H. pylori infection is the leading cause of peptic ulcer disease. Optimal treatment involves 14 days of multidrug therapy with antibiotics and acid suppressants to eradicate H. pylori and reduce risk of recurrence. Initial evaluation with endoscopy is recommended to diagnose and assess patients with alarm symptoms or those failing treatment. Lifestyle modifications like smoking cessation, limited alcohol and stress reduction also help prevent peptic ulcers.

1. GUIDE BY- MR. ARPIT NAREKAR
PRESENTED BY- Ms. PRIYANKA BIJOLIYA
M.Sc. [N.] 1ST YEAR

3. DEFINITION
Peptic ulcer is ulceration of the mucosa in , or
adjustment to an acid secreting region by acid and
pepsin .
The common sites are first part of duodenum
[commonest], stomach, lower esophagus, jejunum and
Meckler's diverti-culum.

4. PEPETIC ULCER

5. Etiology
 Mental stress
 Anxiety
 Excessive consumption of tea,
 Smoking
 Un-common causes of ulcer disease
 Up to 10% of ulcers are idiopathic.
 Peptic ulcer disease occurs with the greatest frequency in
people between 40 and 60 years of age.

6. PATHOPHYSIOLOGY
NORMAL GASTRIC
MUCOSA
ACQUISITION OF
HELICOBACTER PYLORI
ACUTE GASTRIC
ASYMPTOMATIC AND
SYMPTOMATIC ACQUISITION
CHRONIC ACTIVE GASTRIC
ANTRAL-
PREDOMINANT
GASTRITIS
CORPUS PREDOMINANT
GASTRITIS WITH
MULTIFOCAL ATROPHY
DUODENAL ULCER MALT LYMPHOMA GASTRIC ULCER GASTRIC ULCER
V

7. CLINICAL FEATURES
 Abdominal pain,
 Sharp burning,
 Periodic [ Hunger pain]
 Associated nausea and vomiting,
 Passing excessive amounts of gas.
 Loss of appetite,
 Heartburn,
 Intolerance to fatty foods,
 Feeling of fullness, bloating or belching

8. CLINICAL MANIFESTATION
SMOKING,
ALCOHOLILIS ,
NASID, ASPRIN , AND
ANTICOGULANT
PHYSIOLOGICA
L STRESS
FAMILY
HISTORY
IMPROPER FOOD
HABITS , INTAKE
OF FOOD EXCESS
GASTRIC
STIMULANTS
REDUCED
MUCOSAL
BLOOD SUPPLY
INCRESED PRODUCTION OF GESTRIC ACID ,
PEPSIN
AND
INFLAMMATION, ERISON OF GASTRIC
MUCOSA
EXCESS ACID LOAD AND THINNING OF
MUCOSAL BARRIER PROTECTION
H. PYLORI
INFECTTION
EPIGASTRIC PAIN,
DYSPEPSIA
HEMATEMESIS
PYROSIS
VOMITING
DIARRHEA CONSTIPATION
ULCER
FPRMATION

9. INVESTIGATION OF PEPTIC ULCER
 Barium meal study:- It is useful to detect gastric as
duodenal ulcer [in 90% cases].
 Endoscopy:- The upper GI endoscopy is the method
of choice for diagnosing peptic ulcer . Define the size
and site of ulcer.
 Test For H.pylori:- It can be identified in gastric biopsy.

10. BLEEDING PERFORATION

11. MEDICAL MANAGMENT
 General measure; patient to advise not to the smoke or
consume, alcohol, restrict, intake to tea, coffee, and to have
adequate physical and mental stress.
 Treatment:-
Recently, routine eradication of H. pyloric has been
recommended in the treatment.
 Neutralization and Inhibition of acid secretion:-
1. Antacid:- Promote the ulcer healing.
2. H2-Receptors:- Proton pump inhibitors but are
useful for short term relief of acid dyspeptic symptoms.

12. CONTINEU……………………………
 Antibiotic medications to kill H. pylori. ...
 Medications that block acid production and promote
healing. ...
 Medications to reduce acid production. ...
 Antacids that neutralize stomach acid. ...
 Medications that protect the lining of your stomach
and small intestine.

