of the stomach or duodenal narrowing . Patients will experience
recurrent vomiting , and often spewed large amounts of food eaten a few hours earlier .
Other symptoms include abdominal fullness , bloating and loss of appetite . After a long time
vomiting can lead to weight loss , dehydration and mineral imbalance of the body . Coping
with ulcers can reduce clogging , but severe blockage requiring action atu endoscopic surgery

B. CLINICAL
The main clinical picture of peptic ulcer is pain . Located in chronic intermittent
epigastric region will subside satelah typical eating or ingesting antacids . Usually patients
with peptic ulcer complain tenderness , such as stabbing or burning sensation in the middle or
at the back epigastriun . This pain occurs when the acid content of the stomach and
duodenum increased erosion and stimulate the nerve endings are exposed . Pain usually
timubul back when the stomach is empty then the pain and 2 to 3 ajam after eating . Some
theories that explain the onset of pain :
1. Theory motility or tension .
Pain or stinging at the peptic ulcer is caused due to increased contraction of the stomach or
duodenum . In young patients with ulcers duodeni , onset of pain or painful due to contraction
in the nerves of pain in the stomach (gastric pain never ) increased during suffer from ulcers .
2. Theory acidity ( acid theory)
The role of HCL acid and gastric juice in the stomach wall which can cause irritation causing
pain .
3. Inflammation Theory ( the inflammatory theory) .
Another theory states that tau stinging pain in peptic ulcer , first of all due to the
inflammatory reaction . Nerve fibers in the process of ulceration damage and remnants of
fibers that there has been separated from the stomach contents by layer " leucofibrinous
material " and granulation tissue that has become insentifterhadap acid .
Nausea and vomiting . Arise when the pain is very severe . Vomiting large amounts of
food accompanied arise 8-12 hours after eating , probably due to pyloric stenosis caused by
pilorospasme . Before vomiting , already uneasy feeling in the stomach .
Pirosis ( Pain uluhati ) . Some patients experience a burning sensation in the esophagus and
stomach , which rose to the mouth , sometimes with acid eruktasi . Eruktasi or belching is
common when the patient's stomach is empty .
Vomiting . Vomiting can be a symptom of peptic ulcer . It is associated with gastric outlet
obstruction by spasm of the pylorus mucosal or by mechanical obstruction , which can be
attributed to the formation of scar tissue or acute swelling of the inflamed mucous membrane
surrounding the acute ulcer . Vomiting may occur without prior nausea .
Constipation and bleeding . Constipation can occur in patients with peptic ulcer , probably as
a result of diet and drugs . Patients also can come up with
gastrointestinal bleeding . A minority of patients who suffered as a result of previous acute
peptic not have complaints , but they show symptoms afterwards .
Appetite patients usually decreases by fear of onset of pain a few hours after eating . As
a result the patient care of .
Burning, burning sensation and pain in the retrosternal area , sometimes accompanied by
regurgitation that may be caused by esophageal spasm reflex . Therefore burning usually eat /
drink sour .
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Waterbrash or acid regurgitation , Waterbrush is a state in the mouth quickly filled by


fluids, especially saliva without any sense . Sometimes it also happens regurgitation of gastric
fluid with a bitter taste .
continuously or is colic and may also arise during defecation .Symptoms of colon (
colonic symtomp ) , in some patients with ulcers duodeni can be seen a sign of bowel
syndrome, spastic colon irritative type . The patient may complain of constipation and pain in
the abdomen which is not related to food . The pain is usually felt in the abdomen , especially
the left , sometimes maybe

C. Investigations
Typical gastric pain is an indication of the presence of ulcers .
It takes several tests to confirm the diagnosis of stomach cancer can also cause the same
symptoms .
1. Endoscopy is a procedure in which a flexible hose is inserted through the mouth and could
see directly into the stomach . In endoscopy , can take a sample of tissue for biopsy purposes
. Advantages of endoscopy :
2. More reliable for the detection of ulcers in the duodenum and the back wall of the stomach
compared with X-ray examination
3. More reliable in patients who have undergone gastric surgery
4. Can be used to stop bleeding due to ulcers .
5. X-ray with barium contrast of the stomach and duodenum ( also called a barium swallow
or upper GI series ) performed if the ulcer is not to be found by endoscopy .
6. Analysis of the stomach is a procedure in which the stomach fluid is inhaled directly from
the stomach and duodenum so that the amount of acid can be measured .
This procedure is done only if ulkusnya severe or recurrent or prior to surgery .
7. Physical examination may indicate the presence of pain , tenderness epigastric abdominal
ataudistensi
8. examination with barium to the upper GI tract may indicate adanyaulkus , but endoscopy is
a diagnostic procedure of choice .
9. upper GI endoscopy is used to identify changes in inflammation , ulcers danlesi . Through
endoscopic mucosal can be directly seen and known didapatkan.Endoskopi biopsy can detect
some lesions that are not visible through the X -ray examination because of size or location .
10. Therapy or Treatment Measures
Several methods can be used to control the acidity of the stomach including perubahangaya
life , medicine , and surgery . Decrease stress and rest

