peptic ulcer.pptx for nursing students..
- 1. PEPTIC ULCER BY THOUNAOJAM RINITA DEVI
- 3. INTRODUCTION • Peptic ulcers are sores that develop in the lining of the stomach, lower oesophagus, or duodenum. They are usually formed as a result of inflammation caused by the bacteria H.pylori, as well as from erosion from stomach Acids. "Peptic" refers to pepsin: a stomach enzyme that breaks down protein
- 4. An ulcer occurs when the lining of these organs is corroded by acidic digestive juices secreted by the stomach cells. Peptic ulcers are a fairly common health problem.
- 7. DEFINITION • A peptic ulcer is an excavation formed in the mucosal wall of the stomach, pylorus, duodenum (beginning of the small intestine), or oesophagus. • It is frequently referred to as a gastric, duodenal, or oesophageal ulcer, depending on its location. It is caused by the erosion of a circumscribed area of mucous membrane.
- 8. • Peptic ulcers are more likely to be in the duodenum than in the stomach. They tend to occur singly, but there may be several present at one time. • Chronic ulcers usually occur in the lesser curvature of the stomach, near the pylorus.
- 9. TYPES OF PEPTIC ULCER
- 10. GASTRIC ULCERS Gastric ulcers are sores in the lining of the stomach or small intestine. They occur when the protective mucus that lines the stomach becomes ineffective. The stomach produces a strong acid to help digest food and protect against microbes.
- 11. CONTD... • To protect the tissues of the body from this acid, it also secretes a thick layer of mucus. If the mucus layer is worn away and stops functioning effectively, the acid can damage the stomach tissue, causing an ulcer.
- 12. OESOPHAGEAL ULCERS An oesophageal ulcer is a type of peptic ulcer that develops in the lining of the oesophagus, the tube that connects the throat to the stomach. Oesophageal ulcers occur when the layer of mucus, which lines and protects the gastrointestinal tract, wears away
- 13. DUODENAL ULCERS Duodenal ulcers develop in the lining of the duodenum, which is the upper part of the small intestine.
- 14. CAUSES • Different factors can cause the lining of the stomach, the oesophagus, and the small intestine to break down. These include: • Helicobacter pylori (H. pylori), a type of bacteria that can cause a stomach infection and inflammation. • Taking or frequent use of non steroidal antiinflammatory drugs (NSAIDs) , aspirin
- 15. CONTD... ( Bayer) and ibuprofen (Advil) can increase the risk of peptic ulcer disease by four times compared to non-users (in women and people over the age of 60 years). • Other causes of peptic ulcer disease include gastric ischemia, drugs, metabolic disturbances, cytomegalovirus (CMV), upper abdominal radiotherapy, Crohn's disease, and vasculitis..
- 16. RISK FACTORS • Smoking • Drinking too much alcohol • Radiation therapy • Stomach cancer • Spicy food • Having other family members with peptic ulcer disease
- 17. Pathophysiology
- 18. SIGN AND SYMPTOM The most common symptom of a peptic ulcer is burning abdominal pain that extends from the navel to the chest, which can range from mild to severe..Small peptic ulcers may not produce any symptoms in the early phases.
- 19. CONTD.. Other common signs of a peptic ulcer include: • Burning stomach pain that: - May wake a person up from sleeping - May last a few minutes or many hours - Is worse on an empty stomach but better after eating or drinking - Feels better after taking antacids
- 20. • Nausea and vomiting • Lack of hunger • Unexplained weight loss • Bloating • Feeling of fullness • Heartburn Ulcers can cause bleeding. It is rare but heavier bleeding can cause: - Bloody or black, tarry stools - Vomiting that looks like coffee grounds or blood
- 21. DIAGNOSTIC EVALUATION Two types of tests are available to diagnose a peptic ulcer. They are called upper endoscopy and upper gastrointestinal (GI) series.
