PUD
what are the 3 common causes of PUD?
Helicobacter pylori
NSAID-induced
Stress-related
Gastric Ulcer
Epigastric pain worse with eating
30-40% wake up with pain at night
Duodenal Ulcer
pain may be relieved with eating (down with eating)
pain usually 1-3 hours after a meal
Up to 80% of patients awake with pain during the night
What hormone does Zollinger-Ellison Syndrome(ZES) produce
Gastrin producing tumor in pancreas and duodenum
what causes complication of gastric outlet syndrome in pud?
caused by severe edema and scarring from duodenal ulcers
What is the treatment goal of H. pylori
kill bacteria
decrease stomach acid
protect stomach lining
at what age does PUD onset peak
and
who has increased risk
peak onset 30-60yrs of age
Increased risk for older adults (65+)
What sphincter constricts with eating
pyloric sphincter constricts
gastric ulcer worse with eating because food remains in stomach
duodenal ulcer better with food because food isn't in the duodenum
what does ZES gastrin contribute to?
hyperacidity
How does one contract Heliobacter Pylori (H. pylori)
food/water
saliva
what is the triple therapy for h pylori and how long is therapy for?
what can be added to triple therapy?
1 PPI + 2 abx
flagyl and clarithromycin or
amoxicillin and clarithromycin
abx therapy x 10-14 days
PPI x 4-8wks
Can add pepto-bismol(bismuth salts)
describe PUD (peptic ulcer disease)
and
what areas of GI does it affect
A hollowed-out area that forms on the mucosal wall
Affects the of the :
pylorus, esophagus, duodenum
which ulcer causes hematemesis and hemorrhage gastric or duodenal?
gastric ulcer
severe PUD
and
diarrhea
what enzyme does H.pylori produce and what does it break into?
produces urease
it breaks urea into ammonia and carbon dioxide =
neutralizes stomach acid
What are the Nursing considerations for PUD related to H. pylori and NSAIDS?
H.pylori (MC cause of PUD) Tx:Abx
NSAIDs - (inhibit prostaglandins, decreasing mucus and bicarb secretion) Tx:decrease nsaid use
Gastritis
Gastrinoma (Zollinger-Ellison Syndrome)
Alcohol (aggravates)
Smoking (associated)
which ulcer causes melena and obstruction gastric or duodenal?
duodenal ulcer
How is ZES managed?
PPI's (protonix/pantoprazole)
chemotherapy
surgery
what are the 4 steps H.pylori takes to cause PUD?
produce urease
neutralizes stomach acid via urease (producing ammonia)
bacteria penetrate stomach lining
inflammatory rxn leads to PUD/gastric CA
What are the Nursing considerations for PUD related to gastric acid?
Gastric Acid -injures mucosal cells activates pepsin (stomach enzyme) Tx:H2 receptor antagonist (blockers), PPI, mucosal protectants, antacids
what are the general s/s of PUD
Dull, gnawing pain
Epigastric Burning
Dyspepsia
Bloating/Belching
Nausea/Poor appetite
What are the diagnostic tests for PUD
Barium swallow
Endoscopy/biopsy
Gastric aspirate (check for ZES)
Fecal occult blood
what are the 2 biggest life threatening complications of PUD?
gi bleeding can lead to hemorrhage and
perforation that leads to peritonitis
What are the diagnostic test for H. pylori
Biopsy via Endoscopy
Blood - check for antibodies
Stool - check for HpSA (h pylori stool antigen) test
Breath - urea breath test which checks for CO2 in breath after swallowing urea containing substance
What are the Nursing considerations for PUD related to smoking/alcohol
Smoking/Alcohol: increases gastric acid, decreases bicarb = delay in healing Tx: decrease use