ASSIGNMENT
ON
PEPTIC ULCER
SUBMITTED TO: SUBMITTED BY:
Mrs. Madhvi Khushbu Arya
Reader [Link]. (N) 1st year
College of nursing College of nursing
Institute of Liver and Institute of Liver and
Biliary Sciences Biliary Sciences
PEPTIC ULCER DISEASE
Peptic ulcer disease refers to ulcerations in the mucosa of the lower esophagus, stomach, or
duodenum
Pathophysiology and Etiology
1. Etiology of peptic ulcer disease is multifactorial.
a. H. pylori infection—present in most patients with peptic ulcer disease.
b. NSAID-induced injury—presents as a chemical gastropathy.
c. Acid secretory abnormalities (especially in duodenal ulcers).
d. Zollinger-Ellison syndrome (hypersecretory syndrome) should be considered in
refractory ulcers.
2. Risk factors may include drugs (NSAIDs, prolonged highdose corticosteroids), family
history, Zollinger-Ellison syndrome, cigarettes, stress, O blood type, and lower
socioeconomic status.
3. Studies are inconclusive in determining an association between ulcer formation and diet or
the intake of alcohol and caffeine.
Clinical Manifestations
1. Gnawing or burning epigastric pain occurring 1½ to 3 hours after a meal.
2. Nocturnal epigastric, abdominal pain or burning; may awaken patient at night, usually
around midnight to 3 am.
3. Epigastric tenderness on examination.
4. Early satiety, anorexia, weight loss, heartburn, belching (may indicate reflux disease).
5. Dizziness, syncope, hematemesis, or melena (may indicate hemorrhage).
6. Anemia.
Diagnostic Evaluation
1. Upper GI endoscopy with possible tissue biopsy and cytology.
a. PyloriTek, a biopsy urea test, is up to >97% specific and >96% sensitive for
detection of H. pylori.
b. Point of service test with results within 1 hour
2. Upper GI radiographic examination (barium study).
3. Serial stool specimens to detect occult blood.
4. Gastric secretory studies (gastric acid secretion test and serum gastric level test)—elevated
in Zollinger-Ellison syndrome.
5. Serology to test for H. pylori antibodies or stool test to assess for H. pylori antigen.
6. C-urea breath test to detect H. pylori
Management
General Measures
1. Eliminate use of NSAIDs or other causative drugs.
2. Eliminate cigarette smoking (impairs healing).
3. Well-balanced diet with meals at regular intervals. Avoid dietary irritants.
Drug Therapy
Multiple drug regimens are used to treat H. pylori, usually involving triple therapy with two
antibiotics and a proton-pump inhibitor for 10 to 14 days to eradicate the bacteria.
Surgery
1. Surgical interventions may be indicated for hemorrhage, obstruction, perforation, and acid
reduction. Surgery may also be indicated with ulcer disease of long duration or severity or
difficulty with medical regimen compliance.
2. Gastroduodenostomy (Billroth I).
a. Partial gastrectomy with removal of antrum and pylorus of stomach.
b. The gastric stump is anastomosed with the duodenum.
3. Gastrojejunostomy (Billroth II).
a. Partial gastrectomy with removal of antrum and pylorus of stomach.
b. The gastric stump is anastomosed with the jejunum.
4. Antrectomy.
a. Gastric resection includes a small cuff of duodenum, the pylorus, and the antrum (lower
half of stomach).
b. The duodenal stump is closed and the jejunum is anastomosed to the stomach.
5. Total gastrectomy.
a. Also called an esophagojejunostomy.
b. Removal of the stomach with attachment of the esophagus to the jejunum or duodenum.
6. Pyloroplasty.
a. A longitudinal incision is made in the pylorus, and it is closed transversely to permit the
muscle to relax and to establish an enlarged outlet.
b. Often, a vagotomy is performed at the same time.
