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Adult Medical- Surgical Nursing Gastro-intestinal Module: Gastritis and Peptic Ulcer.

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Presentation on theme: "Adult Medical- Surgical Nursing Gastro-intestinal Module: Gastritis and Peptic Ulcer."— Presentation transcript:

1 Adult Medical- Surgical Nursing Gastro-intestinal Module: Gastritis and Peptic Ulcer

2  Gastritis

3 Gastritis  Gastritis is an acute or chronic inflammation of the gastric mucosa  Risk factors include:  Spicy food  Overuse of Aspirin, NSAIDs  Excessive alcohol and caffeinated drinks  Smoking; stressful lifestyle  Helicobacter pylori or other pathogen

4 Gastritis: Pathophysiology  The gastric mucosa is protected from the high acidity of hydrochloric acid in the stomach by mucus secretion  Mucosal damage occurs through:  Interference with the amount of acid: hypersecretion or achlorhydria  Reduction of mucus production  Generalised inflammation results. Where acute can lead to necrosis, scarring or perforation

5 Helicobacter Pylori  H pylori is an organism which has been closely related to gastritis and peptic ulcer  It can be detected in blood and breath tests  Where present, treatment includes antibiotics in addition to control of peptic acid content

6 Gastritis: Clinical Manifestations  Anorexia  Heartburn after eating  Flatulence (belching)  Nausea/ vomiting  Sour taste in mouth

7 Gastritis: Diagnosis  Clinical symptoms and dietary history  Breath test, stool or serological test for H pylori  Endoscopy:  Inspection  Gastric washings for H. pylori  Biopsy  Serum B12 (may be ↓ if intrinsic factor affected)

8 Gastritis: Treatment/ Counselling  Dietary changes  ↓ smoking  Less stressful lifestyle  Antibiotics  Acid reduction through:  H2 receptor inhibitors (Ranitidine)  Proton pump inhibitors (Lanzoprazole)

9  Peptic Ulcer

10 Peptic Ulcer  The gastric and intestinal wall layers are: mucosa → sub-mucosa → muscle→ serosa→ peritoneum  A peptic ulcer is an erosion of the mucosa of the stomach, pylorus, duodenum or oesophagus in a circumscribed area. It may pass through all layers and eventually perforate to the peritoneum  Multiple ulcers may be present at once

11 Gastric Ulcers (15% of total): Main Features  Later onset: usually after 50 years of age  Similar occurance in male : female (1:1)  Normal, ↑ HCl or ↓ HCl (achlorhydria)  Epigastric pain occurs after a meal (within the following hour), relieved by vomiting  Associated with weight loss  Risk of haemorrhage  Long-term risk for gastric malignancy

12 Duodenal Ulcers (80% of total): Main Features  Affect younger age group (30-60 years)  Occurence in male: female is 2-3 :1  Related to hyperacidity (↑ HCl secretion)  Epigastric dull, gnawing pain occurs 2-3 hours after food, often awakens the patient, relieved by food  Vomiting not common  Increased risk of perforation  Less risk of malignancy

13 Peptic Ulcer: Aetiology  Risk factors for peptic ulcer include:  H pylori (70% in gastric; 95% in duodenal)  Genetic link: blood group “O”  Spicy food; also milk and cream  Smoking  Stressful lifestyle  Use of aspirin, NSAIDs, corticosteroids  Excessive alcohol and caffeinated drinks

14 Peptic Ulcer: Stress Ulcers  Stress ulcers are usually found in ICU patients (prophylaxis given routinely)  Related to physiological stress  Also related to corticosteroid therapy  Usually preceded by shock (severe trauma, burns, sepsis) → reduced blood flow to the mucosa and reflux of duodenal contents to the stomach → outpouring of HCl and pepsin on less protected mucosa → ulceration

15 Peptic Ulcer: Pathophysiology  Peptic ulcer is largely related to:  Increased concentration and action of HCl on the mucosa (stress, spicy foods, smoking, caffeine, alcohol)  Reduced mucus secretion: ↓ mucosal resistance and protection from the digestive action of HCl (stress, aspirin, NSAIDs, corticosteroids, H pylori)

16 Peptic Ulcer: Clinical Manifestations  Dull, gnawing epigastric or back pain (thought to be the effect of acid on exposed nerve endings)  Relieved by vomiting (gastric) or by food (duodenal)  Tenderness over the epigastrium  Possible weight loss  Anaemia if acute or chronic haemorrhage  Haematemesis or malaena (“tarry” stool)

17 Peptic Ulcer: Diagnosis  History and physical examination  CBC (anaemia)  Stool: Guiac test for occult blood  Breath test, stool or serum (antibodies) for Helicobacter pylori  Endoscopy: Inspection  Biopsy of mucosa for histology  Gastric washings for culture of H pylori

18 Peptic Ulcer: Medical Management  Lifestyle changes  Medical treatment:  Antibiotics (Flagyl and one other antibiotic)  H2-receptor antagonist (Ranitidine) or Proton- pump inhibitor (Lanzoprazole)  Mucosal protection (Misoprostol)  (Usually avoid antacids as interfere with treatment)

19 Peptic Ulcer: Surgery  Surgery is less used now. Mainly for:  Ulcers not healing after 12 – 16 weeks  Life-threatening complications:  Haemorrhage  Perforation/ penetration  Pyloric obstruction

20 Peptic Ulcer: Surgery  Types of surgical procedure:  Vagotomy (resection of the vagus, parasympathetic nerve: ↓ HCl secretion)  Pyloroplasty (with or without vagotomy)  Gastro-enterostomy (bypass from stomach to jejunum)

21 Peptic Ulcer Complications: Haemorrhage  Haemorrhage: ulcer has eroded a blood vessel  Haematemesis, especially gastric ulcer: fresh blood or “coffee-ground” vomit  Malaena (more obvious if duodenal ulcer)  May be an emergency → hypovolaemic shock  GXM, IV fluids, vital signs, NG tube, NPO  Rest, mouth care, surgical prep (if needed)

22 Peptic Ulcer Complications: Perforation  Perforation:  Ulcer has perforated layers to the peritoneum  Acid contents leaking into peritoneum  Patient in severe shock from extreme pain of chemical peritonitis  Rigid, board-like abdomen, extremely tender  Hypotension: emergency requiring immediate resuscitation and preparation for surgery to repair

23 Peptic Ulcer: Nursing Care  Pre-operative care: (may well be emergency)  General physical check-up, chest Xray, ECG  Blood profile, IVI, group and cross-match (GXM)  Breathing exercises to prepare for post-op  Thrombo-embolic stockings/ prophylactic heparin  Explanation of operation, consent and emotional support

24 Peptic Ulcer: Nursing Care  Post-operative care:  Pain relief  Monitor vital signs, pulse oximetry, IV fluids, urine output and fluid balance  Semi-sitting position once recovered  Breathing and leg exercises  NPO initially→ graduated intake (mouth care)  NG tube aspirations, wound, drain care

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