NRS - MEDICAL SURGICAL NURSING II (LEC)

Gastrointestinal Disorders (PLM-CN BATCH 2020) NRS 3217-9

OUTLINE o Occur when there is accumulation of fluid or gas in

Chapter #: Gastrointestinal II. Peptic Ulcer stomach causing expansion
Disorders A. Risk factors for Peptic → Heart burn
I. Gastritis Ulcer → Sour taste in mouth
A. Two Categories of B. Types of Peptic Ulcers o Usually during acid reflux
Gastritis a. Esophageal
a. Acute b. Stress DIAGNOSTIC PROCEDURE
b. Chronic c. Gastric ENDOSCOPY
B. Etiology d. Duodenal
C. Clinical Manifestations C. Diagnostic Procedure UPPER GASTROINTESTINAL SERIES
D. Diagnostic Procedure D. Management
E. Management of gastritis a. Pharmacolo o In peptic ulcer, it includes Barium Swallow
gical o For gastritis, no need for BA swallow
b. Surgical o Form of x-ray, done in many areas of the gastrointestinal
o Series of plates of x-rays

GASTROINTESTINAL DISORDERS HISTOLOGICAL EXAMINATION

GASTRITIS o Study of tissue sample.
→ Common GI problem o Biopsy is the term whenever tissue samples are
→ Inflammation of gastric or mucosal area (stomach mucosa) obtained.
o One of the causes of gastritis could be due to the
TWO CATEGORIES: presence of a benign/malignant tumor.
ACUTE o Endoscopic histology- tissue sampling performed
→ 1st sign of certain systemic infection through the use of an endoscope. Most especially if
→ If you ate contaminated food, you may have gastritis there is a suspicious ulceration in the stomach,
Invasive procedure: ensure consent from px and
CHRONIC responsibilities pre and post procedure. This type of
→ Prolonged inflammation secondary to benign or malignant tumor, or examination is more direct- has a better imaging of
Helicobacter pylori (H. pylori) tissues.
o Exfoliative cytology- obtaining specimen through
NGT. Gastric lavage is performed by incorporating
saline. “exfoliate” – tissues by soaking with saline to
loosen up cells to collect samples. Although more
cells can be collected through this process, malignant
cells are sometimes not collected, providing
equivocal results.

GASTRIC ANALYSIS
o Gastric content is collected, pH level is obtained.
Gastritis can be caused by hypersecretion of gastric
Actual visualization of gastric area acid and gastric ulcer.
o Reddened area – gastritis
SEROLOGIC TESTING FOR ANTIBODIES
ETIOLOGY – COMMON CAUSES OF GASTRITIS
o Can determine presence of H. pylori infection.
→ Dietary indiscretion
● Ingestion of contaminated food
UREA BREATH TEST
● Ingestion of irritating food / highly seasoned food
→ NSAIDS overuse o Can also determine presence of H. pylori infection
→ Alcoholism due to increased levels of urea produced by the
● May cause irritation and erosion of stomach lining infection.
→ Bile reflux
→ Radiation / Chemotherapy
→ Ingestion of strong or alkali

CLINICAL MANIFESTATIONS
→ Abdominal discomfort / Pain
→ Nausea & vomiting / Anorexia
→ Headache Endoscopic view of Stomach
→ Hiccups o Mucoid- saliva like mucosa that protects the stomach
→ Belching lining.
o Act of bringing up air from the stomach
→ Abdominal distension