7. Vagotomy.
a. The surgical division of the vagus nerve to eliminate the impulses that stimulate HCL
secretion.
b. There are three types: selective vagotomy, which severs only the branches that interrupt
acid secretion; truncal vagotomy, which severs the anterior and posterior trunks to decrease
acid secretion and gastric motility; and parietal vagotomy, which severs only the part of
vagus that innervates the parietal acid-secreting cells.
c. Traditionally performed by laparotomy, the vagotomy procedure can also be done using a
laparoscope.
Complications
1. GI hemorrhage.
2. Ulcer perforation.
3. Gastric outlet obstruction.
Nursing Assessment
1. Determine location, character, radiation of pain, factors aggravating or relieving pain, how
long it lasts, when it occurs.
2. Ask about eating patterns, regularity, types of food, eating circumstances.
3. Ask about medications (especially aspirin, steroids, or antiinflammatory drugs).
4. Inquire about a history of illnesses, including previous GI bleeds.
5. Obtain psychosocial history.
6. Perform physical assessment with documentation of positive abdominal findings.
7. Take vital signs, including lying, standing, and sitting BPs and pulses, to determine if
orthostasis is present due to bleeding.
Nursing Diagnoses
Deficient Fluid Volume related to hemorrhage.
Acute Pain related to epigastric distress secondary to hyperse cretion of acid, mucosal
erosion, or perforation.
Diarrhea related to GI bleeding.
Imbalanced Nutrition: Less Than Body Requirements related to the disease process.
Deficient Knowledge related to physical, dietary, and pharma cologic treatment of
disease.
Nursing Interventions
Avoiding Fluid Volume Deficit
1. Monitor intake and output continuously to determine fluid volume status.
2. Monitor stools for blood and emesis.
3. Monitor hemoglobin and hematocrit and electrolytes.
4. Administer prescribed IV fluids and blood replacement, as prescribed.
5. Insert NG tube as prescribed, and monitor the tube drainage for signs of visible and occult
blood.
6. Administer medications through the NG tube to neutralize acidity, as prescribed.
7. Prepare the patient for saline lavage, as ordered.
8. Observe the patient for an increase in pulse and a decrease in BP (signs of shock).
9. Prepare the patient for diagnostic procedure or surgery to determine or stop the source of
bleeding.
Achieving Pain Relief
1. Administer prescribed medication.
2. Provide small, frequent meals to prevent gastric distention if not NPO.
3. Advise the patient about the irritating effects of certain drugs and foods.
Decreasing Diarrhea
1. Monitor the patient’s elimination patterns to determine effects of medications.
2. Monitor vital signs and watch for signs of hypovolemia.
3. Administer antidiarrheal medication as prescribed.
4. Watch for signs and symptoms of impaired skin integrity (erythema, pain, pruritus) around
anus to promote comfort and decrease risk of infection.
Achieving Adequate Nutrition
1. Eliminate foods that cause pain or distress; otherwise, the diet is usually not restricted.
2. Provide small, frequent meals that neutralize gastric secretions and may be better tolerated.
3. Provide high-calorie, high-protein diet with nutritional supplements, as ordered.
4. Administer parenteral nutrition, as ordered, if bleeding is prolonged and patient is
malnourished.
Educating the Patient about the Treatment Regimen
1. Explain all tests and procedures to increase knowledge and cooperation and minimize
anxiety.
2. Review the health care provider’s recommendations for diet, activity, medication, and
treatment. Allow time for questions and clarify any misunderstandings.
3. Give the patient a chart listing medications, dosages, times of administration, and desired
effects to promote compliance.
Patient Education and Health Maintenance
1. Teach the patient the signs and symptoms of bleeding and when to notify the health care
provider.
2. Promote healthy lifestyle changes to include adequate nutrition, cessation of smoking,
decreased alcohol consumption, stress reduction strategies.
3. Explain the purpose, dosage, and adverse effects of each medication prescribed.