D. MANAGEMENT
The disease is not the end of everything in life , the occurrence of a problem can be known
causes and solutions. Likewise Creator Sanpeg disease , giving a disease as a warning to his
people , who had been negligent in exploring health favors granted . By him , many
alternatives to handle pain include:
1. Identification and avoidance of foods that cause excessive secretion of HCL .
2. Education about avoiding alcohol and caffeine .
3. Quit smoking because tobacco can slow healing .
4. Management of stress , techniques for relaxation or sedation to overcome the
psychological effect .

1. Treatment
The goal of treatment of peptic ulcer :
a. Eliminate pain and heal ulcers .
b . Prevent the recurrence of ulcers and prevent complications .
Antacids .
Antacids reduce symptoms , accelerate healing and reduce the number of large
ulkus.Sebagian recurrence rate of antacids can be obtained without a prescription . The ability
of antacids to neutralize stomach acid varies based on the amount of antacid taken , patients
and different times on the same patient .
Selection antacids usually based on a sense , the effects on the gastrointestinal tract , price
and effectiveness. Tablets may be preferred , but not as effective as medication syrup .
1. Antacids can diserap.Obat will immediately neutralize this entire stomach acid . The most
powerful is the sodium bicarbonate and calcium carbonate , the effect is felt immediately
after the drug is taken .
This drug is absorbed by the bloodstream , so that continuous use could lead to changes in
acid-base balance of the blood and cause alkalosis ( milk - alkali syndrome ) . Because the
drug is not usually used in large quantities for more than a few days .
2. Antacids that can not be absorbed . This drug is preferred because it has fewer side effects ,
does not cause alkalosis . These drugs bind to gastric acid forming material remaining in the
stomach , reducing the activity of digestive fluids and reduces ulcer symptoms without
causing alkalosis . But this antacids affect the absorption of other drugs ( eg tetracycllin ,
digoxin , and iron ) into the blood .

3. Aluminum Hdroksida . An antacid that is relatively safe and widely used . But aluminum
can bind to phosphate in the gastrointestinal tract , thereby reducing blood phosphate levels
and lead to loss of appetite and weakness . The risk of adverse events was greater in patients
who are also alcoholics and patients with kidney disease ( including those undergoing
hemodialysis ) . These drugs can also cause constipation .

4. Magnesium Hydroxide . Is a more effective antacid than aluminum hydroxide . Dose 4


times 1-2 tablespoons / day usually will not affect bowel habits ; but if more than 4 times may
cause diarrhea . Small Sejumla magnesium is absorbed into the blood , so it must be given in
small doses to patients who suffered kidney damage . Many antacids containing magnesium
and aluminum hydroxide .

