Peptic Ulcer

PEPTIC
ULCER
DISEASE
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Subjective Data
 Pain—”gnawing”, “aching”, or “burning”
 Duodenal ulcers: occurs 1-3 hours after a meal and may awaken patient from sleep.
Pain is relieved by food, antacids, or vomiting.
 Gastric ulcers: food may exacerbate the pain while vomiting relieves it.
 Nausea, vomiting, belching, dyspepsia, bloating, chest discomfort, anorexia,
hematemesis, &/or melena may also occur.
 nausea, vomiting, & weight loss more common with Gastric ulcers
Objective Data
 Epigastric tenderness
 Guaic-positive stool resulting from occult blood loss
Diagnostic Plan
 Stool for fecal occult blood
 Labs: CBC (R/O bleeding), liver function test, amylase, and
lipase.
 H. Pylori can be diagnosed by urea breath test, blood test,
stool antigen assays, & rapid urease test on a biopsy sample.
 Upper GI Endoscopy: Any pt >50 yo with new onset of
symptoms or those with alarm markings including anemia,
weight loss, or GI bleeding.
 Preferred diagnostic test b/c its highly sensitive for dx of ulcers and
allows for biopsy to rule out malignancy and rapid urease tests for
testing for H. Pylori.
ENDOSCOPY
RESULT
 confirmed an active duodenal

ulcer and samples were
positive
 for Helicobacter pylori.
GASTRIC ULCER DUODENAL ULCER

Case 81 Medical 6
GAPASIN, Ma. Chealzea C.
LABORATORY
CBC WITH DIFFERENTIAL
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NURSING
DIAGNOSES
• Pain R/T Increased Secretion of Gastric Acidon damaged tissue
• Fluid Volume Deficit R/T Gastrointestinal Bleeding
• Altered Nutrition: Less Than Body Requirements R/T Nausea, Vomiting or Pain or more
than body requirements R/T……..
• Knowledge Deficit R/T Management and Treatment of Peptic Ulcer Disease
8
DUODENAL
ULCER
• duodenal sites are 4x as
common as gastric sites
• most common in middle age
• peak 30-50 years
•
Male to female ratio—4:1
• more common in patients with
blood group O
• associated with increased
serum pepsinogen/
hydrochloric acid 9
Case 81 Medical
CAUSES
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COMPLICATIONS
MM.DD.20XX 11
ADD A FOOTER
TREATMENT
PEPTIC ULCER
AND
IRON DEFICIENCY
13
Case 81 Medical
ANTACIDS: group of inorganic chemicals that neutralize
MEDICATION
stomach acid (AlOH, MgOH)-USUALLY AFTER MEALS
HISTAMINE-2 (H2) ANTAGONIST: drug that blocks the H2
receptor sites; used to decrease acid production in the stomach.
Block the release of hydrochloric acid in response to gastrin.
These drugs include cimetidine (Tagamet), ranitidine (Zantac),
famotidine (Pepcid), and nizatidine (Axid).-WITH FOOD
PROTON PUMP INHIBITOR: drug that blocks the secretory
surface of the gastric parietal cells, thus interfering with the
final step of acid production and lowering acid levels in the
stomach. These drugs suppress the secretion of hydrochloric
acid into the lumen of the stomach-BEFORE MEALS
GOAL: COMPLETE ELIMINATION OF H. PYLORI. ONCE ACHIEVED REINFECTION RATES ARE
LOW. COMPLIANCE!
Omeprazole Lansoprazole Amoxicillin Clarithromycin Iron

The iron deficiency
The H. pylori The H. pylori The H. pylori was treated by antibiotics
was corrected by
was treated by a specifially , amoxicillin and
was also treated clarithromycin for 7 days. additional oral iron
combined
regime of by a triple which was continued
for 3 months to
omeprazole for therapy of replenish the iron
6 weeks lansoprazole stores in the bone
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Case 81 Medical for 7 days marrow.
CAUSES
15
Lifestyle Changes
 Discontinue NSAIDs and use Acetaminophen for pain control if possible.
 Acid suppression--Antacids
 Smoking cessation
 No dietary restrictions unless certain foods are associated with problems.
 Alcohol in moderation
 Men under 65: 2 drinks/day
 Men over 65 and all women: 1 drink/day
 Stress reduction
Evaluation/Follow-up/Referrals
 H. Pylori Positive: retesting for tx efficacy
 Urea breath test—no sooner than 4 weeks after therapy to avoid false negative results
 Stool antigen test—an 8 week interval must be allowed after therapy.
 H. Pylori Negative: evaluate symptoms after one month. Patients who are
controlled should cont. 2-4 more weeks.
 Repeat endoscopy to show healing confirms the original diagnosis of benign
ulceration.
 If symptoms persist then refer to specialist for additional diagnostic testing.
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THANK
YOU!
Phone: Email: Name:

09213349984 machealzeagapasin09@gmail.com Ma. Chealzea C. Gapasin
19

Peptic Ulcer

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Peptic Ulcer

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PEPTIC

 confirmed an active duodenal

GASTRIC ULCER DUODENAL ULCER

CBC WITH DIFFERENTIAL

Omeprazole Lansoprazole Amoxicillin Clarithromycin Iron

Phone: Email: Name:

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