13. NURSING MANAGEMENT
 Nursing Assessment
 Nursing Diagnosis
 Nursing Care Planning & Goals
 Nursing Interventions
 Evaluation

14. NURSING ASSESSMENT
 Assessment for a description of pain.
 Assessment of relief measures to relieve the pain.
 Assessment of the characteristics of the vomiting.
 Assessment of the patient’s usual food intake and food
habits.

15. NURSING DIAGNOSIS
 Acute pain related to the effect of gastric acid
secretion on damaged tissue.
 Anxiety related to an acute illness.
 Imbalanced nutrition related to changes in the diet.
 Deficient knowledge about prevention of symptoms
and management of the condition.

16. NURSING CARE PLANNING & GOAL
 Relief of pain.
 Reduced anxiety.
 Maintenance of nutritional requirements.
 Knowledge about the management and prevention of
ulcer recurrence.
 Absence of complications.

17. NURSING INTERVENTION
1. Relieving Pain and Improving Nutrition
 Administer prescribed medications.
 Avoid aspirin, which is an anticoagulant, and foods
and beverages that contain acid-enhancing caffeine (colas,
tea, coffee, chocolate), along with decaffeinated coffee.
 Encourage patient to eat regularly spaced meals in a relaxed
atmosphere; obtain regular weights and encourage dietary
modifications.
 Encourage relaxation techniques.
2. Reducing Anxiety
 Assess what patient wants to know about the disease,
and evaluate level of anxiety; encourage patient to
express fears openly and without criticism.
 Explain diagnostic tests

18. EVALUATION
 Relief of pain.
 Reduced anxiety.
 Maintained nutritional requirements.
 Knowledge about the management and prevention
of ulcer recurrence.
 Absence of complications.

19. MODIFICATION OF MANAGMENT
 Life style modification
 Hypo secretory drug therapy
 H. pylori eradication therapy
 Surgery

20. LIFE STYLE MODIFICATION
DISCONTINEU NSAIDs
SMOKING CESSATION
ALCOHOL CESSATION
STRESS REDUCTION

21. H.PYLORI ERADICATION THERAPY

22. TYPES OF SURGERY
 ANTRECTOMY/SUBTOTAL GASTRECTOMY-
Lower half of stomach make most of the acid.
Removing this portion decreases acid production.
 SUBTOTAL GASTRECTOMY –
Removes ½ - 2/3 of stomach

23. TREATMENT/PROCEDURE OF
SURGERY
• CREATES A PASSAGE BETWEEN THE
BODY OF STOMACH TO ALL INTESTINE.
• ALLOWS REGURGITATION OF ALKALINE
DUODENAL CONTENTS INTO THE
STOMACH.
• KEEP ACID AWAY FROM ULCERATED
AREA
GASTROSTOMY

24. PYLOROPLASTY

25. ANTRECTOMY

26. VAGOTOMY
CUT VAGUS
NERVE
ELIMINATES
ACID
SECRETION
STIMULUS

27. RELATED RESEARCH STUDY
 There are several types of peptic ulcer disease but
principle types of peptic ulcer disease are duodenal
ulcer and gastric ulcer.
 The duodenal ulcer is more common and it affects
both male and female but men are more prone to
develop peptic ulcer disease.

28. SUMMARY
 H. PYLORI is the most common cause of peptic ulcer disease and is a risk factor for
gastric cancer.
 H. PYLORI eradication reduces risk of disease
recurrence.
 Initial evaluation with endoscopy is recommended for those with alarm symptoms or
those failing treatment
 Optimum treatment regimens are 14d multidrug with antibiotics and acid suppressants
[Triple therapy]

29. REFERENCES
 BOOK NAME/MEDICAL SURGICAL NURSING / VOLUME-2ND /EDITION-12TH
/PUBLICER- BURNNER & SUDDHARTH’S/PAGE NO.-1047-1055.
 BOOK NAME/MEDICAL SURGICAL NURSING /VOLUME-1ST /EDITION-13TH /
PUBLICER-BRUNNER & SIDDHARTH’S/WRITTER-HINKLE CHEEVER/ PAGE NO.-
1212,1265-1268,1265.
 BOOK NAME/MEDICAL SURGICAL NURSING /VOLUME-1ST/ PUBLICER-
BRUNNER & SIDDHARTH’S/WRITTER-SURESH K. SHARMA & S. MADHAVI/ PAGE
NO.-871-878.