DRUGS ulcer .
Ulcers are usually treated for at least 6 weeks with drugs that reduce the amount of acid in the
stomach and duodenum . Ulcer drugs can neutralize or reduce stomach acid and relieve the
symptoms , usually within a few days .
1. sucralfate . It works by forming a protective membrane at the base of the ulcer to
promote healing . Very effective for treating peptic ulcer and a second choice of
antacids . Sucralfate taken 3-4 times / day and is not absorbed into the blood , so that
the little side effects , but can cause constipation .
2. H2 antagonists . Examples are cimetidine , ranitidine , famotidine , and nizatidine .
This drug accelerates ulcer healing by reducing the amount of acid and digestive
enzymes in the stomach and duodenum . Drink 1 / day and some of them can be
obtained without a prescription . In men cimetidine can cause temporary breast
enlargement and if taken for long periods with high doses can cause impotence .
Mental changes ( especially in elderly patients ) , diarrhea , rash , fever and muscle
pain have been reported in 1 % of patients taking cimetidine . If patients experience
any of the side effects mentioned above, it should be replaced with H2 antagonists
cimetidine other . Cimetidine may affect the disposal of certain drugs from the body (
eg, theophylline for asthma , warfarin for blood clotting , and phenytoin for seizures )
.
3. . Omeprazole and Iansoprazole . Is a very powerful drug that inhibits the formation of
gastric enzymes necessary to make this asam.Obat can completely inhibit acid release
and the effect lasts longer . Especially effective is given to patients with esophagitis
with or without esophageal ulcers and patients with other diseases that affect the
formation of stomach acid ( eg, Zollinger - Ellison syndrome ) .
4. Antibiotics . Used when a major cause of ulcers is Helicobacter pylori . Treatment
consists of one or more kinds of antibiotics and other drugs to reduce stomach acid or
menetralilsir . The most widely used is a combination of bismuth subsalicylate (a type
of sucralfate ) with tetracycline and metronidazole or amoxycillin . Another effective
combination of omeprazole and antibiotics . This treatment can reduce the symptoms
of ulcers , even if the ulcer does not respond to previous treatment or if the ulcers
often have a relapse .

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5. Misoprostol . Used to prevent gastric ulcer caused by drugs non -steroidal anti inflammatory . The drug is administered to patients with arthritis who take nonsteroidal anti -inflammatory high doses . But these drugs are not used at all these
arthritis sufferers because it causes diarrhea ( in 30 % of patients )

1. Surgery
Surgery is recommended for patients with ulcers that do not heal ( which failed to
recover after 12-16 weeks of medical treatment ) , life -threatening hemorrhage , pesforasi
and obstruction . Surgical procedures include vagotomi with piloroplasti or Billroth I or II .
Ulcer patients requiring surgery are those who may have been sick , desperate , have
berhentidari his role and experience pressure on their family life .
Preoperative nursing interventions for patients who undergo surgery ulcer disease include
1. Prepare the patient for the test diaknostig
a. Patients undergo laboratory analysis .
b . Series of x ray
c . General physical examination before surgery
2. Meet the fluid and nutritional needs of patients .
3. Clean and empty the gastro -intestinal tract
4. Limiting oral input
And as for the surgery that can be performed on the ulcer disease :
1. Anektomi divided into :
a. Billroth I ( gastroduodenostomi ) is the removal of the bottom portion of the gastric
antrum ( which contains cells that secrete gastrin ) and a small portion of the
duodenum
b . Billroth II ( gastrojejunostomy ) where the remaining segments dianastomikan to the
duodenum ( Billroth I) or jejunum ( Billroth II )
2. Vagotomi is cutting the vagus nerve , to reduce stomach acid to reduce cholinergic
stimulation of the parietal cells and make it less responsive to gastrin ,
3. Piloroplasti is a drainage operation wherein a longitudinal incision is made into
thpylorus and sutured transversely near the exit and merileksasikan enlargement of
muscle .

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3 Main Complaint
The patient feels pain / pain in the pit of the stomach , feeling unwell and less tasteful to food
, the feeling is always full and sometimes accompanied by vomiting .

4 Health History
a. History Disease Now :
The patient had experienced pain in the gut since 2 years ago and had been treated in
hospital Labuang wedge in 2003. The most frequent complaint is felt by the patient is pain in
the gut . This can occur intermittently , usually 2 to 3 hours after a meal or on an empty
stomach and meredah time after ingesting the drug or food . Patients also said that the pain
can be reduced by the time the patient gets adequate rest or relax and control to the hospital
approximately one month the patient no longer controls to the hospital because there are no
symptoms . Usually the drugs consumed are antacids and some other drugs
b . Past Medical History :
Since small clients have never experienced an acute or chronic disease , but sometimes
these patients sometimes flu , fever and a mild cough . The client had been treated with
gastritis 1 times and has also treated with peptic ulcer twice in hospital Labuang Baji . During
the illness , Mr. A diligent control of each month to the hospital . History of gastritis has been
experienced since the age of 45 years , but still may be detained until the age of 50 years .
And in the end the client experience peptic ulcer . Clients not had surgery and did not have
allergies to certain foods or drugs .
c . Family Health History
Clients say that no one in his family who suffer from these diseases ( peptic ulcer ) .

