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1. Peptic Ulcer Disease
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Peptic Ulcer Disease
 This occurs anywhere where pepsin and acid
occur together.
 It is caused by an imbalance b/w secretion of
acid and pepsin , mucosal defense mechanism .
 An acid and reduced mucosal defenses provide
ideal circumstances for pepsin to cause mucosal
ulceration.
 If there is no acid peptic ulceration cannot occur.
logman Mohammed

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 Over secretion of acid associated with
duodenal ulceration.
 Breakdown of the mucosal defences
occurs in gastric ulceration.
logman Mohammed 3

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 Exacerbating factors in peptic ulceration
include :
smoking,alcohol,NSAIDs,steroid,hyperpa
rathyrodism,zolinger-ellison syndrome.
 infection with helicobacter
pylori(HP)may impair mucosal defences
and has recently been associated with DU
and gastritis and to a lesser extent GU .
logman Mohammed 4

5. Types PU
 Acute
 Superficial erosion
 Minimal erosion
 Chronic
 Muscular wall erosion with formation of
fibrous tissue
 Present continuously for many months or
intermittently
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6. Peptic Ulcer Disease
 Sites of ulcer development
 Lower esophagus
 Stomach(common in the lesser curvature)
 Duodenum
 Jejunum(in zollinger-elison syndrome)
6logman Mohammed

7. Duodenal Ulcers
Clinical Manifestations
Epigastric pain, may radiate to back ,relieved
by eating, worse at night. Symptoms are
periodic and last about 14days and recur
at3-4monthly intervals. They are often worse
in spring and autumn.vomiting is rare ,if it
occurs pyloric stenosis should be suspected.
Examination reveals tenderness in
epigastrium
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8. Gastric Ulcers
Clinical Manifestations
Epigastric pain, not periodic, food may
precipitate pain. Pain may be relieved by
vomiting. Patient may be afraid to eat and
weight loss result . Examination reveals
tenderness in epigastrium
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9. Other symptoms
 Dyspepsia, including belching, bloating,
distention, and fatty food intolerance
 Heartburn
 Hematemesis or melena
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10. 10logman Mohammed

11. Diagnostic Studies
 Upper GI Endoscopy procedure most often used
 Tissue specimens can be obtained to identify
H. pylori and to rule out gastric cancer
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12. Diagnostic Studies
 Tests for H. pylori
 Noninvasive tests
 Serum or whole blood antibody tests
 Immunoglobin G (IgG)
 Urea breath test
 Invasive tests
 Biopsy of stomach
12logman Mohammed

13. Diagnostic Studies
 Barium contrast studies
 X-ray studies
 Ineffective in differentiating a peptic ulcer
from a malignant tumor
 Gastric analysis
 Identifying a possible gastrinoma
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14. Diagnostic Studies
 Laboratory analysis
 CBC
 Liver enzyme studies
 Serum amylase determination
 Stool examination
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Medical Management
 The purpose of medical management of peptic
ulcer is to eradicate H. pylori and to manage
gastric acidity.
 This is achieved through pharmacologic
therapy, lifestyle changes, and surgical
intervention.
logman Mohammed

16. Management
Life Style Changes
 Patient Education
 Stop smoking
 Avoid NSAID and aspirin use
 Avoid heavy alcohol use
 Stress reduction counseling might be
helpful in individual
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 Dietary modification is required to avoid over
secretion of acid and hyper motility in the GI tract.
 Avoiding alcohol, coffee and other caffeinated
beverages, and diets rich in milk and cream.
 Effort is made to neutralize acid by eating three
regular meals a day.
Dietary modification
logman Mohammed

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Pharmacologic Therapy
 A combination of antibiotics (clarithromycin &
amoxicillin), proton pump inhibitors (omeprazole),
and bismuth salts (bismuth subsalicylate) that
suppresses or eradicates H. pylori;
 Antibiotics assist in eradicating H. pylori bacteria.
 Histamine 2 (H2) receptor antagonists (Ranitidine)
and proton pump inhibitors are used to treat NSAID-
induced and other ulcers not associated with H. pylori
ulcers.
logman Mohammed

