The document discusses peptic ulcers, including definitions, types, causes, risk factors, pathophysiology, clinical manifestations, diagnosis, management, and nursing considerations. Peptic ulcers are erosions in the GI tract caused by gastric acid and pepsin. There are three main types based on location: gastric, duodenal, and esophageal. Key risk factors include H. pylori infection, smoking, NSAIDs, and stress. Treatment involves reducing acid production, eradicating H. pylori if present, and surgery for severe cases. Nursing focuses on pain management, nutrition, risk reduction, and ensuring proper treatment adherence.

1. SEMINAR
ON MEDICAL SURGICAL NSG
TOPIC :- PEPTIC ULCER
NAME- Dimpee Deka
Post Basic BSc 1st year
Roll no- 4

2. PEPTIC ULCER
 Definition : peptic ulcer
disease(PUD)is a condition
characterized by erosion of the GI
mucosa resulting from the digestive
action of HCL acid and pepsin . any
portion of the GI tract that comes into
contact with gastric secretion is
susceptible to ulcer development .

3. TYPES OF PUD
According to location there are three types:-
 1) Gastric ulcer:- if the peptic ulcer is located in the stomach it is
called a gastric ulcer.
 2) Duodenal ulcer:- one that in the duodenal is called duodenal
ulcer.
 3) Esophagus ulcer:- a peptic ulcer also may develop just above
stomach in esophagus called esophageal ulcer.
 According to severity there are two type :-
 1) Acute peptic ulcer:- Acute ulcer are usually superficial involving
only the mucosal layer .they heal within a period of time but
sometime they may bleed , perforate or become chronic if not
treated .
 2)Chronic peptic ulcer:- it is deep with sharp edges and a clean base
. It involves both mucosa and submucosa . If ulcer penetrates the
stomach ,it also involve the adjacent organs such as pancreas.

4. CAUSES AND RISK
FACTORS
 Factors for the development of peptic ulcers
include:-
 Helicobacter pylori:- Research shows that most
ulcers develop as a result of infection with
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.
 Smoking :- studies show smoking increase the
chances of getting an ulcer , slows the healing
process of existing ulcers, and contributes to
ulcer recurrence.

5.  Caffeine:- caffeine seems to stimulates acid
secretion in the stomach ,which can aggravate
the pain of an existing ulcer. However the
stimulation of stomach acid cannot be attributed
solely the caffeine.
 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 ulcer
often report that emotional stress increase ulcer
pain.

6.  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 .
 Non-steroidal 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.

7. PATHOPHYSIOLOGY
Damage to mucosa
with alcohol abuse,
smoking, use of
aspirin & NSAIDs
Acid & Pepsinogen
release with
chronic vagal
response to
increased stress.
Infection with
H.Pylori
Damage Mucosal Barrier

8. Imbalance of aggressive & defensive factor

9. Imbalance of aggressive & defensive factor
Damaged mucosa unable to secrete enough mucus to act as a barrier against
hydrochloric acid
Low function of mucosal cells; low quality of mucus ;less of tight junction between
cells.
Infection gives increased gastrin & decreased somatostain production
Erosive gastrics:- inflammation >> decreased acid and intrinsic factor
Mucosal ulcerations, possible bleeding and scarring
A damage mucosa could not secrete enough mucus to act as a barrier against gastric
acid
Severe ulceration
Peptic ulcers occurs more often in the Duodenum

10. Clinical manifestation:-
 Abdominal bloating
 Abdominal burning
 Pain in the upper middle part of abdominal ( epigastric
region)
 Heart burn
 Belching(brupping)
 Feeling of fullness- unable to drink as much fluid
 Loss of appetite
 Unexplained weight loss
Serious symptoms that might indicate a life – threatening
condition :-
1)Bloody stool( blood may be red , black, or tarry in
texture )
2)Severe abdominal pain
3)Vomiting blood or black material (resembling coffee
grounds)

11. Comparison of duodenal & gastric Ulcer
Gastric Ulcer Duodenal Ulcer
1. Age: –Usually 50 & Over.
2. Ratio:-Male & Female -2:1
3. Normal to hypoSecretion of
stomach acid.
4. Weight loss to occur
5. Pain occur ½ hour to 1 hour after
meal.
6. No pain at hours of sleep(HCL
production decrease at hour of
sleep.)
7. Ingestion of food increase pain.
8. Vomiting :-Common.
9. Hemorrhage:-Common
10.Hematemesis-Common.
11.Perforation:-Very Less
12.Malignancy :- occasionally occur.
13.Risk factors are gastritis, alcohol,
smoking ,stress and NSAIDs
1 Age: –Usually 30 to 60
2. Ratio:-Male & Female -3:1
3. Normal to hyperSecretion of
stomach acid.
4. Weight gain to occur
5. Pain occur 2 to 3 hour after
meal.
6. Pain at hours of sleep
(Because gastric emptying
continue at hours of sleep.)
7. Ingestion of food relieves pain.
8. Vomiting :-Uncommon.
9. Hemorrhage:- Less
10.Melena-Common.
11.Perforation:-Occur
12.Malignancy :-Rare
13.Blood group :-”O”, COPD,
CIRRHOSIS

