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Peptic ulcer (AHN)


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Peptic ulcer (AHN)

  1. 1. Peptic Ulcer Muhammad Aurangzeb Institute of nursing sciences Khyber Medical University Peshawar
  2. 2. Objectives • At the end of this presentation the student will be able to define: • Define peptic ulcer. • Identify causes & factors for the development of peptic ulcer. • Enlist signs/symptoms and complication of peptic ulcer. • Discuss diagnosis and treatment of peptic ulcer. • Apply nursing intervention for peptic ulcer.
  3. 3. Peptic Ulcer • An Ulcer is …  Erosion in the lining of the stomach or the first part of the small intestine, an area called the duodenum. Ulcers damage the mucosa of the alimentary tract, which extends through the muscularis mucosa into the sub mucosa or deeper.
  4. 4. Ulcers that form in the stomach are called gastric ulcers; in the duodenum, they are called duodenal ulcers. Both types are referred to as peptic ulcers.
  5. 5. Peptic UlcerPeptic Ulcer
  6. 6. • The gastroduodenal mucosal integrity is determined by protective (defensive) & damaging (aggressive) factors.
  7. 7. Mucosal damage  erosions & ulcerations
  8. 8. Causes gastric and duodenal ulcer • In the past it was believed lifestyle factors, such as stress and diet caused ulcers. Later, researchers determined that stomach acids -- hydrochloric acid and pepsin -- contributed to ulcer formation. • Today, research shows that most ulcers (80 percent of gastric ulcers and 90 percent of duodenal ulcers) develop as a result of infection with a bacterium called Helicobacter pylori (H. pylori). • It is believed that, although all three of these factors -- lifestyle, acid and pepsin, and H. pylori -- play a role in ulcer development, H. pylori is considered to be the primary cause.
  9. 9. Cont…
  10. 10. Factors in the development of peptic ulcers • Factors for the development of peptic ulcers include: • Helicobacter pylori Research shows that most ulcers develop as a result of infection with bacterium called Helicobacter pylori (H. pylori). The bacterium produces substances that weaken the stomach's protective mucus and make it more susceptible to the damaging effects of acid and pepsin, as well as produce more acid.
  11. 11. Conti…. • Smoking: Studies show smoking increases the chances of getting an ulcer, slows the healing process of existing ulcers, and contributes to ulcer recurrence. • Caffeine: Caffeine seems to stimulate acid secretion in the stomach, which can aggravate the pain of an existing ulcer. However, the stimulation of stomach acid cannot be attributed solely to caffeine
  12. 12. Conti… • Alcohol no proven link between alcohol consumption and peptic ulcers, ulcers are more common in people who have cirrhosis of the liver, a disease often linked to heavy alcohol consumption. • Stress Although emotional stress is no longer thought to be a cause of ulcers, people with ulcers often report that emotional stress increases ulcer pain.
  13. 13. Conti… • Acid and pepsin It is believed that the stomach's inability to defend itself against the powerful digestive fluids, hydrochloric acid and pepsin, contributes to ulcer formation. • Nonsteroidal anti-inflammatory drugs (NSAIDs) These drugs (such as aspirin, ibuprofen, and naproxen sodium) make the stomach vulnerable to the harmful effects of acid and pepsin. They are present in many non-prescription medications used to treat fever, headaches, and minor aches and pains.
  14. 14. Symptoms of gastric and duodenal ulcer • The following are the most common symptoms for ulcers, however, each individual may experience symptoms differently. • Belching • Nausea • Vomiting • Poor appetite • Loss of weight • Feeling tired and weak
  15. 15. Complication of ulcer • Bleeding. • Perforation. • Narrowing and obstruction.
  16. 16. Diagnosis • Diagnostic procedures include: • Barium Swallow • Endoscopy - a small flexible instrument with a camera on the end is inserted through the mouth into the esophagus, stomach, and duodenum to view the entire upper GI tract. • Blood tests - performed to detect the presence of H. pylori.
  17. 17. Treatment • Lifestyle changes: In the past, physicians advised people with ulcers to avoid spicy, fatty, or acidic foods. • Smoking: Smoking has been shown to delay ulcer healing and has been linked to ulcer recurrence; therefore, people with ulcers should not smoke.
  18. 18. Conti… • Medications: Physicians treat stomach and duodenal ulcers with several types of medications, including: • H2-blockers to reduce the amount of acid the stomach produces by blocking histamine, a powerful stimulant of acid secretion. E.g. Cimetidine, Ranitidine, and Famotidine. • Proton pump inhibitors to more completely block stomach acid production by stopping the stomach's acid pump -- the final step of acid secretion. E.g. Omeprazol.
  19. 19. Cont… • Mucosal protective agents to shield the stomach's mucous lining from the damage of acid, but do not inhibit the release of acid. E.g. Bismuth, Sucralfate • When treating H. pylori, these medications are often used in combination with antibiotics. • Antibiotics: The discovery of the link between ulcers and H. pylori resulted in a probable new treatment option -- antibiotics for patients with H. pylori.
  20. 20. H. pylori Therapy: • Triple therapy: Proton pump inhibitor Clarithromycin Amoxicillin.
  21. 21. Surgery • At present, surgery is performed to treat ulcers. Types of surgery include: • Vagotomy • Pyloroplasty • Antrectomy
  22. 22. Vagotomy • Vagotomy: a surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion (e.g. in treating peptic ulcers).
  23. 23. Pyloroplasty • Pyloroplasty is surgery to widen the opening in the lower part of the stomach (pylorus) so that stomach contents can empty into the small intestine (duodenum). The pylorus is a thick, muscular area. When it thickens, food cannot pass through.
  24. 24. Antrectomy • Surgical removal of the walls of an antrum, especially the antrum of the stomach.
  25. 25. 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.
  26. 26. Nursing interventions. • Support the patient emotionally. • Administer prescribed 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.
  27. 27. 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.
  28. 28. THANK YOU