TRANSCRIBED BY: AGBAYANI, ECHANO, ERENO, LANTIN, MAZON, MEDINA, MELITANTE, MENDOZA, PACHECO, PAGUIRIGAN, RAMOS,

TRINIDAD

Yellow-like tissue manifests malignancy
MANAGEMENT OF GASTRITIS
→ Gastritis is commonly treated as OPD (Outpatient) case, with very
minimal requirements to admit the px
→ Gastric mucosa is capable of repairing itself, possibly within 24H
→ There are px that manifest loss of appetite for about 2-3 days after
the occurrence of gastritis; it can still be treated as OPD
DIETARY MODIFICATION
o First line in management of gastritis
o Px is put under NPO up until the recovery of mucosa
o Certain medications are administered to protect the
stomach lining while px is under NPO (since gastric
acid contents are continuously produced). To
neutralize the acidic environment.
o No alcohol intake, IV fluids can be inserted while
inside the hospital
o Soft and bland diet, non-irritating foods which is the
inirial diet of the patient.
o Eliminate irritating foods (fatty, spicy, highly
seasoned, caffeine, tea, chocolates aside from those
with 75% cocoa content) can further aggravate the
problem of the patient.
o Dark chocolates with 75% cocoa content will enhance
the protective lining of the mucosa.
o Avoid any type of colas or carbonated beverages.
o Avoid binge eating.
o Check history of gastritis, and ulcerations (peptic
ulcer) in patients who do intermittent fasting.
DILUTION AND NEUTRALIZATION OF OFFENDING AGENT
o Done when the patient accidentally or intentionally
induces offending agent (poison)
o If acid was induced, it can be neutralized using
antacids (aluminum-based, magnesium-based).
o No emetics, no lavage if corrosive agent is being
ingested because it will cause severe damage.
o Don’t let the patient vomit because it may cause
further damage, it will be neutralized inside the
stomach.
o If the offending agent is alkali, it will be diluted using
a weak acid (lemon juice or diluted vinegar) but it
depends on the alkali material, whether it is
accidental or intentional.
SUPPORTIVE THERAPY
o NGT, IV Fluids, Rest and reduction of stress and
anxiety
PROMOTING HEALTHY LIFESTYLE
o Advise patient to stop smoking and drinking. Too
much amount of alcohol and carbonated beverages
has CO2.
o Stress therapy, especially Type A personalities.
PHARMACOTHERAPY
o Antacids (systemic and non-systemic)
PEPTIC ULCER
→ Referred to as gastric (gastric area), duodenal (under the
duodenum), and esophageal (under the esophagus area) ulcer
depending on its location.
→ Caused by erosion of the circumscribed area of mucous membrane.
o Excavation or hollowed out area (erosion) in the
mucosal lining of the patient, commonly into the
pylorus, esophagus or duodenum.
o Erosion can extend up to the muscular layer until into
the peritoneum which is considered perforated, one
of the common emergency situations in peptic ulcer
disease.
o Perforations cause gastric contents to leak out into
the peritoneum.
o Occurs alone or in a multiple area.
RISK FACTORS FOR PEPTIC ULCER
STRESS
o Constant PNS stimulation leads to increased gastric
motility which leads to increased gastric secretions
o Surgical operations induce stress
Because of the surgery, nagdevelop siya ng ulcer
although yung ulcer niya nung bata pa siya yun din
naman yon kahit gumaling siya, vulnerable pa rin
yung area na yon for another formation ng ulcer
o Nagbleed siya nang nagbleed because of the stress
ulcer so hindi siya basta basta
o So kapag nagperioperative, yung management niyo
is from the time na maschedule ang px niyo onto
surgery, we have different types of management
because stress ulcer is difficult to manage
CIGARETTE SMOKING
o One of common cause, because of nicotine is a
stimulant.
o And stimulant can cause vasoconstriction so
