MS TEST 5 PEPTIC ULCER DISEASE

Maintenance dosages of H2 receptor antagonists are usually recommended for __ year.

1

Approximately _____ of gastrinomas are malignant.

1/3

Intractable ulcers are those that fail to heal after __ to __ weeks of medical treatment.

12 16

Many people with ulcers have no symptoms, and perforation or hemorrhage may occur in __% to __% of patients who had no preceding manifestations.

20 30

When the patient with peptic ulcer has a hemorrhage that is large (2000 to 3000 mL), most of the blood is vomited. Because large quantities of blood maybe lost quickly, immediate correction of blood loss may be required to prevent hemorrhagic shock.

2000 3000

Peptic ulcer disease occurs with the greatest frequency in people between __ and __ years of age.

40 60

Confirmation that obstruction is the cause of the discomfort is accomplished by assessing the amount of fluid aspirated from the NG tube. A residual of more than ___ mL strongly suggests obstruction.

400

The nurse monitors the patient with peptic ulcer carefully so that bleeding can be detected quickly. If bleeding recurs within __ hours after medical therapy has begun, or if more than __ to __ units of blood are required within __ hours to maintain blood volume, the patient is likely to require surgery.

48 6 10 24

Nursing Diagnoses Based on the assessment data, the patient with peptic ulcer disease may have nursing diagnoses that may include the following: _____ _____ related to the effect of gastric acid secretion on damaged tissue _____ related to an acute illness Imbalanced nutrition related to _____ __ _____

Acute pain Anxiety changes in diet

The goals for the patient with peptic ulcer disease may include relief of pain, reduced anxiety, maintenance of nutritional requirements, knowledge about the management and prevention of ulcer recurrence, and absence of complications.

Acute pain Anxiety changes in diet

How does the patient usually relieve ulcer pain?

By eating, because food neutralizes the acid, or by taking alkali. However, once the stomach has emptied or the alkali's effect has decreased, the pain returns.

_____ ulcers are frequently observed about 72hours after extensive burns and involves the antrum of the stomach or the duodenum.

Curling's

_____ ulcers are common in patients with head injury and brain trauma and may occur in the esophagus, stomach, or duodenum and are usually deeper and more penetrating than stress ulcers.

Cushing's

Stress ulcers should be distinguished from _____ ulcers and _____ ulcers, two other types of gastric ulcers.

Cushing's Curling's

_____ of the stomach and management of extra-cellular fluid volume and electrolyte balances may improve the patient's condition and avert the need for surgical intervention.

Decompression

Person-to-person transmission of the H. pylori also occurs through close contact and exposure to _____.

Emesis

Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. _____ may re-veal lesions that, because of their size or location, are not evident on x-ray studies.

Endoscopy

TRUE OR FALSE: Explaining diagnostic tests and administering medications as scheduled increases anxiety.

FALSE This helps to reduce anxiety

TRUE OR FALSE: Patients with peptic ulcers are not usually anxious, but when they are their anxiety is obvious

FALSE: Patients with peptic ulcers are usually anxious, and when they are their anxiety is not always obvious.

The patient with _____ may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

GOO

_____ and _____ from peptic ulcer are the two most common causes of upper GI tract bleeding.

Gastritis hemorrhage

______ is not a risk factor for ZES.

H. Pylori

Although __ _____ infection is common in the United States, most infected people do not develop ulcers.

H. pylori

Damage to the gastroduodenal mucosa results in decreased resistance to bacteria, and thus infection from _____ bacteria may occur.

H. pylori

In the past, stress and anxiety were thought to be causes of ulcers, but research has documented that peptic ulcers result from infection with the gram-negative bacteria __ _____.

H. pylori

The goals for medical management of a patient with a peptic ulcer are to eradicate _____ and to manage gastric _____.

H. pylori Acidity

_____ infection may be determined by endoscopy and histologic examination of a tissue specimen obtained by biopsy, or a rapid urease test of the biopsy specimen. Other less invasive diagnostic measures for detecting _____include serologic testing for antibodies against the _____ antigen, stool antigen test, and urea breath test.

