ulcer

1. ▣ Ulcers that occur in the upper area of the small
intestine, which is called the duodenum, are
calledduodenal ulcer.

2. ▣ Helicobacter pylori
▣ Use of anti-inflammatory drugs
▣ Other factor-Other causes are rare. For example,
the Zollinger-Ellison syndrome. In this rare
condition, much more acid than usual is made by
the stomach. Other factors such as smoking,
stress, and drinking heavily may possibly
increase the risk of having a duodenal ulcer.
However, these are not usually the underlying
cause of duodenal ulcers.

3. ▣ Long term use of anti-inflammatory drugs
▣ Liver disease
▣ CoPD
▣ Trauma such as sever burn,brain injury
▣ Age (more common in people over the age of
50)
▣ Alcohol use
▣ Family history of

4. ▣ Abdominal distension
▣ Pain or nausea
▣ Loss of appetite
▣ Weight loss
▣ Hematemesis

5. Due to etiological factor
Erosion occurs which is caused by the increased
concentration or activity of acid pepsin or by
decreased resistance of mucosa.
A damage mucosa cannot secretes enough mucus to
act as a barrier against hcl
Patient with duodenal ulcer disease secretes more
acid then normal.

6. Damage to the gastroduodenal mucosa allows for
decreased resistence to bacteria.
Thus infection occurs from h.pylori.

7. ▣ Gastroscopy (endoscopy) is the test that can confirm a
duodenal ulcer . In this test a doctor or nurse looks
inside your stomach and the first part of your small
intestine (duodenum). They do this by passing a thin,
flexible telescope down your gullet (oesophagus). They
can see any inflammation or ulcers.
▣ A test to detect the H. pylori germ (bacterium) is usually
done if you have a duodenal ulcer. If H. pylori is found
then it is likely to be the cause of the ulcer. Briefly, it
can be detected in a sample of stools (faeces), or in a
breath test, or from a blood test, or from a biopsy
sample taken during an endoscopy.

8. ▣ Physical examination (epigastric tenderness,
abdominal distention).
▣ distention).
▣ Endoscopy (preferred, but upper gastrointestinal
[GI] barium study may be done).
▣ Acid-suppressing medication-The most common use
medication is proton pump inhibitor for example-
esomeprazole ,
▣ lansoprazole, omeprazole , pantoprazole and
▣ rabeprazole.
▣ If your ulcer was caused by H. pylori-Antibiotic
should also be give with acid suppressing medicin

9. If recommended, surgery is usually for
intractable ulcers (particularly with Zollinger–
Ellison syndrome), lifethreatening hemorrhage,
perforation, or obstruction. Surgical
procedures include vagotomy, vagotomy with
pyloroplasty, or Billroth I or II.

10. ▣ Assess pain and methods used to relieve it; take a thorough history,
including a 72hour food intake history.
▣ If patient has vomited, determine whether emesis is bright red or coffee
ground in appearance. This helps identify source of the blood.
▣ Ask patient about usual food habits, alcohol, smoking, medication use
(NSAIDs), and level of tension or nervousness.
▣ Ask how patient expresses anger (especially at work and with family),
and determine whether patient is experiencing occupational stress or
family problems.
▣ Obtain a family history of ulcer disease.
▣ Assess vital signs for indicators of anemia (tachycardia, hypotension).
▣ Assess for blood in the stools with an occult blood test.
▣ Palpate abdomen for localized tenderness.

11. ▣ 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 preventing symptoms
and managing the condition