CASE PRESENTATION

PEPTIC ULCER
MA. CHRISTINA T. ALVAREZ
WUP - BS NURSING III-2
OVERVIEW

 What is peptic ulcer?

A peptic ulcer is a sore on the lining of your stomach, small intestine or esophagus. A peptic ulcer in the
stomach is called a gastric ulcer. A duodenal ulcer is a peptic ulcer that develops in the first part of the
small intestine (duodenum). An esophageal ulcer occurs in the lower part of your esophagus.
Ulcers form when the intestine or stomach's protective layer is broken down. Duodenal ulcers are more
common than stomach ulcers. Comparatively rare are esophageal ulcers, which form in the esophagus --
or swallowing tube -- and are often a result of exposure to medications, like certain antibiotics or anti-
inflammatories, or alcohol abuse.
THERE ARE THREE TYPES OF PEPTIC ULCERS:

1. gastric ulcers: ulcers that develop inside the stomach.

2. esophageal ulcers: ulcers that develop inside the esophagus.
3. duodenal ulcers: ulcers that develop in the upper section of the small intestines, called the duodenum.
PROFILE OF THE PATIENT

 A male patient named Juan Dela Cruz age 28 years old from Dipaculao, Aurora, Roman Catholic, Married and
has 2 children, construction worker and smokers and alcohol addict.

CHIEF COMPLAINT

acute pain in upper middle part of abdomen after meals, nausea and vomiting, feeling bloated and burning in
stomach, taking paracetamol to relieve pain, 3 days before admission.
ANATOMY AND PHYSIOLOGY
The main function of the stomach is to store food and release it
to the intestines at a rate whereby the intestines can process it.
The stomach mixes the food and grinds it into a finely divided
chyme that increases the surface area of the food in preparation
for digestion.
PATHOPHYSIOLOGY

Excessive gastric acid secretion is only one factor in

the pathogenesis of peptic ulcer disease. Decreased
mucosal defense against gastric acid is another cause.
The integrity of the upper gastrointestinal tract is
dependent upon the balance between “hostile” factors
such as gastric acid, H.
CAUSES
 Helicobacter pylori

H. pylori is the etiologic factor in most patients with peptic ulcer disease and may predispose individuals to the
development of gastric carcinoma. H. pylori colonizes in the human stomach. The method of H. pylori transmission is
unclear, but seems to be person-to-person spread via a fecal-oral route.
 Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)

A small but important percentage of patients have adverse gastrointestinal events associated with NSAID use that
results in substantial morbidity and mortality. Risk factors for the development of NSAID-associated gastric and
duodenal ulcers include advanced age, history of previous ulcer disease, concomitant use of corticosteroids and
anticoagulants, higher doses of NSAIDs, and serious systemic disorders. (IBUPROFEN, MEFENAMIC ACID,
ASPIRIN, DEFLOPENAC)
 Smoking
 Stress
 Alcohol
SIGNS AND SYMPTOMS

 Burning stomach pain

 Feeling of fullness, bloating or belching
 Intolerance to fatty foods
 Heartburn
 Nausea
 The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does
having an empty stomach. The pain can often be relieved by eating certain foods that buffer stomach acid or by
taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at
night.
SIGNS AND SYMPTOMS

 Less often, ulcers may cause severe signs or symptoms such as:
 Vomiting or vomiting blood — which may appear red or black
 Dark blood in stools, or stools that are black or tarry
 Trouble breathing
 Feeling faint
 Nausea or vomiting
 Unexplained weight loss
 Appetite changes
 LABORATORY TEST

 The most common laboratory test for diagnosing peptic ulcers is a blood test for the presence of antibodies to H.
pylori. A stool sample may be collected to look for the H. pylori antigen.
 liver function tests (LFTs), and levels of amylase and lipase may be useful. CBC count and iron studies can help
detect anemia, which is an alarm signal that mandates early endoscopy to rule out other sources of chronic
gastrointestinal (GI) blood loss.
Name of Generic Name Dosage Action/contraindication/side effects Shape & color of the Nursing
Medication medication card to implications/Nursing
(BRAND NAME) be used responsibilities

