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57 Cards in this Set
- Front
- Back
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What is the difference between gastritis and PUD?
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gastritis is inflammation, while PUD is erosion
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What is eroding in PUD?
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the GI mucosa
PUD is a condition characterized by erosion of the GI mucosa resulting from digestive action of HCL acid and pepsin |
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Two things have to happen in order to have PUD. What are they?
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1. increase in acid
2. breakdown of mucosal barrier |
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What is the patho of peptic ulcer disease?
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PUD is the imbalance between
-acid and pepsin formation and -inability of the mucosal layer to resist the destruction of these substances |
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Where are the peptic ulcers located in PUD?
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Two spots:
stomach and duodenum |
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If a peptic ulcer is located in the stomach, where is the most likely location?
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antrum, right before the pyloric sphincter
also in the body and fundus of the stomach |
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If a peptic ulcer is located in the duodenum (MOST LIKELY), then where in that duodenum is it probably at?
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in the first 1 to 2 centimeters
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What are the factors that increase HCL?
(one of the two parts that is required for the formation of peptic ulcers) |
1. Increase in # of HCL or pepsin cells
2. Increase in senstivity of the cell to the presence of food, alchol, caffeine....so the cell freaks out and produces MORE Hcl 3. Increase in Vagus nerve stimulation that causes increased production of HCL and pepsin 4. Decrease in the inhibition of the production of gastric secretions, even after the food has left the stomach |
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What are the factors that cause the mucosal barrier to be ineffective?
(one of the two parts that is required for the formation of peptic ulcers) |
1. stress ulcers caused by major surgery that decreases blood supply to the gastric mucosa dn cause ulcers to develop
2. Reflux of pancreatic enzumes into the stomach through the pyloric or duodenal area 3. Presence of H. pyloric (gram negative bacteria) digest the protective lining of the stomach |
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If a patient has a gastric ulcer, when does the pain most likely occur?
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1-2 hours after meals and eating tends to make the pain worse
(food is definitely in the stomach 1-2 hours after eating. when you eat food, the parietal cells release HCL so the stomach acid drops...which causes the breaks and holes to hurt b/c of the increased acidity) |
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If a patient has a duodenal ulcer, when do they most likely feel pain?
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2-4 hours after meals (b/c this is when the food is emptying into the duodenal area
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What treatment (done by patient) can help to relieve the pain of a duodenal ulcer?
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If they eat more food it feels better, also taking an antacid can help
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What are the manifestations of gastric and duodenal ulcers?
(peptic ulcer disease) |
pyrosis
regurgitation vomiting hematemesis s/s of shock hematochezia |
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What does the vomit (hematemesis) look like with a peptic ulcer?
describe the bloody vomit |
gastric bleeding is usually bright red or coffee grounds (depending on the amount of bleeding)
If it is coffee ground appearance, it is has been worked on by HCL and pepsin, which has changed its appearance |
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Why would a patient with PUD have signs and symptoms of SHOCK?
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If the bleeding is severe enough to rupture a major blood vessel, the patient will have s/s of being in shock
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What are the s/s of shock?
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increased HR
decreased BP diaphoresis skin cold and clammy (need to go to ICU) |
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What is hematochezia?
How is it related to PUD? |
bright red blood in stool
comes from bleeding in upper GI system (stomach or small intestine) Caused from severe blood vessel erosion |
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How do physiologic stress ulcers develop?
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They are a form of erosive gastritis (ulcers) that develop secondary to major physiological stress, such as BURNS TRAUMA SURGERY
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What is the patho of a stress ulcer?
(This is the reason that all patients seem to be on protonix) |
decrease in blood flow produces an imbalance between destructive properties of HCL acid and pepsin factors resulting in ulceration
(blood flow down = cells not healthy, mucus not produced, cells weak, HCL breaks through and erodes) |
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What is the physical difference between peptic ulcer disease and stress ulcers?
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Peptic ulcers are deeper
stress ulcers are pretty shallow |
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So when a patient undergoes stress from illness or surgery, what happens to the gastric mucosa?
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it breaks down due to decreased blood supply
(transient ischemia) |
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What are the manifestations of stress ulcers?
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no pain or symptoms is common
if there is pain, it usually occurs 2-4 after meals or without regard to meals |
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How do you diagnose a ulcer?
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H. pylori
barium swallow study UGI endoscopy |
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The acute pain associated with PUD....
time after meal for: gastric ulcer duodenal ulcer |
gastric ulcer 1-2 hours after a meal
duodenal ulcer 3-4 hours after a meal (notes say 2-4 or 3-4....) |
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Other than acute pain, what are the other NDs that apply to PUD?
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Acute Pain
Risk for Fluid VOlume Deficit (r/t N&V, bleeding) Sleep Pattern Disturbance (from pain waking you up Knowledge Deficit |
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What are the interventions for FVD?
