Exemplar – Peptic Ulcer Disease

Basic Patho: peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot withstand the
digestive action of gastric acid (hydrochloric acid) and pepsin. Erosions result from the corrosive action of acid
gastric juice on a vulnerable epithelium caused by an imbalance between mucosal defenses and acid/peptic
injury. A damaged mucosa cannot secrete enough mucus to act as a barrier against gastric acid. Depending on
the circumstances, the ulcer may penetrate only the mucosal surface, or it may extend into the smooth muscle
layers.

Manifestations Labs/Diagnostics

 Older adults have few or no s/s.
 Pain is the most common symptom.
 Burning epigastric pain aggravated by
fasting and improved by food or
antacids. (associated w/ duodenal
ulcer)
 With a gastric ulcer, pain is triggered
or worsening by eating usually
occurring shortly after meals w/ little
to no relief from antacids.
 Pain is usually located over a small
area near the midline in the
epigastrium near the xiphoid and may
radiate below the costal margins into
the back or, rarely, to the right
shoulder.
 Liver function tests and levels of
amylase and lipase should be checked
to help evaluate for hepatitis or
pancreatitis.
 Ab ultrasound may reveal gallstone
disease or an ab aortic aneurysm.
 An ECG and measurement of cardiac
enzymes may be used to evaluate
myocardial causes of pain.
 An upper GI and small bowel x-rays
series w/ upright and lateral decubitus
views showing free air indicates
perforation.
 Endoscopy or
esophagogastroduodenoscopy
confirms the ulcer and permits
cytology studies and biopsy to rule
out H pylori or cancer.

Treatments/Interventions Teaching

 Key goals are pain relief, ulcer
healing, prevention of ulcer
recurrence, and reduction of
complications.
 Admin H2-antagonists such as
ranitidine, nizatidine, cimetidine, or
famotidine to block gastric acid.
 Pts w/ peptic ulcers or those who
must continue NSAID therapy for
some other disorder should be treated
w/ PPIs such as omeprazole, etc. for
as long as the NSAID is used.
 Assess for GI bleeding.
 Ask pt about drinking alcohol w/
NSAIDs and to avoid it.
 Advise pts to avoid risk factors such
as an overuse of aspirin and NSAIDs,
spicy foods, and beverages that
contain caffeine.
 Take medications as prescribed.
 Avoid eating within two hrs of
bedtime (eating late increases the
production of gastric acid that may
trigger gastric lining).