whenever you have generalized vasoconstriction,
your stomach area is insufficiently receiving
oxygenated blood, so kapag hindi siya makareceive
ng oxygenated blood dahil masikip yung mga ugat
doon, hindi rin siya makaproduce ng mucus so the
reduction of mucus will give vulnerability to the px to
develop ulcer
DIETARY LIFESTYLE
o Such as alcohol, ingestion of spicy, highly acidic food,
very stimulant and very irritant food
o Alcohol, cause erosion, it is a gastric irritant because
alcohol also produce vasoconstriction, so kapag
nagvasoconstrict mataas ang gastric acid secretions
doon sa area na yon tapos wala pang protective
same thing with caffeine and other CNS stimulant. So
increase ng gastric activity pepsin secretions so
those are the common
o Yung mga nagiintermittent fasting like mga nurses,
kapag nasa hospital, nagmamadali na kumain.
Madami kayo kumain tapos ang bilis bilis niyong
kumain tapos wala sa oras. It will be a possible cause
ng ulcer
HYPERCHLORHYDIA
o There is so many presence ng hydrochloric acid and
pepsin, naghypersecretions ka. So if you have
hypersecretions ng hydrochloric acid and pepsin, that
will lead to mucus ulceration so yung lining di niya
kinakaya sa sobrang dami ng acid so masisira siya
GENETICS AND FAMILIAL TENDENCIES
o Px with blood type O, increase ang pepsinogen level
so therefore increase din ang parietal cell mass, so
kapag ganyan ang nangyari, marami kang parietal
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 cell mas mag increase din ang pepsin production
therefore increase ang acid secretions
o If you have family member develop ulcer tendency
makikita natin into the line may sumusunod na
nagkakaroon ng ulcer because of genes (e.g. same
blood type of your parents)
ULCEROGENIC DRUGS
o Aspirin, NSAIDs and steroids (most common OTC
drugs)
ZOLLINGER-ELLISON SYNDROME (ZES)
o Meron daw excessive amount of hormone which is
gastrin hormone which is sometimes bought by tumor
that also consist of severe peptic ulcer. Magkakaroon
ka ng extreme gastric hyperacidity therefore
ulcerations will develop.
INFECTION
o Presence of H. Pylori or other gram-negative bacteria
o Because of the surgery, nagdevelop siya ng ulcer
although yung ulcer niya nung bata pa siya yun din
naman yon kahit gumaling siya, vulnerable pa rin
yung area na yon for another formation ng ulcer
o Nagbleed siya nang nagbleed because of the stress
ulcer so hindi siya basta basta
o So kapag nagperioperative, yung management niyo
is from the time na maschedule ang px niyo onto
surgery, we have different types of management
because stress ulcer is difficult to manage
o Intravascular Fluid volume should be returned,
otherwise many complications may happen to the
patient.
3. GASTRIC ULCERS
o Located on stomach
o If ulcer is in Gastric Area = Pain becomes MORE
SEVERE AFTER EATING (pain is present even
before and worsens after eating)
o When we eat, stomach naturally produces gastric
acid to digest what we eat. And everytime the ulcer
becomes expose to gastric acid or gastric content,
pain becomes worsen (like putting alcohol on the
wound)
o Paitients tend to have thinner body (mas payat)
because they refuse to eat, given that their pain gets
worsen as they eat.
o
4. DUODENAL ULCERS
o Located on the duodenum (small intestine)
o pain DISAPPEARS when PATIENT EATS. Then pain
returns after 2-4 hours after eating
o Patients with Duodenal Ulcers tends to always eat
o Px gain weight due to eating frequently since their
pain get relief by eating.
o Occurs more on people who do not get formal and
proper education about their condition.
QUESTION:
Kailan nagkakaroon ng pain sa ulcer? Kung kumain or hindi
kumain? – General Knowledge/ Myth/ Thoughts about Ulcer