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IV fluids
Assess hydration status Antiemetics |
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What needs to be included in patient teaching for PUD?
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Med information (timing & frequency)
Avoid ETOH, coffee, smoking Watch NSAIDS/ASA Teach about complications -abdominal pain -distention -vomiting -black, tarry stools -light headed -fainting Reinforce stress and lifestyle management techniques 6-8 weeks for ulcer to heal Must take meds for entire time Can Perforate and cause peritonitis (sepsis and shock) |
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What are the PCs associated with peptic ulcer disease?
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Hemorrhage
Perforation |
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How does a patient with a peptic ulcer perforation die?
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from peritonitis and septic shock
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What are the manifestations of perforation of an ulcer?
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pain, abrupt intense UPPER ABDOMINAL AREA
(can radiate to shoulder because nerve supply to diaphragm comes from C5 up by the shoulder |
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What objective manifestations are present with PUD?
(I think this is with a PUD with a perforation) |
rigid board like abdomen
change in BS - hypoactive or absent Increased RR, but decreased in depth r/t the pain Paralytic ileus |
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What interventions can you expect to perform for a person who has a ruptured peptic ulcer?
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NG tube
IV LR Foley IV Abx Analgesics Surgical procedure (not you, but surgeon) |
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What are the differences between interventions for hemorrhage vs. interventions for perforation?
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Perforation needs:
ABX Analgesics Surgery |
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What can happen in the stomach when a peptic ulcer heals?
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scaring, which can cause a gastric outlet obstruction
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What are the characteristics of a gastric outlet obstruction?
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history of ulcers
vomiting makes you feel better -upper abdm. distention -loud peristalsis -visible peristalsis -projectile vomiting of undigested food |
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What are the interventions of a gastric outlet obstruction?
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NG tube
IV fluids Meds: H2 & PPI Surgery (pyloraplasty (to open the gastric outlet) Endoscopy to dilate the area |
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A patient had to have a sub total gastrectomy due to stomach cancer. The used the billroth II procedure. Your patient ate her plate of food for lunch. She rings the call bell 30 minutes later and complains of weakness, dizziness and cramps. She says want to get to the commode but is too dizzy. What is happening?
What might you OBSERVE when you get to the room? |
dumping syndrome
diaphroesis change in HR (due to change in circulation) |
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In order for your patient to avoid having the "dumping syndrome" again, how do you advise her to eat in the future?
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small meals (6 meals)
avoid CARBS moderate fat and protein don't drink fluids with meals Do not engage in activity after eating |
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Why do you want a person to rest after eating?
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b/c increased activity causes increased demands on the circulatory system. She needs to save her "blood" to digest her food
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If a patient is suffering from PUD and is about to go home, what do you tell them about nutrition?
(what to eat and how to eat) |
low carbs, moderate fat/protein
small frequent meals avoid high roughage (fruits/salads) Milk is good Alcohol is bad |
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What does a person with PUD need to quit?
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drinking and smoking
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What are the drugs to treat PUD?
general |
Antacids
H2 Carafate PPIs |
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What is a complication of a patient with an NG tube?
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hypokalemia
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When do you irrigate a patient that has an NG tube?
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only with an order if they had gastric or esophageal surgery
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Other than pushing an NG tube to the wrong location, why do you not try to reposition an NG tube that comes out?
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b/c you can put pressure on the intragastric sutures and cause damage
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When you pull the residuals 12 hours after surgery and see blood, what do you need to do?
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Nothing. Blood is ok. Residuals will change 12-24 hours afer surgery
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How often do you measure the residuals after surgery?
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q 4 hours
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What might be the treatment for hemorrhage caused from a peptic ulcer?
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gastric lavage
done with an NG tube 50-100ml of saline down tube, leave it for a few minutes then suction it out (need an order for gastric lavage....done to keep tube patent) |
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What are the surgical interventions for peptic ulcers?
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Billroth I
Billroth II Vagotomy Pyloroplasty |
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What is a simple description of a Billroth I?
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partial gastrectomy
removal of 1/2 to 3/4 of stomach and attach duodenum to remainder of stomach |
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What is a simple description of a Billroth II?
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Part of stomach removed. If ulcer is in duodenal section, attach rest of stomach to the jejunum
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What is a vagotomy?
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cutting the vagus nerve that is attached to the pyloric sphincter
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What does "cutting the vagus nerve" do to help with PUD?
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relaxes the pyloric sphincter
decreases HCL secretions |
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What surgery is usually always done with a vagotomy?
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pyloroplasty
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What is a pyloroplasty?
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procedure to open up the pyloric sphincter
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Any type of gastrostomy might have this potential complication.
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pernicious anemia
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What does B12 look like?
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bright red
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