12. DIAGNOSTIC EVALUTION
1. Blood test:- A blood test can determine whether H.
Pylori bacteria are present.
2. Breathe test:-A radioactive carbon atom is used to
detect H. Pylori .
3. Stool antigen test :- This test determines whether H.
pylori are present in the feces(stool).
4. Upper gastrointestinal X-ray (upper GI X-ray):- the
test outlines the esophagus, stomach , and
duodenum.
5. Barium sallow:- In an upper GI series ,or barium
swallow , the patient drink a thick , chalky
liquid(barium) that coats the esophagus and stomach
and makes it easier to detect abnormal areas on X-
ray .
6. Endoscopy

13. MEDICAL MANAGEMENT
The type of treatment is usually determine by what casual the
peptic ulcer- H. pylori or NSAIDs. Treatment will focus on
either lowering stomach acid level so that the ulcer can heal
,or eradicating the H. pylori infection .
1. Proton-pump inhibitor:- these tablets reduce the amount of
acid the stomach produces . Proton-pump inhibitors such
as omeprazole (prilosec ) , lensoprazole (prevacid),
pantoprazole (protonix), esomeprazole(nexium) ,and
rebeprazole(aciphex) .
2. Antacids:- Antacids relieve mild heartburn or dyspepsia by
neutralizing acid in the stomach . Prescribed antacids are
aspirin , sodium bicarbonate ,and citric acid (Alka-seltzer);
alumina and magnesia(maalox); and calcium carbonate
and megnesia (Rodaids).
3. H.Pylori Infection Treatment:-Patients infected with H.Pylori
will usually have to take a proton pump inhibitor and two
different antibiotics –twice a day for seven days. The most
commonly recommended first line treatment in a
combination of a prtoton pump inhibitor and darithromycin
for two weeks.

14. 4. Non –Steroidal anti inflammatory drugs:-People whose peptic ulcer
was caused by taking NSAIDs will have to stop taking them, if
possible the doctor will prescribed an order painkiller ,such as
acetaminophen (Tylenol,Paracetamol).Individuals with another
condition that causes severe pain may have to stop taking NSAIDs
for as long as possible untill their ulcer has healed.
5. Alginates:-Alginates helps relieve indigestion caused by acid reflux
and is often found in antacids. Alginates from a foam barrier on the
surface of stomach contents ,keeping the stomach acid in the
stomach. Antacids which contains Alginates helps medication in the
stay in the stomach for longer.
6. H2-Receptor antagonists:-These medications reduce the amount of
acid in the stomach. they are swallowed as tablets. Patients taking
erythromycin or warfarin will not be able to take imetidine.
individuals who are to undergo an endoscopy will have to stop taking
H2 receptor antagonists for at least 14 before the procedure.

15. SURGICAL MANAGEMENT
1. Vagotomy:-vagotomy is performed to estimate 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.
2. 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.
3. 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.
4. Billroth1
5. Billroth11
6. Gastrectomy:- Gastrectomy is the most common treatment . In this surgery ,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 .

16. NURSING MANAGEMENT
 Nursing assessment:-
 Assess pain by obtaining a history of the onset ,duration ,and
characteristics in relation to food intake and medications.
Patients may describe pain as sharp ,burning , or gnawing,or it
may be achy and perceived as abdominal pressure.
 Assess for chronic use of certain medications(such aspirin,
steroids)
 Collects information of complains that brought client to the
hopital obtain information of diet ,use of alcohol and
tobacco , ingestion of irritating foods, previous diseases or
infection of GI tract ,emotional stress.
 Assess complete physical examination including weight ,
vital signs , signs of GI bleeding and acute abdomen.
 Ask to the patient about family history of ulcer disease
;smoking and alcohol habits ;such as nausea and vomiting
,and changes in stool colour ,levels of energy ,appetite ,and
body weight.

17. NURSING DIAGNOSIS
1. Acute pain related to gastric mucosal erosion.
2. Imbalanced nutrition ,less than body requirement related to
changes in digestive process.
3. Risk for injury related to coplications of peptic ulcer activity
such as hemorrhage and perforation .
4. Increase risk of GI bleeding and perforation of stomach
,related to gastric wall erosion .
5. Deficient fluid volume ,related to acute bleeding duodenal
ulcer.
6. Increase risk of aspiration due to vomiting , related to ulcer.
7. Anxiety related to the symptoms of disease and fear of the
unknown.
8. Ineffective therapeutic regimen management ,related to
lack of knowledge deficit regarding PUD and its treatment.
9. Increase risk of anemia due to acute or chronic GI
bleeding,related to ulcer.