Corpuz, Jaztine Cleff Y.

Sir Francis Raguindin

BSN IV-NPB1

PEPTIC ULCER

 Is a lesion in the mucosa of the lower esophagus, stomach, pylorus, or duodenum.

 also known as ulcus pepticum, PUD or peptic ulcer disease, is an ulcer (defined as
mucosal erosions equal to or greater than 0.5 cm) of an area of the gastrointestinal tract
that is usually acidic and thus extremely painful
 Causative factors include mucosal infection by the bacterium Helicobacter pylori
(mechanism unclear).
 Genetic factors such as cigarette smoking, stress, and lower socio-economic status may
play a role.

Classification:

1. Stomach (called gastric ulcer)

S/S:

 nausea and loss of appetite

 weight loss and repeated episodes of gastrointestinal bleeding.

Tx:

 The pain may be relieved by vomiting or taking antacids

2. Duodenum (called duodenal ulcer)

S/S:

 stomach pain
 weight gain, and
 a burning sensation at the back of the throat
 If the ulcer is bleeding, patient may have:
 vomit containing bright red blood or digested blood that looks like brown coffee
grounds and black, tarry bowel movements.

Tx:

 To treat a duodenal ulcer, the doctor may prescribe antibiotics to treat H. pylori;
antacids; sucralfate, a medicine that forms a protective barrier over the site of the ulcer;
and other medications to reduce the amount of acid the stomach makes.
 Relieved by eating
Corpuz, Jaztine Cleff Y. Sir Francis Raguindin
BSN IV-NPB1

3. Meckel’s Diverticulum (called Meckel’s Diverticulum ulcer)

The majority of people afflicted with Meckel's diverticulum are asymptomatic. Meckel's
diverticulitis may present with all the features of acute appendicitis.

S/S:

 severe pain in the upper abdomen is experienced by the patient along with bloating of
the stomach region
 sleepless nights with extreme pain in the abdominal area.

Tx:

 Treatment is surgical.

 In patients with bleeding, strangulation of bowel, bowel perforation or bowel

obstruction, treatment involves surgical resection of both the Meckel's diverticulum
itself along with the adjacent bowel segment.

Gastric Ulcer Duodenal Ulcer

Gnawing epigastric pain occurring 30 minutes
to 1 hour after meals
Aggravated by eating (because acid secretion
increase at meal time) leads to weight loss
Relieved by vomiting (because acid is expelled
out)
No pain at hours of sleep (HCl production
decreases at hours of sleep)
More common in persons older than age 50
Gnawing epigastric pain occurring 2-3 hours
after meals
Relieved by food (because the pyloric
sphincter, at the junction of stomach and
duodenum, closes upon eating to concentrate
food in the stomach) causes weight gain
Not relived
Pain at hours of sleep (because gastric
emptying continuous at hours of sleep)
More common between ages 25 and 50

Common S/S of Peptic Ulcer:

 Abdominal pain
 Nausea
 Anorexia
 Dizziness
 Syncope
 Hematemesis
Corpuz, Jaztine Cleff Y. Sir Francis Raguindin
BSN IV-NPB1

 Melena with GI hemorrhage

Nursing Interventions

1. Monitor the patient for signs of bleeding through fecal occult blood, vomiting, persistent
diarrhea, and change in vital signs.
2. Monitor intake and output.
3. Monitor the patient’s hemoglobin, hematocrit, and electrolyte levels.
4. Administered prescribed I.V. fluids and blood replacements if acute bleeding is present.
5. Maintain nasogastric tube for acute bleeding, perforation, and postoperatively, monitor
tube drainage for amount and color.
6. Perform saline lavage if ordered for acute bleeding.
7. Encourage bed rest to reduce stimulation that may enhance gastric secretion.
8. Provide small, frequent meals to prevent gastric distention if not actively bleeding.
9. Watch for diarrhea caused by antacids and other medications.
10. Restrict foods and fluids that promote diarrhea and encourage good perineal care.
11. Advise patient to avoid extremely hot or cold food and fluids, to chew thoroughly, and
to eat in a leisurely fashion to reduce pain.
12. Administer medications properly and teach patient dose and duration of each
medication.
13. Advise patient to modify lifestyle to include health practices that will prevent
recurrences of ulcer pain and bleeding.