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103 Cards in this Set

  • Front
  • Back
Peptic Ulcer disease is a mucosal lesion of the _____ or _____
stomach
duodenum
Peptic Ulcer disease: Loss of protection from ___/______
acid/pepsin
Peptic Ulcer disease: Ulcers may be classified as: ________ or ________ depending on location and ____ or ________ depending on degree of mucosal involvement
gastric or duodenal
acute or chronic
This type of ulcer will take 4x as long to heal due to more erosion.
Chronic
People with gastric ulcer will be + for _ ______
h pylori
With gastric ulcers, there's a break in normal barrier and _________ ______ injures epithelium.
hydrochloric acid
What caused the hydrocholic acid to build up in stomach and cause gastric ulcer?
delayed gastric emptying or regugitation of duodenal contents.
Where do duodenal ulcers most occur?
first portion of duodenum
what do duodenal ulcers look like?
deep sharp demarked lesions
Duodenal ulcers are usually associated with high:
gastric acid secretion
with duodenal ulcers, are ph levels high or low?
low
duodenal ulcers have high association with positive:
h pylori
who commonly gets duodenal ulcers?
elderly
______ _______: acute gastic mucosa lesions occuring after an acute injury to the body ie burns, trauma, head injury, resp failure, shock, sepsis
stress ulcer
What causes stress ulcers?
no exact cause
Stress ulcers are associated with elevated levels of
hydrochloric acid
what age is common for gastric ulcers?
>50
who is more prone to get a gastric ulcer? men or women?
women
Pain 30-60 mins after meals
gastric ulcer
with gastric ulcers, theres a ___% chance of malignancy
10
People with gastric ulcers usually have pain and :
don't want to eat
what color blood is seen when the ulcer is higher up?
bright red
hematemesis is more common with what type of ulcer?
gastric
Can gastric ulcers heal?
yes
Duodenal ulcers are most common with what age?
>50
Duodenal ulcers are common with blood type:
O
When does pain occur with duodenal ulcers?
1 1/2-3 hours after meal
people with duodenal ulcers often:
awaken in the night
What relieves duodenal ulcers?
ingestion of food
are people with duodenal ulcers usually well nourished? or poorly nourished?
well nourished
A neonate with PUD may have _____ causing:
perforation
massive hemorrhage
PUD presents this way in infants - 2 year olds
poor eating
vomiting
crying after feeding
adb distention
tarry stools
melena (bloody stools)
irritabilty
hemorrhage
what does melena mean?
bloody stools
PUD presents this way in children 2-6 years old
-vomiting with eating
-periumbilical pain
-melena
-crying with pain at night or a.m.
-perforation
PUD presents this way in children 6 and up:
pain
burning epigastric r/t fasting
melena
vomiting
obstruction
how is h pylori detected?
blood
breath test
gastroscopy
what are 3 complications of PUD?
hemorrhage
perforation
obstruction
what is the most common complication of PUD?
hemorrhage
erosion of granulation tissue foudn at the base of the ulcer during healing or from erosion of the ulcer thru a major blood vessel
hemorrhage
2 causes of lower gi bleeding
diverticulitis
angiodysplasia
what is angiodysplasia?
malfunction of cells
2 causes of upper gi bleeding:
pud
gastritis
4 causes of gastritis
-drug induced (ASA, NSAIDS)
-etoh induced
-stress
-varices
5 examples of stress gastritis are:
resp failure
sepsis
thermal burns
peritonitis
neuro trauma
Definitive management of upper gi bleeding:
NG decompression
gastric lavage
antacids
h2blockers
mucosal barrier enhancers
omeprazole (prilosec)
Lansoprazole (prevacid)
what is gastric lavage?
use bulb syringe to deliver cool water into ng tube and suck out
If in acute phase of upper gi bleeding, prilosec and prevacid may be
given IV
What is the most lethal complication of PUD?
perforation
perforation is commonly seen in large penetrating
duodenal ulcers
Occurs when the ulcer penetrates the surface with spillage of either gastric of duodenal contents into the peritoneum
perforation
symptoms of perforation r/t PUD:
-sudden/severe upper abd pain
-rigid/board like abd
-shallow/rapid resps
-0 bowel sounds
PUD: with perforation, _____ ________ in 6-12 hours, followed by _____ ______
bacterial peritonitis
paralytic ieus
With perforation, person should:
go to the O.R. right away!