ANSWER:
Kapag walang kinain, since wala pang laman ang stomach and
there is a lot of gastric acid/ acidic nature of stomach.
o Development and timing of the pain is actually
dependent/ based on the location of the ulcer
.

Microscopic view of a stomach lining which is infected by H. Pylori

(sumisiksik yung H. Pylori sa stomach lining kaya nagcacause ng
ulcer

TYPES OF PEPTIC ULCERS

1. ESOPHAGEAL ULCERS
o Not common; occurs very minimal compared with
gastric and duodenal.
o Occurs when lower esophageal sphincter is
incompetent for total closure, causing backflow of
acid (acid reflux)
o But there are cases where prior to developing
esophageal ulcer, patients develop gastric or
duodenal ulcer first.
o Common patients who develop esophageal ulcers:
pt. with liver problems (ex. Liver cirrhosis)

2. STRESS ULCERS
o Can lead to gastric ulcer

A. CUSHINGS
o Bought about by head injury. those px that are
actually experiencing head injury could lead to having
or development of stress ulcer
B. CURLING’S
o Burn causes depletion of so much fluid so
intravascular fluid is compromised.
o This is why fluid replacement is very crucial in the 1st
24 hours after the burn period.
3
 → Hemorrhage more → Melena more
likely to occur common than
→ Hematemesis hematemesis
more common → More likely to
than Melena perforate
→ Less likely to
perforate
Malignancy Occasional Rare
Possibility

QUESTION: May significant reason ba bakit nasa lesser curvature

ang gastric ulcers

ANSWER:
→ Due to the anatomical structure
→ Mas common dito ang gastric acid so sila ang mas expose

QUESTION: Clarify if both gastric and duodenal ulcer pain occurs

PC wherein gastric pain occurs 30mins – 1h PC and is not relieved
by food, while duodenal pain occurs 3-4h PC and is relieved by
food?

ANSWER:
→ Constant ang pain kapag may sugat ka tapos exposed ito sa sugat
→ There are misconceptions that when you have ulcer, you need to
constantly eat in order to relieve pain
→ In this case, for gastric ulcer, mas mataas ang occurrence ng pain dahil
within 30 mins – 1h dahil sobrang dami ng HCl na nagawa ng katawan
dahil at any given time, constant ang pagproduce ng katawan ng HCl
→ Meanwhile, for duodenal ulcer, after 4h pa nago-occur ang pain kasi
within 4h totally natutunaw ang kinain ni patient, therefore wala nang
nagneu-neutralize ng pain nila
COMPARING GASTRIC AND DUODENAL ULCERS → Hence, the tendency of those with duodenal ulcers is to constantly eat
GASTRIC DUODENAL – which is why it is recommended for them to have chips at the bedside
Incidence → Usually 50 and → 30-60 y/o that they can snack on.
over o Productive year/
→ M:F = 1:1 nagtatrabaho pa QUESTION: Why peptic ulcer disease is uncommon in childbearing
→ 15% of all peptic → M:F = 2-3:1 age in women?
ulcers → 80% of all peptic
ulcers (most ANSWER:
common) → Maybe due to the hormones in childbearing stage (18 above)
Risk Factors → H. Pylori → H. Pylori → Di pa gaanong ka-”busy” ang tao = less stressors
→ Gastritis → Gastritis
→ Alcohol → Alcohol DIAGNOSTICS
→ Smoking → Smoking PHYSICAL EXAMINATION
→ NSAID’s → Cirrhosis → Pain
→ Stress → Stress ● Location
Causes Breakdown of GMB → Insufficient buffers o Under the epigastric region
to neutralize ● Tenderness
gastric acid in → Abdominal distention
stomach
→ Defective/ UGIS W/ BARIUM SWALLOW
incompetent → Upper Gastrointestinal Series with Barium Swallow
pyloric sphincter → Client will be asked to swallow barium, a chalky, white substance,
o Due to bile reflux mixed with water.
→ Hypermotility of ● This thick substance will coat the inside of the upper GI
the stomach tract which will allow for better visualization.
S/Sx or Clinical → Hyposecretion of → Hypersecretion of → While the client is drinking the substance, shots of x-rays imaging
Findings HCl acid HCl acid will be taken as barium absorbs x-rays, appearing white in the x-ray
→ Weight loss → Weight gain film.
→ Pain occurs 1-2h → Pain occurs 2-4h → This allows visualization of the linings of the upper GI tract to
PC PC determine the presence of ulcerations.
→ Rarely occurs at → Often awakened
night between sleep ENDOSCOPY
→ May be relieved → Vomiting → Allows direct visualization of the gastrointestinal tract to asses for
by vomiting uncommon inflammatory changes, lesions, ulcer, etc.
→ Vomiting common → Ingestion of food → Most often they also take a biopsy sample of the suspicious lesions
→ Not relieved by relieves pain that may be seen during the procedure
ingestion of food – → Hemorrhage less → Endoscopy is an invasive procedure; thus, asking for consent before
sometimes likely than gastric the procedure is essential.
increase in pain ulcer

