PEPTIC ULCER DISEASE (PUD) excoriation / erosion of submucosa & mucosal lining due to:

a.) Hyper secretion of acid pepsin

b.) Decrease resistance to mucosal barrier
Incidence Rate:
1. Men 40 55 yrs old
2. Aggressive persons/ type A personality
3. Hereditary
4. Emotional Stress
Predisposing factors:
1. Hereditary
2. Emotional
3. Smoking vasoconstriction GIT ischemia
4. Alcoholism stimulates release of histamine = Parietal cell release Hcl acid = ulceration
5. Caffeine tea, soda, chocolate
6. Irregular diet
7. Rapid eating
8. Ulcerogenic drugs NSAIDS, aspirin, steroids, indomethacin, ibuprofen
Indomethacin - S/E corneal cloudiness. Needs annual eye check up.
NSAID and steroids= gastropathy
9. Gastrin producing tumor or gastrinoma Zollinger Ellisons syndrome
10. Microbial invasion helicobacter pylori. Metronidazole (Flagyl)

Types of ulcers
Ascending to severity
1. Acute affects submucosal lining
2. Chronic affects underlying tissues
heals & forms a scar, deeper
According to location
1. Stress ulcer
2. Gastric ulcer
3. Duodenal ulcer most common
Stress ulcers common among critically ill clients
2 types
1. Curlings ulcer cause: trauma & Burns
Hypovolemia
GIT schemia
Decrease resistance of mucosal barriers to Hcl acid
Ulcerations
2. Cushings ulcer cause stroke/CVA/ head injury
Increase vagal stimulation
Hyperacidity
Ulcerations
Treatment: Vagotomy - done to prevent hemorrhage and shock prior to surgery on the stomach

GASTRIC ULCER
SITE
PAIN

HYPERSECRETION
VOMITING
HEMORRHAGE
WT
COMPLICATIONS
HIGH RISK
INCIDENCE

Antrum or lesser curvature

- 30 min 1 hr after eating
- epigastrium
- gaseous & burning
- not usually relieved by food & antacid
- Eating leads to pain
Normal gastric acid secretion
common
hematemesis
Wt loss
a. stomach cancer
b. hemorrhage
50 or 60 years old and above
Male; female = 1:1
15% of peptic ulcers are gastric

DUODENAL ULCER
Duodenal bulb
- 2-3 hrs after eating
- mid epigastrium
- cramping & burning pain
- usually relieved by food & antacid
- 12 MN 3am pain
- Eating lessens pain
Increased gastric acid secretion
Not common
Melena
Wt gain
a. perforation
20 years old and above
Male: Female = 2-3:1
80% of peptic ulcers are duodenal

90-95% is cases of duodenal ulcers - less bicarbonate ions, decrease so increase incidence
Diagnosis:
1. Endoscopic exam
2. Stool from occult blood (+)
3. Gastric analysis Gastric Ulcer: normal gastric acid secretion
Duodenal: increased gastric acid secretion
4. GI series confirms presence of ulceration
Nursing Mgt:
1. Diet bland, non irritating, non spicy
2. Avoid caffeine & milk/ milk products
Increase gastric acid secretion
3. Administer meds
a.) Antacids
ACA
Aluminum containing antacids

Magnesium containing antacids

ex. aluminum hydroxide gel

ex. milk of magnesia
(Amphogel)
S/E diarrhea
S/E constipation
Maalox (fever S/E)
b.) H2 receptor antagonist:
1. Ranitidine (Zantac) SE: fever
2. Cimetidine (Tagamet)hastens the effect of oral anticoagulants
3. Famotidine (Pepcid) SE: fever
- Avoid smoking decrease effectiveness of drug
Nursing Mgt:
1. Administer antacid & H2 receptor antagonist (Cimetidine) 1hr apart
-Cemetidine decrease antacid absorption & vise versa
c.) Cytoprotective agents
Ex
1. Sucralfate (Carafate) - Provides a paste like subs that coats mucosal lining of stomach
2. Misoprostol (Cytotec) SE: menstrual spotting
d.) Sedatives/ Tranquilizers - Valium, lithium
e.) Anticholinergics / Antispasmodic
1. Atropine SO4
2. Prophantheline Bromide (Profanthene)
(Pt has history of hpn crisis with peptic ulcer disease. Rn should not administer alka seltzer- has large amount of Na.
3. Surgery: subtotal gastrectomy - Partial removal of stomach
Billroth I (Gastroduodenostomy)

Removal of of stomach & anastomoses of

gastric stump to the duodenum.

Billroth II (Gastrojejunostomy)
Removal of -3/4 of stomach & duodenal bulb &
anastomostoses of gastric stump to jejunum.

Before surgery for BI or BII - Do vagotomy (severing of vagus nerve) & pyloroplasty (drainage) first.
Nursing Mgt:
1. Monitor NGT output or drainage immediately post op- bright red
a.) Immediately post op should be bright red
b.) Within 36- 48h output is yellow green
c.) After 48h output is dark red due to HCl acid
2. Administer meds:
a.) Analgesic
b.) Antibiotic
c.) Antiemetics
3. Maintain patent IV line
4. VS, I&O & bowel sounds
5. Complications:
a.) Hemorrhage hypovolemic shock
Late signs anuria
b.) Peritonitis
c.) Paralytic ileus most feared
d.) Hypokalemia
e.) Thrombophlebitis
f.) Pernicious anemia
g.) Septicemia