This usually occurs in clients with ulcers location in the antrum and prepuloric and pyloric areas of the stomach and the duodenum
gastric outlet obstruction
Usually with gastric outlet obstuction, the client has long history of ulcer pain. (______)
chronic
3 symptoms of gastric outlet obstruction
projectile vomiting
constipation
possible to palpate stomach
conservative therapy for all PUD:
adequate rest
diet modifications
smoking cessation
stress reduction
long term follow up
With conservative therapy for PUD, what diet modifications should one make?
No spicy, greasy, fat, etoh, smoking, tomato, orange juice (high acid content)
PUD: Care for acute exacerbation with complications:
npo
ng suction
bed rest
iv fluid
blood transfusions
stomach lavage
abx for peritonitis
With PUD, what position is encouraged?
left lateral decubitis position
Implementation with PUD:
v/s q4 or q2
large bore iv access
ns or lr fluid and rbcs
strict I & O
vasopressors
ng tube (to check pH)
What are some pharmacologic interventions with PUD?
-antacids
-H2 blockers
-mucosal healing agents
-prostaglandins
-proton pump inhibitors
-cytoprotective agents
-abx therapy
What are 3 types of antacids?
systemic
non systemic
calcium containing
A systemic antacid has a bicarbonate base, and is absorbed well, may lead to systemic _______ so avoid long term use
alkalosis
Non systemic antacids are aluminum or mag hydroxide but they are:
poorly absorbed
Duration of antacid action:
30 mins
when should one take antacids?
1 and 3hrs after food
are antacids absorbed on an empty stomach?
only partially
two s/e's of antacids:
diarrhea or constipation
what is used for gastric bleeding:
maalox
teach client: what will facilitate action of antacid tablets?
full glass of h2o
these inhibit action of histamine at the h2 receptors and gastric acid secretion
h2 antagonists
h2 antagonists reduce total
pepsin output
h2 antagonists promote
ulcer healing
h2 antagonists are highly
selective
four examples of h2 antagonists:
cimetidine (tagament)
raniditine (zantac)
famotidine (pepcid)
nizatidine (axid)
how often are h2 antagonists usually taken?
1x per day
what 2 routes can h2 antagonists be administered?
iv or po
how long are h2 antagonists effective?
up to 12 hrs
whats the oldest type of h2 antagonists?
tagamet
These suppress gastic acid secretion by binding with potassium ATPase enzume responsible for the hydrogen secretion from parietal cells
proton pump inhibitors
4 examples of proton pump inhibitors
lansoprazole (prevacid)
Omeprazole (prilosec)
Pantoprazole (protonix, pantoloc)
esomeprazole (nexium)
whats one advatage with pantoprazole (protonix)?
can be given iv
proton pump inhibitors are only
used for short term
what medications are used to prevent fastric ulcerations caused by nsaids and asa?
prostaglandins
one example of a prostaglandin?
misoprostol (cytotec)
prostaglandins inhibis
gastric acid secretion
Prostaglandins increase _____ and _____ production
bicarbonate
mucous

(cytoprotective effects)
what is the preferred type of drug for stress ulcerations?
cytoprotective
forms a protective barrier between the fastric acid, pepsin and bile salts and the gastric or duodenal wall
cytoprotective drugs
one example of a cytoprotective drug is:
sucralfate (carafate)
how often are cytoprotective drugs usually given?
4x day
when should cytoprotective drugs be given?
30 min before meals or 30 mins before or after actacids
Colloidal bismuth or bismuth subsalicylate (pepto bismol) facilitates healing but causes
black stools
__________ drugs have limited use due to h2 blockers and proton pump inhibitors
anticholinergic
can't give antacids containg magnesium to patients with
renal problems
antacids interfere with absorption of : (5)
fat soluable vits
vit a
folate
fe
b12
abx regimes for h pylori
proton pump inhibitor
combo of 2 abx (either flagyl/tetracycline or amoxicillin/clarithromycin)
abx regimes for h pylori may last ___-___ days (problems with compliance)
10-14
with dumping syndrome, the symptoms occur when?
30mins after eating
what are some sx for dumping syndrome?
weakness
sweating
palpitations
dizziness
abd cramps
borborygmi
urge to defecate
With dumping syndroms, delay gastric emptying by:
1. divide meals into ___ small feedings and avoid ____
2. eating in what positions?
3. do what after meal?
4. increase ___ and ___ content in diet
5. don't take __ with meals, take 30 mins before or after
1. 6/sweets
2. recumbent/semirecumbent
3. lay down
4. protein/fat
5. fluids
Sx of postprandial hypoglycemia
sweating
weakness
tachycardia
mental confusion
anxiety