A peptic ulcer is the erosion in the mucosal wall of the stomach or the first part of the small intestine, an area called the duodenum. An ulcer occurs when the lining of these organs is surrounded by the acidic digestive juices which are secreted by the stomach cells.

1. peptic ulcer
MISS AMANJOT KAUR SIDHU
MSN (CCN)

2. DEFINITION
A peptic ulcer is the erosion in
the mucosal wall of the stomach
or the first part of the small
intestine, an area called the
duodenum. An ulcer occurs
when the lining of these organs
is surrounded by the acidic
digestive juices which are
secreted by the stomach cells.

3. CONTD…
The English word “Peptic” comes
from the Latin word pepticus which
means “to digest” and “ulcer”
comes from the Latin word ulcus
which means “a sore or wound.”

4. CONTD…
If the peptic ulcer is in the stomach, it
is called as gastric ulcer. If it is in the
duodenum then, it is known as the
duodenal ulcer. A peptic ulcer may also
develop just above the stomach, in the
esophagus, is also called as esophageal
ulcer.

5. TYPES OF PEPTIC ULCER
1.Acute: Acute ulcers are usually
superficial involving only the mucosal
layer. They heal within a period of time
but sometimes they may bleed,
perforate or become chronic if not
treated.

6. Contd..
2. Chronic: It is deep with sharp edges
and a clean base. It involves both mucosa
and sub-mucosa. If ulcer penetrates the
stomach, it also involves the adjacent
organs such as pancreas.

7. CAUSES
•H. Pylori infection- Bacteria spreads through
food & water
•Regular use of analgesics such as aspirin,
ibuprofen etc.
•Alcohol consumption
•Irritants- excessive use of strong coffee, tea,
spices, alcohol and tobacco.

8. Contd…
•Zollinger-Ellison syndrome—a rare
disease that makes the body produces
too much acid which harms the
lining of the stomach or duodenum.
•Radiation therapy

9. RISK FACTORS
Hereditary factors
Smoking
Personality type: Highly nervous, emotional,
ambitious and aggressive individuals are
more prone to ulcers. Anxiety, worry and
strain may cause hypersecretion of acid and
increase motility of intestines.

10. Contd…
Mental stress: Mental stress has not
been linked to the development of new
peptic ulcers. However, people with
ulcers who experience sustained
mental stress tend to have worse
symptoms.

11. PATHOPHYSIOLOGY
Dueto above causes and risk factors
Damageoccurs to mucosal wall
Damaged mucosa is unable to secreteenough mucus to act as abarrier against
hydrochloricacid
Low function ofmucosal cells &low qualityof mucus

12. CONTD…

13. CLINICAL MANIFESTATIONS
Abdominal bloating
Abdominal burning
Heart burn
Belching
Loss of appetite
Nausea with or without vomiting
Weight loss

14. CONTD…
• Serious symptoms that might indicate a
life-threatening condition:
• Vomiting or vomiting blood — which may
appear red or black
• Severe abdominal pain
• Bloody stool that may be red, black or terry

15. DIAGNOSTIC EVALUATION
In order to detect an ulcer, first take
a medical history and perform a
physical examination. Then, may
need to undergo diagnostic tests,
such as:

16. CONTD…
•Breath test
•Endoscopy
•Upper gastrointestinal
series

17. MANAGEMENT
Medical management:
 Antibiotic medications to kill H. pylori: If H.
pylori is found in the digestive tract, doctor may
recommend a combination of antibiotics to kill
the bacterium. These may include amoxicillin,
clarithromycin, metronidazole, tinidazole,
tetracycline and levofloxacin.

18. CONTD…
Triple therapy: The combination of
bismuth subsalicylate and antibiotics
tetracycline and metronidazole works in
80-95% of people. The bismuth
subsalicylate and tetracycline have to be
taken 4 times a day and the
metronidazole 3 times a day.

19. CONTD…
Dual therapy: This therapy was
developed as a response to the
complexity and side effects of triple
therapy. It comprises 2 antibiotics,
amoxicillin and metronidazole, both
taken as pills 3 times a day.

20. CONTD…
•Proton pump inhibitors (PPIs):
PPI’s reduce stomach acid by
blocking the action of the parts of
cells that produce acid. These drugs
include omeprazole, lansoprazole,
rabeprazole, esomeprazole and
pantoprazole.

