2. Peptic ulcers are open sores in the mucosa of the lower oesophagus (esophageal ulcer), duodenum (dudenal ulcer ) and stomach (gastric ulcers). Caused by helicobacter pylori

3. A benign gastric ulcer Endoscopic image of gastric

4. Peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot tolerated hyper secretion and the digestive action of gastric acid (HCl) and pepsin.

5.  age more than 4o years  NSAIDS – non steroids anti inflamatory drugs  Steroids, alcohol intake  Family history, chronic illness  Smoking, spicy food  Stress, people with blood group 0

6.  Burning epigastric pain (1to 3h) after meal  Abdominal pain or heart burn  Nocturnal epigastric burn  Anorexia, weight loss,hematemesis and Melina

7.  Constipation or diarrhea.  Bleeding (50% gastric ulcers). Patients may present with GI bleeding

8. DescriptionDUODENAL ULCER GASTRIC ULCER Age30-60Usually 50 and over SexMale: female = 2-3: 1 Male: female = 1: 1 S& S and Clinical Findings Hypersecretion of stomach acid Normal (HCL) hyposecretion of (HCL)

9. May have weight gain. Pain occurs 2-3 hours after a meal often awakened between meal 1-2 AM ingestion of food may be relieved pain Vomiting uncommon Weight loss may occur Pain occurs 1/2 to 1 hour after a meal rarely occurs at night; pain may be relieved by vomiting; ingestion of food does not help, Vomiting common

10. Hemorrhage less likely than with gastric ulcer, but if present melena more common than hematemesis. More likely to perforate than gastric ulcers Hemorrhage more likely to occur than with duodenal ulcer; hematemesis more common than melena. Malignancy Possibility RareOccasionally Risk Factors H. pylori, alcohol, smoking, cirrhosis, stress H. pylori, gastritis, alcohol, smoking, use of NSAIDs, stress

11. A physical examination (S&S). A barium study of the upper GI tract may show an ulcer. Endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, lesions, and biopsy.

12. Stools may be tested periodically until they are negative for oc­cult blood. Gastric secretary studies

13. H pylori infection may be determined by blood test (serology) There is also a breath test that detects H pylori, as well as a serologic test for antibodies to the H pylori antigen.

14. The goals of Medical Management are to eradicate H pylori and to manage gastric acidity, Methods used include pharmacologic therapy, lifestyle changes, and surgical intervention.

15. Medication=- Combination of antibiotics such as amoxicillin, clarithromycin and metronidazole (flagyl) Proton pump inhibitors like omeprazole Action =- decrease gastric secretion Histamine 2(H2)receptorantagonist like cimetidine (tagamet)

16. ♠life style changes which include=- ♠ REDUCING ENVIRONMENTAL STRESS requires physical and psychological modifications. ♠ SMOKING CESSATION (smoking decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum).

17. ♠DIETARY MODIFICATION (to avoid over secretion of acid and hypermotility in the GIT  Others =-  SURGICAL MANGEMENT  FOLLOW UP CARE

18. Nursing assessment  Assess chiefs complain of the patient specifically epigastric pain  Ask about eating pattern  Ask about medication specially asprin  History of illness and psychosocial history  Physical assessment and take V\S

19. NURSING DIAGNOSIS: Epigastric pain related to the effect of gastric acid secretion on damaged tissue. Goals =- relive pain

20. :N- implementation =-  Assess pain ☻administer prescribed medications. ☻The patient should avoid aspirin, foods and beverages that contain caffeine, and decaffeinated coffee,

21. ☻ Meals should be eaten at regularly paced Intervals in a relaxed setting. ☻ stop smoking and avoid stress

22. NURSING DIAGNOSIS: Anxiety related to severity of symptoms and outcome of disease Goals =- reduce anxiety

23. N –implementation =- ☻ assess anxiety and appropriate information is provided at the patient's level of understanding, ☻ All questions are answered and the patient is encouraged to express fears openly.

24. ☻ Explaining diagnostic tests and administering medications on schedule also-help to reduce anxiety. ☻ The nurse interacts with the patient in a relaxed manner and helps him or her at any time.

25. ☻ The patient's family is also encouraged to participate in care and to provide emotional support.

26. NURSING DIAGNOSIS Nutritional alter less than body requirement R\L to changes in diet and disease process Goal =- maintain nutritional balance

27. N – implementation  assess nutritional status  advise patient about the importance of complying with the medication regimen and dietary restrictions.  Small frequent meals  Avoid spicy food  Reassess nutritional status

28. NURSING DIAGNOSIS: Knowledge deficit about prevention of symptoms, management of the condition and complications Goal=- teaching for the patient

29. N- implementation ☻ assess patient knowledge, Teach the patient about the factors that will help or aggravate the condition. ☻ Teach the patient about medication

30. ☻instruct the patient to avoid certain medications and foods that aggravate symptoms like alcohol, caffeinated and beverages such as coffee, tea, and colas).

31. ☻It is important to counsel the patient to eat meals at regular times and in a relaxed setting, and to avoid overeating. ☻ The nurse also informs the patient about the irritant effects of smoking on the ulcer and provides information about smoking cessation programs

32. Complication  GIT hemorrhage  Ulcer perforation  Gastric out let obstruction  Anemia