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1. Physical Examination Head To Toe


a. General Situation : weakness
Weight :
Before Pain : 56 kg
After Pain : 54kg ( 2kg down for 2 Munggu )
b . physical examination
Skin : The skin has begun to wrinkles , dry , no more or lumps , cyanosis ( - ) and edema
(- ) .
2 heads : Symmetrical perpendicular to the midline of the body , no injuries , gray hair .
3. Eyes : Jaundice ( - ) , light reflex ( + ) , pallor sign ( - )
4. Nose : Form symmetrical , olfactory function well , polyps ( - ) are not
found blood / fluid out of the nose .
5. Mouth and throat : somewhat dry lips , cyanosis ( - ) , the function of tasting
good , no infection of the tonsils , the number of teeth is not complete .
6. Neck : No swelling of the thyroid gland , neck may
moved freely .
7. Chest : The shape and movement remains good chest / symmetrical .
8. S . Respiratory : No shortness of breath regularly with frequency
heart 26x / min , sound normal pernafasaan
auscultation .
9. S. Cardiovascular : Blood pressure during a regular , heart rate
normally no signs of abnormality .
10. Abdomen :
a. Inspection : The shape of a flat abdomen , the umbilicus is not prominent ,
There are no lumps .
b . Auscultation : peristalsis , increased noise , sound noisy peristaltic
intestin
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c . Palpation :
Not found any time , pain epigastric area ,
liver and spleen not palpable
d . Percussion : timpani sound

11. S. Musculoskelatal : Joint pain sometimes in alamami klayen when


The weather is too cold , muscle weakness ( + ) , stiffness
Muscles and joints ( - ) , moderate muscle tone , muscle atrophy ( - ) ,
Edema ( - )
12. S. Endocrine : never detected the presence of diseases caused by disorders
endocrine System

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A. Nursing Diagnosis
1.Gangguan sense of comfort , pain associated with gastric mucosal damage continuity .
2. Nutrition less than body requirements related to the lack of oral intake .
3. Potential bleeding associated with gastric mucosal damage capillaries .
4. Lack of knowledge about the prevention of the symptoms and treatment of conditiont
associated with inadequate information

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CHAPTER IV
CLOSING
A. Conclusions
Erosive gastritis or duodenal ulceration is a condition in which the stomach erosion or
ulceration of the stomach or duodenum that has reached the vascular system darahlambung or
duodenum ; can be acute or chronic .
Gastric ulcer is gastric mucosal ulceration caused by damage to the mucosal barrier ,
allowing repeated washing hydrochloric acid . Factors
causes include treatment ( aspirin and indomethacin ) , chemical substances ( tobacco
and alcohol ) , setres , and heredity .
Peptic ulcer is a break continuity of gastric mucosal epithelial spread to bottom . Mukosayang
damage does not extend to the bottom of epithelial called erosion , although often regarded as
the " ulcer " ( eg, ulcers due to stress . By definition , peptic ulcer can be located in any part
of the gastrointestinal tract are exposed to gastric acid sap , ie the esophagus , stomach ,
duodenum , and after gastroenterostomi , also jejenum .

B. Suggestions
To achieve nursing care in treating clients , proseskeperawatan approach must be done
systematically . Nursing services should be carried out in accordance with standard operating
procedures and taking into account and maintain client privacy . Nurses should always
maintained good cooperative relations or kolaburasi well to peers, medical doctor or the other
in the implementation of nursing care and in terms of the treatment to the client so that the
desired objectives can be achieved

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DAFTAR PUSTAKA

Baughman, Diane, C & Hackley, JoAnn, C. 2000. Keperawatan Medikal-Bedah: Buku Saku
dari Brunner&Suddarth. Jakarta: ECG
Corwin, Elizabeth, J. 2009. Buku Saku Patofisiologi, Ed. 3. Jakarta: ECG
Smeltzer, Suzanne. 2001. Buku Ajar Keperawatan Medikal Bedah.Ed. 8.Vol. 3. Jakarta :
EGC
Price, Silvia A. 2005. Patofisiologi Konsep Klinis Proses-Proses Penyakit. Ed. 6. Volume 1.
Jakarta: EGC
http://harnawatiaj.wordpress.com/2014/05/15ulkus-peptikum/
http://www.news-medical.net/health/Peptic-Ulcer-Symptoms-%28Indonesian%29.aspx

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