Omeprazole Prilosec 40mg OD Oral Action. Gastric

pump inhibitor; Capsule Assess patient for
suppresses gastric basal and white hypersensitivity to
stimulated acid secretion drugs.
Contraindication. Instruct patient to
Contraindicated with take drug 30
hypersensitivity to minutes before
omeprazole or its meal.
components. Use cautiously Instruct patient and
with pregnancy and lactation. family to swallow
Side effects/Adverse effect.
the drugs whole- do
Nausea, diarrhea, fatigue, not chew and not to
constipation, vomiting, open.
flatulence, acid regurgitation, Instruct patient to
dry mouth, dizziness, report severe
headache, abdominal pain, headache, fever,
skin rashes, weakness, back chills and changes
pain. in color of urine &
stool or any
worsening
symptoms.
Name of Medication Generic Name Dosage Action/contraindicati Shape & color of the Nursing
(BRAND NAME) on/side effects medication card to be implications/Nursing
used responsibilities
Biaxin clarithromycin 500mg action. inhibits tablet Assess patient for
1tab protein synthesis yellow hypersensitivity to
BID in susceptible drugs
PO bacteria, causing
cell death instuct patient to
contraindication. take drug with
contraindicated food. do not drink
with grapefruit juice
hypersensitivity to while taking
clarithromycin, drugs.
erythromycin or
any macrolide report severe or
antibiotic. watery diarrhea,
side effects. severe nausea and
stomach pain. vomiting, mouth
diarrhea. sores
nausea.
vomiting.
abnormal taste in
your mouth.
Name of Medication Generic Name Dosage Action/contraindication/side Shape & color of the Nursing
(BRAND NAME) effects medication card to be implications/Nursing
used responsibilities

Pepcid famotidine 40mg action. Famotidine reduces tablet Assess patient for
1tab the acid and pepsin content, yellow hypersensitivity
BID as well as the volume, of to drugs.
PO basal, nocturnal, and
stimulated gastric secretion. report for severe
contraindication. vomiting, nausea,
Hypersensitivity to any abdominal
component of these discomfort,
products. Cross sensitivity in rash,and muscle
this class of compounds has cramps or any
been observed. Therefore, worsening
PEPCID should not be symtoms.
administered to patients with
a history of hypersensitivity
to other H2-receptor
antagonists.
side effects.
fatigue,vomiting, nausea,
abdominal discomfort,
anorexia, dry mouth,
rash,and muscle cramps.
DIAGNOSTIC EXAM

 Endoscopy. doctor may use a scope to examine your upper digestive system (endoscopy). During endoscopy, the
doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus, stomach
and small intestine. Using the endoscope, your doctor looks for ulcers.
 Upper Gastrointestinal Series (UGI) An upper GI series is a procedure in which a doctor uses x-rays, fluoroscopy,
and a chalky liquid called barium to view your upper GI tract. The barium will make your upper GI tract more
visible on an x-ray.
 X-ray that visualizes structures of the upper GI tract
MEDICAL MANAGEMENT

 Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. pylori bacterium if
present, eliminating or reducing use of NSAIDs if possible, and helping your ulcer to heal with medication.
Medications can include:
 Antibiotic medications to kill Helicobacter pylori. (amoxicillin, clarithromycin (Biaxin), metronidazole
(Flagyl), tetracycline (Sumycin), or tinidazole (Tindamax).
 Medications that block acid production and promote healing. (Prevacid, Prilosec, and Zegerid-
ProtonPumpInhibitor)
 Medications to reduce acid production. (cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine
(Axid AR)H-2-receptor-blockers
 Antacids that neutralize stomach acid. (Calcium carbonate, Gaviscon, Pepto-Bismol)
 Medications that protect the lining of your stomach and small intestine. (cytoprotective agents-sucralfate
(Carafate) and misoprostol (Cytotec).
SURGICAL MANAGEMENT

 Elective surgery is uncommonly needed for peptic ulcer disease in current medical practice. Currently accepted
indications, elective and emergent, for surgery in the management of peptic ulcer disease include bleeding,
perforation, obstruction, intractable disease, and suspected malignancy
THANKYOU!
Assessment Diagnosis Planning Intervention Rationale Evaluation
subjective data: acute pain related after 8hrs of Independent: pain is not alwaysgoal has met.
“sumasakit po ang to abdominal pain nursing Assess the client’s present, but if after 8hrs of
sikmura ko as evidenced by intervention the pain, including the present should be nursing
pagkayari ko abdominal patient will location, onset, compared w/ pt’s intervention the
kumain” as guarding, facial verbalized relief duration, previous pain patient has
verbalized by the grimace and pain of pain and frequency, quality, symptoms. verbalized relief
patient scale 6/10 demonstrate intensity, and of pain and
relaxed posture severity. demonstrated
objective data: and be able to encourage patient reduces abdominal relaxed body
• abdominal sleep/rest to assume position tension and posture and be
guarding appropriately. and comfort. promotes sense of able to sleep/rest
• facial control appropriately.
grimacing encourage small
• pain scale 6/10 frequent meals. to prevent
• restlessness distension and the
VS taken as release of gastrin.
follows; identify and limit
Temp- 36.4 foods that create food has an acid
BP-NURSING
110/80 CARE PLAN discomfort (spicy neutralizing
RR-22 or carbonated affects and dilutes
PR-86 drink) the gastric
Spo2- 98% contents.