H. pylori H. pylori H. pylori

Recurrence of peptic ulcer disease within 1 year may be prevented with the prophylactic use of __ _____ _____ taken at a reduced dose.

H2 receptor antagonists

The ingestion of milk and caffeinated beverages, smoking, and alcohol may increase _____ _____.

HCl secretion

_____, the most common complication of peptic ulcer, occurs in 10% to 20% of patients with peptic ulcers.

Hemorrhage

Potential complications for the patient with peptic ulcer disease may include the following: _____ _____ _____ _____ _____

Hemorrhage Perforation Penetration Pyloric obstruction

After _____, the incidence of peptic ulcers in women is almost equal to that in men.

Menopause

Histamine-2 (H2) receptor antagonists and proton pump inhibitors are used to treat _____-induced ulcers and other ulcers not associated with _____ infection.

NSAID H. pylori

The use of _____ inhibits the secretion of mucus that protects the mucosa.

NSAIDs

Other predisposing factors associated with peptic ulcer include chronic use of _____, _____ ingestion, and excessive _____.

NSAIDs alcohol smoking

Stress and eating spicy foods may make peptic ulcers worse. Familial tendency also may be a significant predisposing factor. People with blood type __ are more susceptible to peptic ulcers than are those with blood type __, __, or __.

O A B AB

_____ is erosion of the ulcer through the gastric serosa into adjacent structures such as the pancreas, biliary tract, or gastrohepatic omentum.

Penetration

_____ _____ disease is relatively uncommon in women of childbearing age, but it has been observed in children and even in infants.

Peptic ulcer

As a rule _____ _____ occur alone, but they may occur in multiples.

Peptic ulcers

_____ is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. It is an abdominal catastrophe and requires immediate surgery.

Perforation

This erosion may extend as deeply as the muscle layers or through the muscle to the _____.

Peritoneum

_____ _____ occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.

Pyloric obstruction, also called gastric outlet obstruction (GOO)

Chronic gastric ulcers tend to occur in the lesser curvature of the stomach, near the _____.

Pylorus

_____ is a burning sensation in the stomach and esophagus that moves up to the mouth.

Pyrosis

_____ is unabsorbed fat in the stool.

Steatorrhea

Usually, the _____ ulceration is preceded by shock. This leads to decreased gastric mucosal blood flow and to reflux of duodenal contents into the stomach. In addition, large quantities of _____ are released.

Stress pepsin

_____ ulcers are clinically different from _____ ulcers and are most common in ventilator-dependent patients after trauma or surgery.

Stress peptic

_____ _____ is the term given to the acute mucosal ulceration of the duodenal or gastric area that occurs after physiologically stressful events, such as burns, shock, severe sepsis, and multiple organ traumas.

Stress ulcer

_____ is usually recommended for patients with intractable ulcers (those that fail to heal after 12 to 16weeks of medical treatment), life-threatening hemorrhage, perforation, or obstruction and for those with ZES that is unresponsive to medications.

Surgery

In treating the patient with pyloric obstruction, what is the first consideration?

The first consideration is to insert an NG tube to decompress the stomach

_____ results from obstruction of the pyloric orifice, caused by either muscular spasm of the pylorus or mechanical obstruction from scarring or acute swelling of the inflamed mucous membrane adjacent to the ulcer.

Vomiting

For patients with _____, hypersecretion of acid may be controlled with high doses of H2 receptor antagonists.

ZES

_____ is suspected when a patient has several peptic ulcers or an ulcer that is resistant to standard medical therapy.

ZES

The _____-_____ _____ (___) consists of severe peptic ulcers, extreme gastric hyper-acidity, and gastrin-secreting benign or malignant tumors of the pancreas.

