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103 Cards in this Set
- Front
- Back
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Peptic Ulcer disease is a mucosal lesion of the _____ or _____
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stomach
duodenum |
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Peptic Ulcer disease: Loss of protection from ___/______
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acid/pepsin
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Peptic Ulcer disease: Ulcers may be classified as: ________ or ________ depending on location and ____ or ________ depending on degree of mucosal involvement
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gastric or duodenal
acute or chronic |
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This type of ulcer will take 4x as long to heal due to more erosion.
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Chronic
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People with gastric ulcer will be + for _ ______
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h pylori
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With gastric ulcers, there's a break in normal barrier and _________ ______ injures epithelium.
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hydrochloric acid
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What caused the hydrocholic acid to build up in stomach and cause gastric ulcer?
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delayed gastric emptying or regugitation of duodenal contents.
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Where do duodenal ulcers most occur?
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first portion of duodenum
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what do duodenal ulcers look like?
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deep sharp demarked lesions
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Duodenal ulcers are usually associated with high:
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gastric acid secretion
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with duodenal ulcers, are ph levels high or low?
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low
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duodenal ulcers have high association with positive:
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h pylori
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who commonly gets duodenal ulcers?
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elderly
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______ _______: acute gastic mucosa lesions occuring after an acute injury to the body ie burns, trauma, head injury, resp failure, shock, sepsis
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stress ulcer
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What causes stress ulcers?
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no exact cause
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Stress ulcers are associated with elevated levels of
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hydrochloric acid
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what age is common for gastric ulcers?
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>50
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who is more prone to get a gastric ulcer? men or women?
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women
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Pain 30-60 mins after meals
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gastric ulcer
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with gastric ulcers, theres a ___% chance of malignancy
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10
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People with gastric ulcers usually have pain and :
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don't want to eat
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what color blood is seen when the ulcer is higher up?
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bright red
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hematemesis is more common with what type of ulcer?
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gastric
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Can gastric ulcers heal?
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yes
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Duodenal ulcers are most common with what age?
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>50
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Duodenal ulcers are common with blood type:
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O
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When does pain occur with duodenal ulcers?
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1 1/2-3 hours after meal
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people with duodenal ulcers often:
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awaken in the night
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What relieves duodenal ulcers?
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ingestion of food
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are people with duodenal ulcers usually well nourished? or poorly nourished?
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well nourished
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A neonate with PUD may have _____ causing:
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perforation
massive hemorrhage |
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PUD presents this way in infants - 2 year olds
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poor eating
vomiting crying after feeding adb distention tarry stools melena (bloody stools) irritabilty hemorrhage |
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what does melena mean?
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bloody stools
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PUD presents this way in children 2-6 years old
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-vomiting with eating
-periumbilical pain -melena -crying with pain at night or a.m. -perforation |
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PUD presents this way in children 6 and up:
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pain
burning epigastric r/t fasting melena vomiting obstruction |
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how is h pylori detected?
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blood
breath test gastroscopy |
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what are 3 complications of PUD?
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hemorrhage
perforation obstruction |
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what is the most common complication of PUD?
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hemorrhage
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erosion of granulation tissue foudn at the base of the ulcer during healing or from erosion of the ulcer thru a major blood vessel
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hemorrhage
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2 causes of lower gi bleeding
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diverticulitis
angiodysplasia |
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what is angiodysplasia?
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malfunction of cells
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2 causes of upper gi bleeding:
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pud
gastritis |
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4 causes of gastritis
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-drug induced (ASA, NSAIDS)
-etoh induced -stress -varices |
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5 examples of stress gastritis are:
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resp failure
sepsis thermal burns peritonitis neuro trauma |
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Definitive management of upper gi bleeding:
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NG decompression
gastric lavage antacids h2blockers mucosal barrier enhancers omeprazole (prilosec) Lansoprazole (prevacid) |
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what is gastric lavage?
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use bulb syringe to deliver cool water into ng tube and suck out
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If in acute phase of upper gi bleeding, prilosec and prevacid may be
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given IV
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What is the most lethal complication of PUD?
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perforation
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perforation is commonly seen in large penetrating
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duodenal ulcers
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Occurs when the ulcer penetrates the surface with spillage of either gastric of duodenal contents into the peritoneum
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perforation
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symptoms of perforation r/t PUD:
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-sudden/severe upper abd pain
-rigid/board like abd -shallow/rapid resps -0 bowel sounds |
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PUD: with perforation, _____ ________ in 6-12 hours, followed by _____ ______
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bacterial peritonitis
paralytic ieus |
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With perforation, person should:
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go to the O.R. right away!
