1. PEPTIC ULCER DISEASE
NRS452
Norhaini Majid

2. Introduction PUD ,a break in a mucous lining of GI tract
Duodenal - most common, age
Gastric Ulcer – affect older age

6. Risk Factors H.pylori infection – how? Use of NSAIDs Cigarette smoking
Family history of PUD
Other possible risks – physiological stress, alcohol /caffeine consumption

8. Pathophysiology Normal gastric mucosa Disruption of mucosal barrier
Inflammatory process
Erosion and ulcer formation
Refer page , Med/Surg Nsg

9. Manifestation of PUD Classic symptom? Typically described as …….
Occurs
Stomach
3 – 4 hours after meal
midnight

10. Manifestation of PUD (cont…)
Heartburn
Vomit
Older adult
Chest pain
Dysphagia
Weight loss
Anemia

11. Manifestation of PUD complications
Hemorrhage
Obstruction
Perforation

12. Hemorrhage Occult blood in stool Hematemesis Fatigue
Weakness, dizziness
Orthostatic hypotension
Hypovolemic shock

13. Obstruction Sensations of epigastric fullness Nausea & vomiting
Electrolyte imbalances
Metabolic alkalosis

14. Perforation Severe upper abdominal pain – shoulder
Rigid, boardlike abdomen
Absence of bowel sounds
Diaphoresis
Tachycardia
Rapid, shallow respiration
Fever

15. Zollinger-Ellison Syndrome
PUD cause by gastrinoma or gastrin-secreting tumor (pancreas, stomach, or intestine
Gastrin ?
Affect stomach, duodenum, esophagus and jejunum

16. Zollinger-Ellison Syndrome Characteristic
Ulcer-like pain
Diarrhea
Steatorrhea

17. Zollinger-Ellison Syndrome Complication
Perforation
Bleeding
Fluid & electrolyte imbalances

18. Diagnostic Tests Barium Swallow Gastroscopy Biopsy Serologic test
Urea breath test
Zollinger-Ellison Syndrome
Gastric Analysis

22. Medications Combination therapy
Two antibiotics + proton pump inhibitors (e.g omeperazole, metronidazole and clarithromycin)

24. Treatments
Dietary mx
Surgery
Rx of complications

26. Treatment of Peptic Ulcer Disease
Goals of Treatment
Relieve pain
Prevent complications (bleeding, perforation, penetration, obstruction)
Minimize recurrences
Reduce financial costs

27. Nursing Care? Student Activity
Identify nursing problem and solve it using nursing process approach
Discuss