Zollinger-Ellison syndrome (ZES)

Stools may be tested periodically until they are negative for occult blood. Gastric secretory studies are of value in diagnosing _____ (the absence of free hydrochloric acid in the gastric juice) and _____.

achlorhydria ZES

Peptic ulcers in the body of the stomach can occur without excessive _____ secretion.

acid

The combination of _____, _____, and _____ creates an ideal climate for ulceration. ischemia

acid pepsin

Over secretion of _____ and _____ in the GI tract can be minimized by avoiding extremes of temperature of food and beverage and over stimulation from consumption of meat extracts, alcohol, coffee (including decaffeinated coffee, which also stimulates acid secretion) and other caffeinated beverages, and diets rich in milk and cream (which stimulate acid secretion).

acid hypermotility

Management of the patient with peptic ulcer depends on the amount of blood lost and the rate of bleeding.

amount rate

Currently, the most commonly used therapy for peptic ulcers is a combination of _____, _____ _____ inhibitors, and _____ salts that suppress or eradicate H. pylori.

antibiotics proton pump bismuth

Peptic ulcers treated with _____ to eradicate the _____ bacteria have a lower recurrence rate than those not treated with _____.

antibiotics H. pylori Antibiotics

Pain relief for the patient with peptic ulcer disease can be achieved with prescribed medications, but the patient should avoid aspirin, foods and beverages that contain caffeine, and decaffeinated coffee. In addition, meals should be eaten at regularly paced intervals in a relaxed setting. Some patients benefit from learning _____ _____ to help manage stress and pain.

aspirin caffeine decaffeinated relaxed relaxation techniques

Fifteen percent of patients with peptic ulcer experience _____.

bleeding

The patient usually describes peptic ulcer pain as _____ or _____. It occurs about 2 hours after a meal and frequently awakens the patient between _____ and _____.

burning gnawing midnight 3AM

In a patient with an ulcer, heartburn is often accompanied by sour eructation, or _____, which is common when the patient's stomach is empty.

burping

Because _____ peritonitis develops within a few hours of perforation and is followed by _____ peritonitis, the perforation must be closed as quickly as possible and the abdominal cavity lavaged of stomach or intestinal contents.

chemical bacterial

Patients with peptic ulcers may experience constipation or diarrhea, probably as a result of _____ and _____.

diet Medications

The intent of _____ _____ for patients with peptic ulcers is to avoid over secretion of acid and hypermotility in the GI tract.

dietary modification

Although vomiting is rare in uncomplicated _____ ulcer, it may be a symptom of a complication of an ulcer.

duodenal

Patients with _____ ulcers secrete more acid than normal, whereas patients with _____ ulcers tend to secrete normal or decreased levels of acid.

duodenal gastric

Peptic ulcers are more likely to occur in the _____ than in the _____.

duodenum stomach

A physical examination may reveal pain, epigastric tender-ness, or abdominal distention. A barium study of the upper GI tract may show an ulcer, however, _____ is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions.

endoscopy

The patient may have coexisting parathyroid adenomas or hyperplasia and may therefore exhibit signs of hypercalcemia. The most common symptom of ZES is _____ _____.

epigastric pain

In a patient with an ulcer, sharply localized tenderness can be elicited by applying gentle pressure to the _____ at or slightly to the right of the midline.

epigastrium

The nurse assesses the patient with peptic ulcer for _____ or _____ and _____, which may precede or accompany bleeding. It is important to monitor _____ _____ frequently and to evaluate the patient for _____, _____, and _____.

faintness dizziness nausea vital signs tachycardia hypotension tachypnea

H. pylori may be acquired through ingestion of _____ and _____.

food Water

A peptic ulcer may be referred to as a _____, _____, or _____ ulcer, depending on its location.

gastric duodenal esophageal

ZES is identified by the following: hypersecretion of _____ juice _____ ulcers _____ (islet cell tumors) in the pancreas.

gastric duodenal gastrinomas

(GOO) stands for _____ _____ _____ which is also called _____ _____.

gastric outlet obstruction Pyloric obstruction

Ninety percent of tumors are found in the "_____ _____," which encompasses the cystic and common bile ducts, the second and third portions of the duodenum, and the junction of the head and body of the pancreas.

gastric triangle

Peptic ulcers are found in rare cases in patients with tumors that cause secretion of excessive amounts of the hormone _____.