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 o The procedure involves inserting an endoscope into
the body cavity of the client; thus, consent is needed.
→ Obtained samples will be sent for laboratory analysis.
→ Nursing Considerations:
● Patient should be put on NPO 6 to 8 hours prior to the
procedure and after the procedure until gag reflex has
returned.
o Local anesthetic is used, usually the spray, to numb
the mouth and throat of the client. Gag reflex will be
absent.
o Patient is prone to developing aspiration which may
lead to aspiration pneumonia. Therefore, the nurse
should watch out for this complication.
o Ingestion of food shall not be allowed until gag reflex
has returned.
FECAL OCCULT BLOOD TEST (FOBT) & GUAIAC STOOL EXAM
→ Fecal Occult Blood Test (FOBT): is used to examine stool
samples for hidden or occult blood which may not be visibly
apparent.
→ Guaiac stool exam is the most common type of FOBT which uses
guaiac, a substance from a plant that is used to coat FOBT test
cards to detect the heme component of blood that may be present
in the stool sample.
→ Nursing Considerations:
● Prepare the patient beforehand by advising not to eat
dark-colored foods and meat products.
o These may alter the color of the stool which may
hinder the examiner from obtaining accurate findings.
● Advise not to intake vitamin C.
o Vitamin C hydrolyzes the blood that may be present
and masks true results.
● Also advice not to take iron supplements at least a week
before the procedure.
GASTRIC ANALYSIS & GASTRIC ACID STIMULATION
→ Gastic Analysis involves obtaining gastric contents and examining
it.
→ Gastric Acid Stimulation Tests involves measuring the secretions
of pepsin and hydrochloric acid.
→ Put patient on NPO for 12 hours.
→ Medications will be administered to stimulate the secretions.
Frequently used are:
● H2 Antagonists/Blockers, SQ
● Pentagastrin, SQ
o When giving these medications, monitor the client’s
blood pressure and pulse rate.
o Inform clients that they may also experience a
“flushed” feeling.
o Only used for diagnostic purposes
→ Gastric analysis will be done 1 hour after administration of
medication.
o Absorption may be slow as it is administered
subcutaneously.
→ Patient will also be inserted an NG tube hooked in the suction
machine to aspirate gastric contents every 15 minutes for 1 hour.
→ Normal Result: Increased secretion of hydrochloric acid.
→ Abnormal Result:
● Decreased or low levels of hydrochloric acid may indicate
severe atrophic gastritis.
o Even though hydrochloric acid levels may be low,
severe alkaline environment may still cause
ulcerations in the lining of the stomach.
▪ It creates an environment where infectious
microorganisms may thrive.
o Thus, it is important to maintain the normal acidic
environment in the stomach.
SEROLOGICAL TESTING FOR ANTIBODIES (AGAINST H.
PYLORI)/UREA BREATH TEST
→ Refer to discussion in gastritis.
UREA BREATH TEST
MANAGEMENT
→ Goal: Eradicate H. pylori and manage gastric acidity
→ Neutralize offending agents/ stop medications (NSAIDs)
PHARMACOLOGIC
ANTIBIOTICS
→ Amoxicillin and Clarithromycin: the most used antibiotics in PUD.
→ Dual therapy: 1 antibiotic + 1 PPI
o Commonly amoxicillin and clarithromycin
→ Triple therapy: 2 antibiotics + 1 PPI
o Amoxicillin & tetracycline + metronidazole
o Clarithromycin & tetracycline + metronidazole
→ Quadruple therapy: 2 antibiotics + 1 PPI + H2 receptor
antagonist/bismuth salicylate
→ Antibiotics are given in combinations depending on the extent of the
problem of the pt.
ANTI-ULCERS
→ Antacids neutralizes HCl and reduces pepsin activity
