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Peptic ulcer (ulcerations of mucosa of lower oesophagus, stomach, or…

- - - - C-urea breath test (sensitivity 92-94%)
      - ELISA
      - pyloritek: a biopsy urea test (95%)
  - - - fluoroscopic & X-ray exam.
        
        barium swallow, barium meal, gastrografin (water-soluble contrast)
        
        indication
        
        detect oesophageal, gastric or duodenal ulcers
        
        identify pyloric stenosis/ volvulus of stomach
        
        identify polyps, tumour and hiatal hernia
      - nursing care
        
        Pre-investigation
        
        stop smoking
        
        withhold medication for 8 hours (narcotics & anticholinergic drugs)
        
        give laxatives: dulcolax suppository
        
        inform pt that chalk-flavoured liquid will be swallowed but no significant discomfort
        
        low residue diet 2-3 days before test; NPO for 8 hours
        
        Post-investigation
        
        barium -> cause fecal impaction, alert client that stool will turn light in colour in next few days
        
        if no bowel movement : may need laxatives
        
        drink plenty of water
  - - - pain assessment (determine location, characteristic, radiation of pain, intensity & duration)- OLDCARTS
      - Visceral pain: caused by stretching on inflammation of a hollow muscular organ (e.g. gut, gallbaldder)
      - Somatic pain: from parietal peritoneum, focal pain, localized, sharp & severe
    - - diet & nutrition
        
        eating pattern, type of food, regularity
      - medication
        
        any aspirin, NSAIDs, steroids
      - Premorbid status: pervious GI bleed
      - lifestyle: stressful? bowel history
      - physical exam. -> +ve abdominal findings
      - Vital signs: BP/P lying & standing -> presence of orthostatic/ postural hypotension due to bleeding
- - - - aims to neutralize gastric acid & increase the pH of stomach
      - a short-term relief of heartburn
      - side-effects: constipation, diarrhoea, rebound hyperacidity
    - - inhibit stimulation of gastric parietal cells -> prevent over secretion of acid, promote healing of acid-sensitive ulcer
      - for pt unresponsive to antacids
      - side effects: confusion, nausea, diarrhoea, abdominal pain
    - - Pantoprazole (Pantoloc); Omeprazole (Prilosec)
      - reduce gastric secretions; for severe erosive GERD, or pt unresponsive for H2 receptor antagonist therapy
      - long tern: overproduction of gastrin (may cause tumour), headache, diarrhoea
    - - Scralfate
    - - Prochlorperazine(Stemetil)
      - Metoclopramide (Maxolon)
  - - - haemorrhage
      - obstruction
      - perforation
      - acid reduction
    - - Truncal vagotomy -> sever 切斷 anterior & posterior trunk
      - selective vagotomy-> only branches
      - parietal vagotomy ->sever only part of vagus
    - - ongitudinal incision is made into the pylorus -> closed transversely to permit the muscle to relax; an enlarged outlet is established to enhance gastric emptying that reduced by vagotomy
    - - small segment of duodenum, pylorus & antrum (ard half of the stomach) is resected
      - anti-secreting portions of stomach is reduced
    - - Gastroduodenostomy (Billrote I)
        
        remove distal antrum & pylorus
        
        duodenum is anastomosed (接合）to the gastric stump
        
        dumping syndrome reduced
      - Gastrojejunostomy (Billroth II)
        
        remove antrum & pylorus
        
        jejunum is anastomosed to the gastric stump
        
        pancreatic & bile secretion preserved
    - - Haemorrhage; perforation, gastric outlet obstructions
  - - - NG Tube
        
        drainage for signs of visible and occult blood
        
        med may administer thru NG tuble
      - monitor I & O, haemoglobin, electrolytes
      - alert for early s/s of shock (BP drop; pulse increase)
    - - med? (need advise pt for irritating effect of certain drug/ food)
      - if not NPO -> provide smell & frequent meals
    - - small, frequent meals -> neutralize gastric secretions
      - high-calorie, high-protein
      - may need parenteral nutrition
    - - explain test/ procedures to gain cooperation, minimize anxiety
      - provide a list to explain medication, dosage....
      - promote healthy lifestyle change
      - allow chance & time for question
      - teach pt s/s of bleeding