gastrin

Esophageal ulcers occur as a result of the backward flow of HCl from the stomach into the esophagus otherwise known as _____ _____ _____ _____ (____)

gastro-esophageal reflux disease (GERD)

Peptic ulcers occur mainly in the _____ mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin.

gastroduodenal

Patients at risk for stress ulcers (eg, patients with _____ injury or extensive _____) may be treated prophylactically with IV H2 receptor antagonists and cytoprotective agents (eg, misoprostol, sucralfate) because of the risk of upper GI tract hemorrhage.

head Burns

Other nursing interventions for the patient with peptic ulcer include monitoring the _____ and _____, testing the stool for _____ or _____ blood, and recording hourly urinary output to detect _____ or _____.

hemoglobin hematocrit gross occult anuria oliguria

The erosion is caused by the _____ concentration or activity of acid-pepsin or by _____ resistance of the mucosa.

increased decreased

Patients with peptic ulcers may present with GI bleeding as evidenced by the passage of _____ (tarry stools).

melena

As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the ___-_____ or the _____.

mid-epigastrium Back

A damaged mucosa cannot secrete enough _____ to act as a barrier against HCl.

mucus

Vomiting may or may not be preceded by _____, and usually it follows a bout of severe _____ and _____, which is relieved by vomiting. Emesis often contains undigested food eaten many hours earlier.

nausea pain bloating

Symptoms of _____ include back and epigastric pain not relieved by medications that were effective in the past.

penetration

A _____ _____ is an excavation (hollowed-out area) that forms in the mucosal wall of the stomach, in the pylorus (the opening be-tween the stomach and duodenum), in the duodenum (the first part of the small intestine), or in the esophagus.

peptic ulcer (Fig. 37-2)

There is an association between peptic ulcers and chronic ____ disease or chronic _____ disease.

pulmonary renal

Other ulcer symptoms include _____ (heartburn), _____, ____ or _____, and _____.

pyrosis vomiting constipation diarrhea bleeding

If the patient reports a recent history of vomiting, the nurse determines how often emesis has occurred and notes important characteristics of the vomitus: Is it bright _____, does it resemble _____ _____, or is there _____ food from previous meals?

red coffee grounds undigested

Studies have shown that _____ decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum.

smoking

The likelihood of recurrence is reduced if the patient avoids _____, _____ beverages, _____, and _____ medications like NSAIDs.

smoking caffeinated alcohol ulcerogenic

When the patient with peptic ulcer has a hemorrhage that is small, much or all of the blood is passed in the _____, which appear _____ _____ because of the digested hemoglobin.

stools tarry black

A patient has just had surgery. Fiber-optic endoscopy within 24 hours of trauma or surgery reveals shallow erosions of the stomach wall. By 72 hours, multiple gastric erosions are observed. As the patient's condition continues, the ulcers spread. When the patient recovers, the lesions are reversed. This pattern is typical of _____ ulceration.

stress

Excessive secretion of HCl in the stomach may contribute to the formation of peptic ulcers, and _____ may be associated with its increased secretion.

stress

Reducing _____, _____ cessation, _____ modification, and _____ management are all ways to manage peptic ulcer disease.

stress smoking dietary surgical

A small portion of patients who bleed from an acute ulcer have very mild _____ or none at all.

symptoms

Research indicates that continued smoking may significantly inhibit _____ _____.

ulcer repair

Signs and symptoms of perforation include the following: Sudden, severe _____ abdominal pain _____ _____ (fainting) Extremely tender and rigid (boardlike) _____ _____ and _____, indicating shock

upper Vomiting Collapse Abdomen Hypotension tachycardia

Usually after aspirating a residual of more than 400 mL from the NG tube, an _____ __ _____ or _____ is performed to confirm pyloric obstruction.

upper GI study endoscopy

Surgical procedures for ulcers include _____ (transecting nerves that stimulate acid secretion) with or without _____ (opening the pylorus), and _____ (removal of the antrum [pyloric portion of the stomach] with anastomosis to either the duodenum or jejunum.

vagotomy pyloroplasty antrectomy