PRESENTED BY:-

RAHUL KUMAR JAGA

F.Y. MSc. NURSING
 Definition:-
“Itis a erosion of the gastrointestinal
mucosa resulting from digestive
action of hydrochloric acid &
pepsin”
Any portion of the GI tract comes in to
contact with gastric secretions is
susceptible to ulcer development. including
the lower esophagus, stomach, duodenum.
Peptic Ulcers:
Gastric & Dudodenal
 Anatomy & physiology:-
Stomach is a 'j'-shaped organ, with
two openings- the oesophageal and
the duodenal- and four regions- the
cardia, fundus, body and pylorus.
Each region performs different
functions; the fundus collects
digestive gases, the body secretes
pepsinogen and hydrochloric acid,
and the pylorus is responsible for
mucus, gastrin and pepsinogen
secretion.
.
•Blood supply by-left gastric artery

•Venous return by- portal vein

•Just inferior to (below)
diaphragm

•Anterior (in front of)

spleen and pancreas

•Tucked under left lower

margin of liver

•Capacity: 1.5 L food

Functions:-
•Temporary food storage.
•Chemical digestion.
•Mechanical breakdown.
•Control the rate at which food enters the
duodenum.
•Acid secretion and antibacterial action.
•Preparation of iron for absorption
•Secretion of gastric hormone.
Etiology-

• Helicobacter pylori (which produce a chronic

gastritis
• Side effect of NSAIDs.
Risk factor-
• Smoking, ethanol, bile acids, aspirin, steroids,
and stress.
• Alcohol
• Use of corticosteroid
• Infection
• Family history of peptic ulcer
Pathophysiology:-
Due to etiological factor

Break down of mucosal barrier

Excessive secretion of HCL & it directly enter in to the mucosa

Injury to the tissue & ulcer

Cellular distraction & inflammation

Difference b/w
Clinical manifestation:-
• Pain—”gnawing”, or “burning”
• Duodenal ulcers: occurs 1-3 hours after a meal and
may
• Nausea, vomiting, dyspepsia, chest discomfort,
anorexia, hematemesis, & malena may also
occur.
• Burning sensation in epigastric region
• Pyrosis (Heart burn)
• Constipation
• Diarrhea
• Weight loss
Diagnostic evaluation:-
• History
• Physical Examination
• CBC
• Urinalysis
• Endoscopy
• Upper GI barium Contrast study
• Liver enzyme study
• Gastric cytology
• H pyloric testing of breath, urine, Blood stool
Complication:-
•Haemorrhage

•Perforation

•Gastrointestinal obstruction
 Management:-
Medical management:-
Monitor vital sign
H2 receptor-(decrease gastric secretion)
Antibiotic eg. clarithromycin and amoxicillin
Antacid -Neutralize gastric secretion

Omeprazole 20 mg bd for 14 d or
Rabeprazole 20 mg bd for 14 d or

Mucosal protective agent eg. Sucralfate

Surgical management:-
• Vagotomy - cutting the vagus nerve to interrupt
messages sent from the brain to the stomach to
reducing acid secretion.
• Antrectomy - remove the lower part of the stomach
(antrum), which produces a hormone that stimulates
the stomach to secrete digestive juices. A vagotomy
is usually done in conjunction with an antrectomy.
• Pyloroplasty - the opening into the duodenum and
small intestine (pylorus) are enlarged, enabling
contents to pass more freely from the stomach. May
be performed along with a vagotomy.
• Gastroduodenostomy ( Billroth-1) Removal of the
lower portion of the entrum of the stomach. as well as a small portion of
the duodenum and pylorus. the remaining segment is anastomosis to the
duodenum.

•Gastrojejunostomy ( Billroth-2) Removal of

distal third of stomach anastomosis with
duodenum or jejunum.remove gastric
producing cell in the antrum and part of the
parietal cells.
•Total gastrectomy- Removal of the stomach
with attachment of esophagus to the jejunum or
duodenum
 NURSING MANAGEMENT
NURSING ASSESSMENT
•Subjective Data:
• Epigastric pain (gnawing or burning) after meals
• Heartburn
• Constipation
• Patient reports tarry stools Feeling full
• Unexplained weight loss
• Dysphagia
•Objective Data:
• Bleeding, tarry stools
• Anemia
• Vomiting
• Hypovolemia
Nursing diagnosis

• Pain related to the wound in the stomach,

primary to HCl secretion.
• Vomiting related to indigestion of food.
• Loss appetite related to ulceration of the
stomach.
• Loss of weight related decreased nutrients
intake secondary to peptic ulcer.
• Stress and anxiety related to disease process.
 Nursing interventions.

• Support the patient emotionally.

• Administerprescribed medications.
• Provide small meals a day or small hourly meals as
ordered.
• Schedule care so that the patient gets plenty of rest.
• Monitor the effectiveness of administered
medications, and also watch for adverse reactions.
• Assess the patient’s nutritional status and the
effectiveness of measures used to maintain it.
Weigh him regularly.
 Cont…

 Teach the patient about peptic ulcer disease,

and help him to recognize its signs and
symptoms.
 Instruct the patient to take antacids 1 hour after
meals.
 Warn the patient to avoid aspirin containing
drugs because they irritate gastric.
 BIBLIOGRAPGY
• Anne Waugh and Allison Grant “Ross and Wilson Anatomy and Physiology” 12 th edition,
Elsevier publisher, page no.-390-408
• B.D. Chaurasia “textbook of anatomy” 2nd edition, medical publisher,
• Black.M.J, Haawks.J.H. Medical Surgical Nursing. VoII. 7 th Edition.New delhi Saunders
publication.
• Bracinwald.E.Fauci.S A, Hanser L.S, Jaeson. J.L,Kasper.P .L, Long.Harrison’s Principles of
Internal Medicine. 16th edition.
• Brunner & suddarht “ textbook of Medical Surgical Nursing” 11 th edition, Elsevier publisher,
page no.- 2014,2026-2028
• Burke. K, Lemon. P. Medeical Surgical Nursing. 7 th edition.New Delhi. Saunder’s
Publication
• Gerard J. Tortora, Bryan Derricksan “principles of Anatomy & Physiology”, 12 th edition,
Wiley and sons publisher, page no.-198,235
• Lewis. S. Heitkemper M. Medical surgical Nursing. 6 th edition. Missouri: Elseveir’s
publications
• Smelter S C, Bare B G. Textbook of Medical Surgical Nursing. 12 th edition. Philadelphia:
Lippincott Williams and Wilikins Publishers
• www.slideshere.com
THANK YOU