peptic ulcer or gastric ulcer is a important disease condition , as a nurses daily we are dealing with cases many more..this ppt helps you to know about peptic ulcer meaning, types of ulcer, medical management,nursing management responsibilities

1. PEPTIC ULCER DISEASE ( PUD),
MEANING, CASUSES,MANAGEMENT
AND NURSING RESPONSIBILITIES……..
PREPARED BY
MURUGESH H J RN
KFCH HOSPITAL JIZAN
SAUDI ARABIA..

2. GASTROINTESTINAL SYSTEM……
GASTROINTESTINALSYSTEM–
 The gastrointestinal tract is the tract or passageway of the digestive system that leads
from the mouth to the anus. The GI tract contains all the major organs of the digestive
system including the esophagus, stomach, and intestines.
 ULCERS-a break in skin or mucous membrane with loss of surface tissue,
disintegration and necrosis of epithelial tissue, and often pus.
 3 Common Types of Ulcers- based on location
• Peptic Ulcer. Peptic ulcers are ulcers that develop in the stomach lining or small
intestine. ...
• Duodenal Ulcer. Duodenal ulcers are a type of peptic ulcer that form in the upper small
intestine. ...
• Esophageal Ulcer. That develop over the esophagus, at the junction of lower intestine
& antrum of stomach mainly due to back flow of Hcl ..

3. PEPTIC ULCER OR GASTRIC ULCER OR GI ULCER OR
STOMACH ULCER……..
 Peptic ulcer disease (PUD) is a common gastrointestinal tract disease characterized by mucosal
damage secondary to pepsin and gastric acid secretion( Hcl)….
 Pathophysiology
Caused mainly because of helicobacter pylori infection & secondarly over seceretion of Hcl..
EROSION H.PYLORI INFECTION , OVERS SECRETION OF HCL & DECREASED MUCOSAL RESISTANCE DAMAGE DAMAGED MUCOSA CAN NOT SECRETE ENOUGH MUCUS
BARRIER AGAINST Hcl ACID SECRETION more acid secretion further damages the mucosal thickness DECREASED RESISTACE –damage to the gi mucosa results in decreased
resistance to bacteria , further may worsens the stomch mucosa

4. WHOIS MOSTLY GOING TO GET & MOST COMMON
CAUSES…
 Who is most likely to get peptic ulcers?
 Peptic ulcer can occur at any age. Duodenal ulcers usually appear between ages 30 and 50
and are more common in men than women. Stomach ulcers tend to occur later in
life, after age 60, and affect women more often than men.
CAUSES FOR PEPTIC ULCER :
 The most common causes of peptic ulcers are infection with the bacterium Helicobacter
pylori (H. pylori) ….
 long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
(Advil, Motrin IB, others) and naproxen sodium (Aleve)…..
 Other causes like ---- ***over Hcl secretion , ***Irritants – ingestion of milk, caffeinated
beverage's & alcohol also increases Hcl secretion ***blood type A blood group people have
tendency to get peptic ulcer *** stress or work related pressure *** chronic smoking *** food
intake & food habits

5. Clinical manifestations…….
**** pain – as a rule , the patient with an ulcer complaints of dull, gnawing pain or a
burning sensation in the medepigastrium or the back that is relieved by eating
**** pyrosis( heart burn )- is a burning sensation in the stomach & esophagus
that moves up to the mouth
**** vomiting – vomiting results from obstruction of the pyloric orifice caused by
either muscular spasm of pylorous or mechanical obstruction from scarring ..
****constipation & diarrhea –as a results of diet & medications
****Bleeding – 15% of patients may present with GI bleeding is evidenced by the
passage of melena ( tarry stools)

6. COMPLICATIONS…
 Common complications are …..
1.Hemorrhage –either haematemesis or malena ( 15-20% of cases)
2. perporation & and penentration – it is an serious complication in which stomach
contents will fully erode , gastric contents will come out ..may damage the lungs or
other vital organs…
3.Pyloric obstruction –pyloric sphincter will become less functionative , stomach
contents getting obstructed & causes secondary diseases..
4. Infections

7. DIAGNOSIS…..
***ESOPOHAGO-GASTRO-DUODENOSCOPY……
*** PHYSICAL EXAMINATION –A physical examinatoion ,may reveal pain,
epigastric tenderness or abdominal distension …
***BARIUM STUDY
***ENDOSCOPY
***STOOL OCCULT BLOOD
***CARBON 13 (13 DEGREE CENTIGRADE) UREA BRAETH TEST – Reflects
activity of H.pylori

8. MANAGEMENT ….
Medical management
>. Pharmacology –
Most commonly used therapy for peptic ulcer is a combination of Antibiotics , proton
pump inhibitors eg: omeprazole,pantaprazole,Rabeprazole etc…. and bismuth salts
that suppresses or eradicates the H.pylori infection ….
>. Stress reduction & rest….
>. Smoking cessation
>. Dietary modifications- Avoiding extremes of thetemperature of food & bevarages
like caffeinated drinks,alcohol …use diets rich in milk, creams etc., that soothens the
mucosa…..

9. MANAGEMENT …. cont.
 Surgical management
Rarely taking surgical interventions , because antibiotyics eradicates the h.pylori
infections &Proton pump inhibitors decreases the gastric acid secretion & activity …
>. Pyloroplasty – it involves trasecting the nerves that stimulates the acid secretion &
opening the pylorus…
>. Antrectomy- it is a surgical removal of the pyloric portion of the stomach with
anastomosis to either the duodenum or jejunum …

10. NURSING MANAGEMENT …
Nursing management mainly includes..
NURSINGASSESSMENT:-
***Assessment for a description of pain
*** Assessment of relief measures to relieve the pain
*** Assessment of the characterstics of the vomitus
*** Assessment of the patients usual food intake & food habits..

11. NURSING DIAGNOSIS….
Based on the assessment data, the patients nursing diagnosis may include the
following …
1. Acute pain related to effect of gastric acid secretion on damaged tissue
2. Anxiety related to an acute illness
3. Imbalanced nutrition related to changes in the diet
4. Deficient knowledge about prevention of symptoms and management of the
condition

12. NURSING INTERVENTIONS….
01.RELIEVING PAIN & IMPROVING NUTRITION
*** Administer prescribed medications
*** Avoid aspirin, which is an anticoagulant , may cause internal bleeding ..
***advice to avoid food & bevarages containing acid enhancing caffeine.
***encourage relaxation techniques
02.REDUCING ANXIETY…
***. Encourage patient to express fears openly
***explain diagnostic tests and administering drugs on schedule..
***encourage family to participate in patient care & give emotional support

13. NURSING INTERVENTIONS….
03.MONITORING AND MANAGING THE COMPLICATIONS…
If HEMORRHAGE is a concern;
**assess fopr faintness or dizziness and nausea , before or withbleeding ;
***Test stool for occult blood or gross blood
*** Monitor vital signs frequently , o 2saturation,sings of hypotension
*** insert urinary catheter maintain intake output chart
*** monitor lab reports
*** insert & maintain a nasogastric tube and monitor drainage ; provide lavage as
ordered ..

14. NURSING INTERVENTIONS….
If PERFORATIONand PENENTRATIONare concerns;
*** Note and report symptoms of penentration ( Back & epigastric pain not
relieved by medications that were effective in the past)
***Note & report symptoms of perforation ( sudden abdomen pain, referred
pain to shoulder, vomiting & collapse, extremely tender & rigid abdomen ,
hypotension & tachycardia or other signs of shock)
04. HOME MANAGEMENT & TEACHING SELF CARE ..

15. THANK YOU ALL…….