19. Pharmacologic Therapy for PU D
 Currently favored regimens are triple
therapy with a PPI along with two
antibiotics. For example:
■ Omeprazole 20 mg + metronidazole 400 mg
and clarithromycin 500 mg (all twice daily)
■ Omeprazole 20 mg + clarithromycin 500
mg and amoxicillin 1 g (all twice daily).
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 Surgery:
 Failed medical tretment(unusual nowadys)
 Complications- hemorrhage ,perforation, or
obstruction. Operation include:
 Vagotomy
 Partial gastrectomy
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21. Surgical procedure options
1. Gastroduodenostomy (Billroth I).
a. Partial gastrectomy with removal of antrum and pylorus of
stomach.
b. b. The gastric stump is anastomosed with the duodenum.
2. Gastrojejunostomy (Billroth II)
a. Partial gastrectomy with removal of antrum and pylorus of
stomach.
b. b. The gastric stump is anastomosed with the jejunum.
3. Antrectomy
a. Gastric resection includes a small cuff of duodenum, the
pylorus, and the antrum.
b. b. The duodenal stump is closed, and the jejunum is
anastomosed to the stomach.
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22. 4. Total gastrectomy:
a. Called an esophagojejunostomy.
b. b. Removal of the stomach with attachment of the
esophagus to the jejunum or duodenum.
5. Pyloroplasty
a. A longitudinal incision is made in the pylorus, and it is
closed transversely to permit the muscle to relax and
to establish an enlarged outlet.
b. b. Often, a vagotomy is performed at the same time.
6. Vagotomy
a. The surgical division of the vagus nerve to eliminate
the impulses that stimulate HCL secretion.
22logman Mohammed

23. Vagotomy Pyloroplasty
Duodenal
anastomosis
Billroth II (gastrojejunostomy)
Antrectomy Billroth I
(gastroduodenostomy)
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24. Peptic Ulcer Disease Complications
 Hemorrhage
 Perforation
 Gastric outlet obstruction
 Malignancy (GU)
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Nursing Management of Peptic Ulcer
Assessment:
 The nurse asks the patient to describe the pain
and the methods used to relieve.
 The nurse asks about history of vomiting and
characteristics of the vomitus: Is it bright red,
does it resemble coffee grounds?
 The nurse records vital signs and reports any
tachycardia and hypotension. Is there any
tenderness of abdomen?
logman Mohammed

26. Assessment
 Has the patient noted any bloody or tarry stools?
 The nurse assess life style and habits such as
drinking coffee ,alcohol, smoking.
 Does the patient take NSAIDs? Any anxiety or
stress?
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 Acute pain related to the effect of gastric acid
secretion on damaged tissue.
 Anxiety related to coping with an acute
disease.
 Imbalanced nutrition related to changes in
diet.
 Deficient knowledge about prevention of
symptoms and management of the condition.
Nursing diagnoses
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To relieving pain:
 Administration of prescribed medications.
 The patient should avoid aspirin, foods and
beverages that contain caffeine, and
decaffeinated coffee
 Meals should be eaten at regularly paced
intervals in a relaxed setting.
Nursing interventions
logman Mohammed

29. To reducing anxiety:
 The nurse assesses the patient’s level of anxiety.
 Appropriate information and explanation are
provided
 all questions are answered
 patient is encouraged to express fears openly.
 The patient’s family is encouraged to participate
in care and to provide emotional support
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30. Maintaining optimal nutritional status:
 The nurse assesses the patient for malnutrition
and weight loss.
 The patient is advised about the importance of
complying with the medication regimen and
dietary restrictions.
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 Instructs the patient about the factors that will help or
aggravate the condition.
 The nurse provides information about medications to be taken
at home, stressing the importance of continuing to take
medications
 The patient is instructed to avoid certain medications and
foods that exacerbate symptoms
 It is important to counsel the patient to eat meals at regular
times.
 Informs the patient about the irritant effects of smoking on the
ulcer.
To improve the patient knowledge
logman Mohammed