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This usually occurs in clients with ulcers location in the antrum and prepuloric and pyloric areas of the stomach and the duodenum
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gastric outlet obstruction
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Usually with gastric outlet obstuction, the client has long history of ulcer pain. (______)
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chronic
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3 symptoms of gastric outlet obstruction
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projectile vomiting
constipation possible to palpate stomach |
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conservative therapy for all PUD:
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adequate rest
diet modifications smoking cessation stress reduction long term follow up |
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With conservative therapy for PUD, what diet modifications should one make?
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No spicy, greasy, fat, etoh, smoking, tomato, orange juice (high acid content)
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PUD: Care for acute exacerbation with complications:
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npo
ng suction bed rest iv fluid blood transfusions stomach lavage abx for peritonitis |
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With PUD, what position is encouraged?
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left lateral decubitis position
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Implementation with PUD:
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v/s q4 or q2
large bore iv access ns or lr fluid and rbcs strict I & O vasopressors ng tube (to check pH) |
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What are some pharmacologic interventions with PUD?
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-antacids
-H2 blockers -mucosal healing agents -prostaglandins -proton pump inhibitors -cytoprotective agents -abx therapy |
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What are 3 types of antacids?
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systemic
non systemic calcium containing |
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A systemic antacid has a bicarbonate base, and is absorbed well, may lead to systemic _______ so avoid long term use
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alkalosis
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Non systemic antacids are aluminum or mag hydroxide but they are:
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poorly absorbed
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Duration of antacid action:
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30 mins
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when should one take antacids?
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1 and 3hrs after food
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are antacids absorbed on an empty stomach?
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only partially
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two s/e's of antacids:
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diarrhea or constipation
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what is used for gastric bleeding:
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maalox
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teach client: what will facilitate action of antacid tablets?
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full glass of h2o
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these inhibit action of histamine at the h2 receptors and gastric acid secretion
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h2 antagonists
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h2 antagonists reduce total
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pepsin output
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h2 antagonists promote
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ulcer healing
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h2 antagonists are highly
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selective
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four examples of h2 antagonists:
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cimetidine (tagament)
raniditine (zantac) famotidine (pepcid) nizatidine (axid) |
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how often are h2 antagonists usually taken?
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1x per day
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what 2 routes can h2 antagonists be administered?
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iv or po
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how long are h2 antagonists effective?
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up to 12 hrs
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whats the oldest type of h2 antagonists?
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tagamet
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These suppress gastic acid secretion by binding with potassium ATPase enzume responsible for the hydrogen secretion from parietal cells
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proton pump inhibitors
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4 examples of proton pump inhibitors
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lansoprazole (prevacid)
Omeprazole (prilosec) Pantoprazole (protonix, pantoloc) esomeprazole (nexium) |
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whats one advatage with pantoprazole (protonix)?
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can be given iv
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proton pump inhibitors are only
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used for short term
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what medications are used to prevent fastric ulcerations caused by nsaids and asa?
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prostaglandins
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one example of a prostaglandin?
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misoprostol (cytotec)
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prostaglandins inhibis
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gastric acid secretion
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Prostaglandins increase _____ and _____ production
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bicarbonate
mucous (cytoprotective effects) |
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what is the preferred type of drug for stress ulcerations?
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cytoprotective
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forms a protective barrier between the fastric acid, pepsin and bile salts and the gastric or duodenal wall
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cytoprotective drugs
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one example of a cytoprotective drug is:
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sucralfate (carafate)
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how often are cytoprotective drugs usually given?
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4x day
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when should cytoprotective drugs be given?
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30 min before meals or 30 mins before or after actacids
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Colloidal bismuth or bismuth subsalicylate (pepto bismol) facilitates healing but causes
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black stools
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__________ drugs have limited use due to h2 blockers and proton pump inhibitors
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anticholinergic
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can't give antacids containg magnesium to patients with
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renal problems
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antacids interfere with absorption of : (5)
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fat soluable vits
vit a folate fe b12 |
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abx regimes for h pylori
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proton pump inhibitor
combo of 2 abx (either flagyl/tetracycline or amoxicillin/clarithromycin) |
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abx regimes for h pylori may last ___-___ days (problems with compliance)
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10-14
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with dumping syndrome, the symptoms occur when?
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30mins after eating
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what are some sx for dumping syndrome?
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weakness
sweating palpitations dizziness abd cramps borborygmi urge to defecate |
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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 |
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Sx of postprandial hypoglycemia
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sweating
weakness tachycardia mental confusion anxiety |
