PEPTIC ULCER IN ENGLISH

                                                       

                                                PEPTIC  ULCER IN ENGLISH

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PEPTIC ULCER-

Ø  A peptic ulcer is an mucosal erosion in esophagus, stomach or duodenum. Peptic ulcer may be classified as a gastric, duodenal, or esophageal ulcer, depending on its location.

Ø  Peptic ulcers are more likely to occur in the duodenum than in the stomach

Ø  Gastric ulcers tend to occur in the lesser curvature of the stomach, near the pylorus.

Ø  Erosion starts in circumscribed area of mucous membrane. This erosion may extend as deeply as the muscle layers or through the muscle to the peritoneum.

CAUSES-

Ø  Causes of peptic ulcers may include-

Ø  Esophageal ulcers occur as a result of the backward flow of HCl from the stomach into the esophagus (gastro-esophageal reflux disease [GERD]). This HCL destroys mucosa of esophagus.

Ø  peptic ulcers may result from infection with the gram-negative bacteria Helicobacter pylori, which may be acquired through ingestion of food and water.

Ø  Person-to-person transmission of the bacteria also occurs through close contact and exposure to emesis.

Ø  excessive secretion of HCl in the stomach may contribute to the formation of peptic ulcers, and stress may be associated with its increased secretion.

Ø  The ingestion of milk and caffeinated beverages, smoking, and alcohol may also increase HCl secretion

Ø  Familial tendency also may be a significant predisposing factor. Other predisposing factors associated with peptic ulcer include chronic use of NSAIDs, alcohol ingestion, and excessive smoking.

Ø  Stress and eating spicy foods may make peptic ulcers worse and affect healing of ulcers.

CLINICAL MANIFESTATIONS-

Clinical manifestations of peptic ulcers include -

Ø  The patient with an ulcer complains of dull, gnawing pain (hunger pain) or a burning sensation in the mid-epigastrium or the back.

Ø  Pain is usually relieved by eating, because food neutralizes the acid, or by taking alkali; however, once the stomach has emptied or the alkali’s effect has decreased, the pain returns.

Ø  tenderness by applying gentle pressure to the epigastrium at or slightly to the right of the midline.

Ø  Other symptoms include pyrosis (heartburn), vomiting, constipation or diarrhea, and bleeding from ulcer.

DIAGNOSTIC INVESTIGATIONS-

Ø  History and Physical examination. (presence of clinical manifestations of peptic ulcer)

Ø  Barium meal examination.

Ø  Stool examination for occult blood.

Ø  Endoscopy .

Ø  Endoscopic biopsy.

TREATMENT-

Ø  The goals Treatment  are to eradicate H. pylori and to manage gastric acidity. Methods used include-

Ø  Medications,

Ø  Lifestyle changes, and

Ø  Surgical intervention.

Ø  Medications includes antibiotics to eradicate H. pylori such as metronidazole, amoxicillin, clarithromycin and Histamine-2 (H2) receptor antagonists and proton pump inhibitors are used to treat NSAID-induced ulcers and other ulcers not associated with H. pylori infection. (lansoprazole, omeprazole, or rabeprazole )

Ø  Lifestyle changes includes stress reduction and rest. It also includes avoiding of smoking and less spicy diet.

            Surgical interventions  include vagotomy, with or without pyloroplasty, and antrectomy, which is removal of the pyloric (antrum) portion of the stomach with anastomosis  to either   duodenum or jejunum

NURSING  MANAGEMENT-

Ø  Proper assessment is done by health history and physical examination and nursing care plan is prepared.

Ø  Nutritional history is very important in the assessment of ulcer patients.

Ø  Patient is encouraged to discuss the problem and ask doubts and concerns.

Ø  The nurse assesses the patient’s vital signs and reports tachycardia and hypotension, which may indicate anemia from GI bleeding.

Ø  Prescribed medicines are given on time to reduce pain and increase comfort.

Ø  The patient is advised to avoid aspirin, foods and beverages that contain caffeine, and decaffeinated coffee.

Ø  The nurse assesses the patient’s level of anxiety. Patients with peptic ulcers are usually anxious. Appropriate information is provided at the patient’s level of understanding to reduce anxiety level.

Ø  The nurse interacts with the patient in a relaxed manner, helps identify stressors, and explains various coping techniques and relaxation methods.

Ø  The nurse assesses the patient for malnutrition and weight loss. After recovery from an acute phase of peptic ulcer disease, the patient is advised about intake of proper diet and adequate nutrition.

Ø   The patient is monitored for signs of internal hemorrhage from ulcer such as faintness or dizziness and nausea.

Ø  During surgery and postoperatively, the stomach contents are drained by means of an NG tube.

Ø  The nurse monitors fluid and electrolyte balance and assesses the patient for localized infection or peritonitis

Ø  IV fluids are given as prescribed to maintain fluid and electrolyte balance postoperatively.

Ø  Patient is also monitored for Signs and symptoms of perforation such as Sudden, severe upper abdominal pain, vomiting, collapse (fainting), extremely tender and rigid (board like) abdomen.

Ø   If perforation occurs, it is an emergency and physician should be informed immediately and IV fluid may be started as prescribed to prevent shock.

Ø  Intake output is monitored and I/O chart is maintained.

Ø  Health education is provided to prevent recurring of peptic ulcer during discharge planning such as avoiding acid producing food material and avoiding alcohol and smoking.

Ø  Patient is advised to take medicines as prescribed and return for follow up if symptoms re appear.