Peptic Ulcer - ulceration in the mucosa of the lower oesophagus, stomach, duodenum
cause
mucosal cytoprotection is deficient
excessive acid secretion & autodigestion occurs
multifactorial: inflammation, acid secretion abnormality, mucosal barrier efffect
clinical manifestation
epigastric pain
weight loss
haemorrhage
perforation
tenderness
Indication: sudden, intense midepigastricnpain radiating to the right shoulders
hematemesis/ melaena
anaemia, dizziness, syncope
occurs in duodenal ulcer
s/s if acute symptoms of acute abdomen with sudden onset of severe, localised epigastric pain
peritonitis develops when pain become generalised right abdomen with decrease bowel sounds and shock
diagnostic studies
Lab test
imaging studies
test for H. pylori
C-urea breath test
serum ELISA
pyloritek
abdominal X-ray
barium study
oseophagogastroduodenoscopy (OCD)
fluoroscopic & x-ray examination : barium swallow
indication
nursing care
low residue diet 2-3 days prior to the test
NPO for 8 hrs
withhold medication for 8 Hours unless otherwise indicated
bring V-ray films
nursing assessment
pain assessment
visceral pain - caused by stretching/inflammation of a hollow muscular organ
somatic pain - arises from the parietal peritoneum
focused history
diet & nutrition
medication
aspirin
NSAIDs
steroids
bowl history
psychosocial exam & abdominal assessment
vital signs
premorbid status
medication
antacids
H2RA
PPI
pepsin inhibitor
magnesium hydroxide - triact
famotidine - pepcidine
pantoprazole (pantoloc)
sucralfate - carafate
side effect: GI disturbances -
constipation, diarrhoea, rebound hyperacidity
indication : short term relief of heartburn
therapeutic actions: neutralize gastric acids, increase stomach PH
therapeutic actions: inhibits stimulation of gastric parietal cells at H2 receptor sites, decrease gastric acid secretion, promote healing of acid-sensitive ulcer
indication: S/S unresponsive to antacid
side effect:
- CNS: confusion;
- GI: nausea, diarrhea, abdominal pain
therapeutic actions: reduce gastric secretion
indication: severe erosive GERD, not responsive to H2RA
side effect: overproduction of gastrin
CNS: headache, dizziness, fatigue
GI: nausea, diarrhea, abdominal pain
antiemetics - treat underlying cause of nausea, vomiting
prochlorperazine (stemetil)
nursing intervention
avoid fluid volume deficit
achieving pain relief
achieving adequate nutrition
client education on treatment regimen
surgery
indication
haemorrhage
obstruction
oerforation
acid reduction
severe ulcers / difficulty with medical regimen compliance
vagotomy
pyloroplasty & vagotomy
antrectomy & vagotomy
subtotal gastrectomy
gastroduodenostomy
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