21. CONTD…
Long-term use of proton pump
inhibitors, particularly at high
doses, may increase the risk of
hip, wrist and spine fracture. So,
taking a calcium supplement may
reduce this risk.

22. CONTD…
•Histamine (H-2) blockers: They reduce
the amount of stomach acid released into
digestive tract, which relieves ulcer pain
and encourages healing. These include
the medications ranitidine, famotidine,
cimetidine and nizatidine.

23. CONTD…
Medications that protect the lining of your
stomach and small intestine: It includes
cytoprotective agents that help protect the
tissues that line stomach and small intestine.
They include the sucralfate, which strengthen
the gut lining against attacks by acid
digestive juices.

24. SURGICAL MANAGEMENT
 Vagotomy: It is performed to
eliminate the acid secreting stimulus
to the gastric cells. Cutting the vagus
nerve, which transmits messages
from the brain to the stomach, can
reduce acid secretion. However, this
can also interfere with other
functions of the stomach. A newer
operation cuts only the part of the
nerve that affects acid secretion.

25. CONTD…
 Antrectomy: This is often done
in conjunction with a vagotomy. It
involves removing the lower part
of the stomach (antrum). This part
of the stomach produces a
hormone that increases production
of stomach acid. Adjacent parts of
the stomach may also be removed.

26. CONTD…
 Pyloroplasty: This procedure
also is sometimes done with
vagotomy. It enlarges the opening
between the stomach and
duodenum (pylorus) to encourage
passage of partially digested
food. Once the food has passed,
acid production normally stops.

27. CONTD…
 Billroth I: Billroth I
(Gastroduodenostomy) is
formation of new opening
between stomach and
duodenum. In Billroth I surgery,
lower part of stomach is
removed and remaining portion
is anastomosed to duodenum.

28. CONTD…
 Billroth II: Billroth II
(Gastrojejunostomy) is
anastomosis of stomach
with jejunum. In Billroth II
surgery, duodenal stump is
closed after excision of
lower part of stomach.

29. CONTD…
•Tying off an artery: If
bleeding is a problem, cutting
off the blood supply (artery)
to the ulcer can stop the
bleeding.

30. CONTD…
Gastrectomy: In this, the entire stomach
(total gastrectomy) or part of the stomach
(partial or subtotal gastrectomy) is removed.
Parts of nearby tissues or organs (e.g.
spleen) may also be removed. Following
total gastrectomy, the esophagus is attached
directly to the small intestine.

31. COMPLICATIONS
 Hemorrhage: Hemorrhage, the most common
complication occurs in 10% to 20% of patients with
peptic ulcers in the form of hematemesis or melena.
 Perforation and penetration: Perforation is the
erosion of the ulcer through the gastric serosa into
the peritoneal cavity without warning, while
penetration is the erosion of the ulcer through the
gastric serosa into adjacent structures.

32. CONTD…
Pyloric obstruction: Pyloric obstruction
occurs when the area distal to the pyloric
sphincter becomes scarred and stenosed from
spasm or edema or from scar tissue that
forms when an ulcer alternately heals and
breaks down.

33. PREVENTION
 Protect yourself from infections. It's not clear just
how H. pylori spreads, but there's some evidence that
it could be transmitted from person to person or
through food and water.
You can take steps to protect yourself from
infections, such as H. pylori, by frequently washing
your hands with soap and water and by eating foods that
have been cooked completely.

34. CONTD…
 Use caution with pain relievers. If you regularly use
pain relievers that increase your risk of peptic ulcer,
take steps to reduce your risk of stomach problems.
For instance, take your medication with meals.
Work with your doctor to find the lowest dose
possible that still gives you pain relief. Avoid drinking
alcohol when taking your medication, since the two can
combine to increase your risk of stomach upset.

35. CONTD…
If you need to take a pain medication
associated with ulcers, you may need
to also take additional medications
such as an antacid, a PPI, an acid
blocker or cytoprotective agent.

36. NURSING MANAGEMENT
 Nursing diagnosis:
1.Acute pain related to gastric mucosal erosion
2.Imbalanced nutritional status, less than body requirements related to
changes in digestion
3.Increased risk of GI bleeding and perforation of stomach, related to
gastric wall erosion
4.Deficient fluid volume, related to acute bleeding duodenal ulcer
5.Risk for injury related to complications of peptic ulcer activity such as
hemorrhage and perforation
6.Increased risk of aspiration due to vomiting related to ulceration
7.Anxiety related due to knowledge deficit.