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Peptic ulcer DONE (manifestation (Duodenal ulcer (normal appetitie,…

- - - - indicate peritonits
  - - - anemia
      - dizzinss
      - syncope
      - hematemesis/ melaena
- - - - caused by stretching / inflammation of a hollow muscular organ
    - - arise @ parietal peritoneum
      - focal pain, localized, sharp & severe
  - - - eating patterns
      - food types
      - eating circumstances
    - - aspiriin
      - NSAIDS
      - Steroids
- - - - well balanced meal
      - regular meal pattern
      - avoid irritating & spicy food
  - - - hemorrhage
      - obstruction
      - perforation
      - acid reduction
      - severe ulcer
      - can't compliance with medical regimen
    - - vagotomy
        
        surgical division of vagus nerve to reduce HCL secretion
        
        types
        
        turncal vagotomy
        
        sveres anterior & postrior trunk
        
        ↓ acid secretion & gastric otility
        
        Selective vagotomy
        
        severs only branches that interrupt acid secretion
        
        parietal vagotomy
        
        only the part that innervate parietal acid-secreting cells
        
        vagotomy & pyloroplasty
        
        longitiduinal incision @ pylorus, closed travesresly to permit muscle relax
        
        enlarged outlet to enhance gastric emptying by vagotomy
        
        antrectomy & vagotomy
        
        removal of small segment duodenum, pylorus & antrum
        
        removal of gastrin secreting cell @ antrum
        
        acid-secreting cells ↓
        
        gastric phase of digestion delayed
        
        jejunum anastomse to stomach with duodenum closed
        
        subtotal gastrectomy
        
        partial resection of small cuff of duodenum, pylorus, 2/3 of stomach
        
        Billroth I (Gastrodudoenostomy
        
        removal of distal antrum, pylorus
        
        dudenum anastomose to gastric stump
        
        less dumping syndrome
        
        Billroth II (Gastrojejunostomy)
        
        removal of antrum, pylorus
        
        jejunum anastomse to gastric stump
        
        pancreatic & bile preserved
    - - hemorrhage
      - perforation
      - gastric outlet obstruction
      - refer to ca stomach
  - - - prep for Surgery to stop bleeding
      - saline lavage as prescribed
      - IVF, Blood transfusion
      - strict I/O
      - note for emesis
      - note for bloody stool
      - monitor for hb, hematocrit, electrolytes
      - monitor for Shock s/s,, ↑P,, ↓BP
    - - adminsitered prescription
      - small & frequent meal to prevent gastric distension
      - educate irritating effect of certain drugs
    - - small, frequent meal
      - avoid food that cause ditress
      - provide high-calorie, high protein diet
      - nutritional supplement as ordered
      - administer IVF
      - min 1500 ml of fluid intake
    - - provide pamphlets
      - review recommendation of diet, acitivities, meds
      - explain procedures to minize anxiety
      - education of exercise
      - cessation of smoking, alcohol
      - sress reduction strategies
      - educate pt s/s of bleeding and to notify HCW
- - - - upper Gi examination
      - barium swallow, barium meal
      - gastrografin
        
        water soluble contrast
      - specific care
        
        preperation
        
        no smoking
        
        NPO 8 hrs
        
        whithold medication for 8 hrs unless indicated
        
        administer laxatives night before invesitgation
        
        bring old x ray films
        
        inform of chalk-flavor liquid, no significant discomfort
        
        low residue diet 2-3 days
        
        post
        
        barium cause fecal impaction
        
        educate pt stool color will be light in next several days
        
        drink more water
        
        notify HCW if no bowel movement in 2-3 days
    - - tissue biopsy & cytology
    - - to detect the 3 forms of pepetic ulcer
      - detect eso varices / strictures
      - detect pyloric stenosis
      - detect volvulus of stomach
      - detect polyps, tumor hiatal hernia
      - detect foreign bodies
    - - no jewlery
      - gown up
- - - - Aspirin, most common cause of ulcer
      - prolong high dose of corticosteroid
      - NSAID
    - - ciagarettes
      - stress