→ General rule: Should be given 30 minutes to 1 hour 30 minutes
before meals OR 2 hours after meal and at bedtime
o At bedtime – kung meron talagang hyperacidity na
nararamdaman during time of sleep si pt.
o Kung kumain ng 6pm at matutulog ng 8pm, we can
give antacids, 2 hours na pagitan
→ Systemic Antacids
● Sodium bicarbonate (NaHCO3) in the form of Alka-seltzer
(tablets dissolved in water) and Bromo-seltzer
o Not IV kasi ginagamit lang yun for certain ABG
results
o Alka-seltzer and bromo-seltzer are popular during
the 80s and early 90s
o General type of antacids, thus if taken the effect will
also be general – blood will also be neutralized
o Kaya hindi na popular si systemic/general
antacids in pts. with gastric or peptic ulcer
diseases
→ Non-Systemic Antacids
● Aluminum-based antacids (AlOH3) – has a very small
degree of systemic absorption so it is still considered non-
systemic
o Hindi ganoon kataas ang systemic absorption
o Neutralizes gastric acid directly, increase pH level,
and inactivate the pepsin
o RENAL: Used to lower serum phosphorus level
among pts. with renal failure – if the phosphorus level
is too high, then calcium is depleted (since they are
inversely proportional), pts tends to have a coca-cola
skin color because phosphorus is being deposited
under the skin (nagmumukhang kahoy), aluminum-
based antacids aids in the excretion of excess
phosphorus, monitor for phosphorus level (routine
diagnostic) since hypophosphatemia can occur
o Causes constipation
o Examples: Aluminum hydroxide (Alu-tab, Amphojel)
● Magnesium-based antacids (MgOH2)
o Causes diarrhea, severe diarrhea (especially for
those who have intolerance in milk of magnesia)
o Be careful especially if pts has a heart condition, the
doctor should be aware of the conditions present to
provide proper alternatives
o Combinatined with aluminum and magnesium salts
antacids to prevent diarrhea and constipations
o Examples: Maalox (suspension of aluminum
hydroxide and magnesium hydroxide), Semicon (dili
q siya masearch), Kremil-S
● To control constipations and diarrhea, pinag-halo na
siyang dalawa
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→ Does not stop acid production
Simethicone
→ Anti-gas drug
→ Incorporated in antacids available in the market
Bismuth salicylate (PeptoBismol)
→ H. pylori congest in gastric lining -> antibodies will rush on the
infection site -> inflammatory response -> integritiy of gastric lining
will be destroyed = Peptic ulcer disease
→ Multiple ulcers are expected in PUDs caused by H. pylori.
→ Suppresses H. pylori into the gastric mucosa.
→ Assist healing into the mucosal lesions by decreasing inflammation
caused by infection.
→ Taken on empty stomach, do not take on full stomach.
H2 Antagonists/Blockers
→ Most popular drug used in treatment of gastric ulcers and duodenal
ulcers, including reflux esophagitis before the development of PPI
medications
→ “-tidine” (Famotidine, Ranitidine)
→ Blocks histamine 2 receptors in the parietal cells = reduced gastric
acid secretions and concentrations
→ Reduce only since not only histamine receptors produce acid.
Proton Pump Inhibitors/Acid Pump Inhibitors
→ “-prazole” (Esomeprazole, Omeprazole)
→ Suppresses gastric secretions by inhibiting H+/K+/ATPase
(enzymes located at gastric parietal cells responsible for producing
gastric contents)
→ Blocks the final phase of production = no production of acid
→ Take PPIs 30 mins ac (before meals)
Why people develop immunity in H2 antagonists?
o In essence, hindi nagdedevelop ng immunity
o Yung katawan mo parang ang gumawa ng paraan.
Sarado yung pintuan on the parietal cells para
makapasok si histamine at makabuo ng potent acid,
