Peptic Ulcer Introduction
- Peptic refers to a pepsin.
- Pepsin is a stomach enzyme that breaks down into protein.
- Pepsinogen enzyme is released from the chief cell of the stomach.
- Parietal cells of the stomach release HCL and intrinsic factors.
Peptic Ulcer Definition
- A peptic ulcer is a gastrointestinal disorder in which a lesson in the lining oesophagus, stomach and duodenum. Peptic ulcer is an ulcer lesion of GI tract.
Types of ulcer
- Gastric ulcer
- Duodenal ulcer
- Oesophageal ulcer.
-
Gastric ulcer –
it is a lesion of mucous membrane of stomach due to ingestion of alcohol, caffeine, aspirin, NSAID drugs etc.
- Pain occurs 1-2 hours after a meal.
- Pain relief after vomiting.
- Gastric ulcers usually occur on the lesser curvature of the stomach.
- Epigastric abdominal pain.
- Gastric ulcers commonly occur in older people.
- Gastric ulcer commonly in females.
-
Duodenal ulcer –
It is lesion of mucous membrane of duodenum.
- Burning right epigastric pain occurs.
- Pain occurs 2-4 hours after meals.
- Pain relief after food consumption.
- Duodenal ulcer most commonly occurs in young adults.
- Duodenal ulcer causes a very low risk of malignancy.
-
Oesophageal ulcer –
Ulcer lesion in mucosa of oesophagus.
- Occur due to hydrochloric acid in oesophagus.
- Mostly the lower part of the oesophagus is affected.
Cause of peptic ulcer
- Infection by bacteria ( H. Pylori )
- Use of NSAID.
- Genetic disorder.
- Prolonged excessive emotional and stress situation.
- Excessive intake of alcohol and Caffeine.
- Smoking, coffee, tea.
- Gastritis.
- Fasting.
- Hypercalcemia.
- Diet.
Pathophysiology of Peptic Ulcer
Cause/risk factor / H- pylori bacteria
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Excessive secretion of HCL and decrease mucus secretion
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Irritate mucous membrane of GI tract
↓
The lesion in the GI tract
↓
Peptic ulcer.
Signs and symptoms of Peptic Ulcer
-
Gastric ulcer
- Pain in the left epigastric region.
- Weight loss
- Burning sensation pain
- Nausea vomiting
- Haemoptysis ( blood in vomiting )
- Anorexia
- Heartburn
- Malnourished
- Projectile vomiting.
-
Duodenal ulcer
- Pain in right epigastric region
- Abdominal discomfort
- Malana
- Weight gain
- Well nourish
- Dyspepsia ( indigestion )
- Nausea and vomiting.
Peptic ulcer lab investigation
- History collection and physical examination.
- Stool examination.
- Barium meal x-ray.
- Endoscopic examination.
- Gastric analysis.
- CBC and haemoglobin test.
- History and screening of gastric carcinoma.
- Urea breathe test.
Treatment of Peptic Ulcer
- Antacid
- Antimicrobial drug
- H2 blockers
- Proton pump inhibitors
- Mucosal protective agents
- IV fluid
- Nasogastric tube administer
- Antibiotics for H. Pylori
- NPO
- Hyper secretory drug therapy.
Peptic ulcer surgery
- Vagotomy – cut the vagus nerve.
- Total gastrectomy – remove stomach.
- Pyloroplasty – help to widen the pylorus.
- Billroth 1 – partial gastrectomy with permanent gastroduodenostomy.
- Billroth 2 – partial gastrectomy with permanent gastrojejunostomy.
- Gastric reaction.
Peptic ulcer diet plan
- Encourage more fluid.
- Avoid – spicy food
- Alcohol, smoking, caffeine
- Oily food
- Tea, coffee
- Provide small frequent food.
- High vitamin B12 diets.
Complications of peptic ulcer
- Dumping syndrome.
- Vitamin B12 deficiency.
Nursing management of Peptic Ulcer
- Nurses determine the patient’s condition and assess vital signs.
- Determine the severity and intensity of pain.
- Assess risk factors about smoking, alcohol, NSAID, drugs.
- Prepare antibiotics for treating H. Pylori infection.
- Nurses avoid aspirin, NSAID, coffee, tea etc.
- Nurses educate about refusing high spicy junk foods.
- Monitor hematemesis and melena.
- Examine the diagnostic procedure and identify which type of ulcer.
- Provide stool softener medication.
Key Points
- An ulceration lesions in GI tract is called – Peptic ulcer.
- The most common cause of peptic ulcer – H. Pylori.
- A common peptic ulcer is – Duodenal ulcer.
- A common symptom of peptic ulcer – Projectile vomiting.
- Which type of peptic ulcer in older people – Gastric ulcer.
- Which type of ulcer in young people – Duodenal ulcer.
- Common diagnostic test of peptic ulcer – Endoscopic examination.
- The common complication of peptic ulcer – Dumping syndrome.
- Weight loss situation arises in which type of peptic ulcer – Gastric ulcer.
- H. Pylori bacteria detect by – Urea breathe test.