- 22. Upper endoscopy • In this procedure, doctor inserts a long tube with a camera down to throat and into the stomach and small intestine to examine the area for ulcers. • Not all cases require an upper endoscopy. • However, this procedure is recommended for people with a higher risk of stomach cancer. This includes people over the age of 45, as well as people who experience: -anaemia - weight loss - gastrointestinal bleeding - difficulty swallowing
- 24. Upper GI series • If the person doesn’t have difficulty in swallowing and have a low risk of stomach cancer, doctor may recommend an upper GI test instead. For this procedure, the person will drink a thick liquid called barium (barium swallow). Then a technician will take an X-ray
- 25. • of stomach, oesophagus, and small intestine of the person. The liquid will make it possible for the doctor to view and treat the ulcer. • Because H. pylori is a cause of peptic ulcers, doctor will also run a test to check for this infection in the stomach.
- 27. • X-ray : it helps to detect abnormalities in esophagus stomach and small intestine • Endoscopy : Performed to examine ulcers • Biopsy : during endoscopy ,small tissue samples are removed to examine peptic ulcers. It can also help to identify whether H.pylori in stomach is present or not • CBC: A CBC with decreased hematocrit and hemoglobin values may indicates bleeding
- 28. • Stool antigen test : Performed to observe protiens present in the stool related to H.pylori • Gastroscopy: Performed to obsereve inside patient’s stomach and duodenum
- 29. Management • Treatment will depend on the underlying causes of the ulcer. If the tests show that person has an H. pylori infection, then doctor will prescribe a combination of medication. • The person will have to take the medications for up to two weeks. The medications include antibiotics to help kill infections and proton pump inhibitors (PPIs) to help reduce stomach acid.
- 30. • Antacids in combination with cimetidine (Tagamet) or ranitidine (Zantac) for treatment of stress ulcer and for prophylactic use.
- 31. • H2-receptor antagonists acid blockers like ranitidine (Zantac) or famotidine (Pepcid) can also reduce stomach acid and ulcer pain. These medications are available as a prescription and also over the counter in lower doses. • Mucosal barrier fortifiers : sucralfat (Carafate) which will coat the stomach and reduce symptoms of peptic ulcers.
- 32. Surgical management Antrectomy Billroth -1( Gastroduodenostomy) : It involves the removal of lower portion of antrum,pylorus and small portion of duoddenum Billroth -2 ( Gastrojejunostomy): It involves removal of stomach
- 34. Pyloroplasty During this surgical procedure , an incision is made in the lower stomach (Pylorus) of Patients It is transversally sutured closed to widen the outlet and relaxing the muscles Delayed gastric emptying is the most common complication of the surgical treatment
- 36. Vagotomy • It performed under general anesthesia,incision is made in the patient’s abdomen and vagus nerve is located. Either the trunk or branches leading to stomach are cut. Then, the abdominal muscles are sewn back together and skin is closed with sutures.
- 37. Types of vagotomy Truncal or total abdominal vagotomy: • Total gastric or selective vagotomy • Proximal gastric or highly selective vagotomy
- 39. Nursing management Nursing assessment : • Assess pain and methods used to relieve it; take a thorough history, including a 72-hour food intake history. • If patient has vomited, determine whether emesis is bright red or coffee ground in appearance. This helps identify source of the blood.
- 40. • Ask patient about usual food habits, alcohol, smoking, medication use (NSAIDs), and level of tension or nervousness. • Ask how patient expresses anger (especially at work and with family), and determine whether patient is experiencing occupational stress or family problems. • Obtain a family history of ulcer disease. • Assess vital signs for indicators of anaemia (tachycardia, hypotension). • Assess for blood in the stools with an occult blood test. • Palpate abdomen for localized tenderness
- 41. Nursing Diagnoses • Acute pain related to the effect of gastric acid secretion on damaged tissue • Anxiety related to coping with an acute disease • Imbalanced nutrition related to changes in diet • Deficient knowledge about preventing symptoms and managing the condition
- 42. Complications • Hemorrhage: upper GI • Perforation • Penetration • Pyloric obstruction (gastric outlet obstruction)
- 43. THANK YOU