mayroon siyang parang “backdoor” na dinaanan
aside from the receptor site.
o Prolonged na paginom = nakakapagproduce pa din
ng acid kaya naglead sa development ng PPI
Mucosal Barrier Fortifier/Mucosal Protective Drugs
→ In the form of complex of sulfate sucrose (Mixed drugs)
→ This drug is non absorbable, and it will combine with your protein.
Once the drugs are combined into protein, it will become viscous (In
essence, it is cement-like)
o Basically, it acts to cover up the holes around the
area, much like a cement when covering holes in the
road.
o This non-absorbable drugs adheres to the ulcer area
and serves as a protection under the ulcer area from
acidic environment of your hydrochloric acid and
pepsin
● Sucralfate
o Carafate and Iselpin (Brand name)
o Promotes healing
o Does not neutralize acid
o Cannot do anything to suppress acid secretion
o Blocks the wound around the area where there is
ulcer
o Best use for gastric and duodenal ulcers
o Best given 1 hour before meal
o Best use against ulcer secondary to NSAID use
o Before giving food to the patient, medication should
be applied on the stomach lining so that even if it
produces gastric acid, it would protect the area
around it
Prostaglandin Analog Anti-Ulcer Drug
→ Has two mechanism of action
o Suppress the gastric acid
o Increase cytoprotective mucous into the GI Tract
→ Has effect with your pepsin
o Has moderate capabilities to decrease pepsin
secretions
→ Contraindicated against pregnant women
o Induces labor
▪ Induces uterine contractions
▪ Used in the early 1980s to 1990s for
abortion
Cytotec
→ Brand name misoprostol
→ No more Cytotec in the market
Rebamipide (Mucosta)
→ Can be use as a substitute for Cytotec
→ Newest form of Prostaglandin Analog Anti-Ulcer Drug
→ Over the counter medication that can be given when stomach aches
since it does not have the ablity to cause uterine contractions and is
not much regulated as compared to Cytotec.
Question: Clarification for administration of antacids in general?
Answer:
→ In general, antacids shall be given 30 minutes before meal.
→ Two hours after meals is followed during the night. When a patient
eats dinner at 6:00 PM, antacids shall be given at 8:00 pm, so that
the acidic environment of the stomach can be neutralized while they
are asleep. Since they eat before bedtime, antacids shall be given.
If they did not eat at night, then it shall not be given. However, it was
rare to advise patients with ulcer to not eat at night since it increases
tendencies for occurrence of pain. Small amount of feeding is
usually advised.
STRESS REDUCTION
→ Not just physical stress but, also includes emotional, psychological
and environmental stress.
→ We should identify the stressors for the patient.
● Initate behavior modification, most especially to
individuals with Type A personalities, since they are
commonly the ones who develops stress ulcers.
SMOKING CESSATION
→ Quit smoking.
DIETARY MODIFICATION
→ Eating three regular meals is advised
→ Avoid irritant foods. Only tolerated food shall be eaten.
→ Avoid foods that can cause pain to them.
SURGICAL MANAGEMENT
→ Only done and recommended to patients with intractable ulcers.
● Unresponsive to treatment for about 12-16 weeks.
→ Also done when there are life threatening situations like massive
bleeding, perforations causing peritonitis due to leaking of gastric
content, and obstruction due to replacement by scar tissues in the
location of ulcer.
VAGOTOMY
→ Severing of the vagus nerve.
→ Performed to reduce gastric acid secretion
→ Some patients experience problems with feelings of fullness,
dumping syndrome, and gastritis.