peptic ulcer disease nrs452 norhaini majid. introduction pud,a break in a mucous lining of gi tract...
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PEPTIC ULCER PEPTIC ULCER DISEASEDISEASE
PEPTIC ULCER PEPTIC ULCER DISEASEDISEASE
NRS452NRS452Norhaini MajidNorhaini Majid
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Introduction• PUD ,a break in a mucous lining of
GI tract• Duodenal - most common, age 30
-55• Gastric Ulcer – affect older age 55
- 70
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Risk Factors• H.pylori infection – how?• Use of NSAIDs• Cigarette smoking• Family history of PUD• Other possible risks – physiological
stress, alcohol /caffeine consumption
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Pathophysiology• Normal gastric mucosa• Disruption of mucosal barrier• Inflammatory process• Erosion and ulcer formation
» Refer page 682-683, Med/Surg Nsg
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Manifestation of PUD
• Classic symptom?• Typically described as …….• Occurs
– Stomach– 3 – 4 hours after meal– midnight
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Manifestation of PUD (cont…)
• Heartburn• VomitOlder adult• Chest pain• Dysphagia• Weight loss• Anemia
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Manifestation of PUD complications
• Hemorrhage
• Obstruction
• Perforation
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Hemorrhage• Occult blood in stool• Hematemesis• Fatigue• Weakness, dizziness• Orthostatic hypotension• Hypovolemic shock
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Obstruction• Sensations of epigastric fullness• Nausea & vomiting• Electrolyte imbalances• Metabolic alkalosis
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Perforation • Severe upper abdominal pain – shoulder• Rigid, boardlike abdomen• Absence of bowel sounds• Diaphoresis• Tachycardia• Rapid, shallow respiration• Fever
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Zollinger-Ellison Syndrome
• PUD cause by gastrinoma or gastrin-secreting tumor (pancreas, stomach, or intestine
• Gastrin ?• Affect stomach, duodenum,
esophagus and jejunum
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Zollinger-Ellison Syndrome
Characteristic• Ulcer-like pain
• Diarrhea
• Steatorrhea
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Zollinger-Ellison Syndrome
Complication
• Perforation• Bleeding • Fluid & electrolyte imbalances
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Diagnostic Tests• Barium Swallow• Gastroscopy• Biopsy• Serologic test• Urea breath testZollinger-Ellison Syndrome• Gastric Analysis
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Medications• Combination therapy
• Two antibiotics + proton pump inhibitors (e.g omeperazole, metronidazole and clarithromycin)
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Treatments• Dietary mx• Surgery• Rx of complications
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Treatment of Peptic Ulcer Disease
Goals of Treatment
•Relieve pain •Prevent complications (bleeding, perforation, penetration, obstruction) •Minimize recurrences •Reduce financial costs
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Nursing Care?
• Student Activity– Identify nursing problem and solve it
using nursing process approach – Discuss