Exam 4 Nurs 160 Peptic Ulcer
What are the treatments for PUD? Medical? Nursing?
Treatment for peptic ulcers depends on the cause. Treatments can include: Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. You'll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid. Medications that block acid production and promote healing. Proton pump inhibitors reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix). Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk. Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing. Available by prescription or over-the-counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) and nizatidine (Axid). Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients. Antacids can provide symptom relief, but generally aren't used to heal your ulcer. Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine. Options include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec). Another nonprescription cytoprotective agent is bismuth subsalicylate (Pepto-Bismol). Follow-up after initial treatment Treatment for peptic ulcers is often successful, leading to ulcer healing. But if your symptoms are severe or if they continue despite treatment, your doctor may recommend endoscopy to rule out other possible causes for your symptoms. If an ulcer is detected during endoscopy, your doctor may recommend another endoscopy after your treatment to make sure your ulcer has healed. Ask your doctor whether you should undergo follow-up tests after your treatment. Ulcers that fail to heal Peptic ulcers that don't heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal. These reasons may include: Not taking medications according to directions. The fact that some types of H. pylori are resistant to antibiotics. Regular use of tobacco. Regular use of pain relievers that increase the risk of ulcers. Less often, refractory ulcers may be a result of: Extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome An infection other than H. pylori Stomach cancer Other diseases that may cause ulcer-like sores in the stomach and small intestine, such as Crohn's disease Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with using different antibiotics.
Patient Education
You may find relief from the pain of a stomach ulcer if you: Choose a healthy diet. Choose a healthy diet full of fruits, vegetables and whole grains. Not eating vitamin-rich foods may make it difficult for your body to heal your ulcer. Consider switching pain relievers. If you use pain relievers regularly, ask your doctor whether acetaminophen (Tylenol, others) may be an option for you. Control stress. Stress may worsen the signs and symptoms of a peptic ulcer. Examine your life to determine the sources of your stress and do what you can to address those causes. Some stress is unavoidable, but you can learn to cope with stress with exercise, spending time with friends or writing in a journal. Don't smoke. Smoking may interfere with the protective lining of the stomach, making your stomach more susceptible to the development of an ulcer. Smoking also increases stomach acid. Limit or avoid alcohol. Excessive use of alcohol can irritate and erode the mucous lining in your stomach and intestines, causing inflammation and bleeding.
What are the complications of PUD?
Complications of peptic ulcer may include bleeding, perforation, penetration, or obstruction. Bleeding Peptic ulcers sometimes bleed. Sometimes an ulcer may involve just the surface lining of the digestive tract. The person may then have a slow but constant loss of blood into the digestive tract. Over time, anemia may develop because of this slow blood loss. If ulcers become larger and extend deeper into the digestive tract lining, they may damage large blood vessels, resulting in sudden, serious bleeding into the intestinal tract. This can be very dangerous. Without prompt medical treatment to stop the bleeding, a person could bleed to death. Blood transfusions often are needed when serious bleeding occurs. If you are vomiting blood and/or material that looks like coffee grounds, or if you have stools that are black, look like tar, or are maroon or bloody, see a doctor immediately. The chances of successfully treating your ulcer are best if you see a doctor when you first notice any bleeding. Perforation Perforation occurs when an ulcer eats through the wall of the stomach or intestine into the abdominal (belly) cavity. Although perforation is a much less frequent complication than bleeding, it is still a significant problem in people who have unsuspected or untreated peptic ulcers. As people use more nonsteroidal anti-inflammatory drugs (NSAIDs), the incidence of perforation is increasing. When perforation occurs, partially digested food, bacteria, and enzymes from the digestive tract may spill into the belly cavity, causing inflammation and infection (peritonitis). Peritonitis usually causes sudden and severe pain. Treatment usually requires urgent hospitalization and surgery.
How are Gastric Ulcers and Duodenal Ulcers Diagnosed?
In order to detect an ulcer, you may have to undergo diagnostic tests, such as: Tests for H. pylori Your doctor may recommend tests to determine whether the bacterium H. pylori is present in your body. Tests can test for H. pylori using your: Blood Breath Stool Which type of test you undergo depends on your situation. For the breath test, you drink or eat something that contains radioactive carbon. H. pylori breaks down the substance in your stomach. Later, you blow into a bag, which is then sealed. If you're infected with H. pylori, your breath sample will contain the radioactive carbon in the form of carbon dioxide. Using a scope to examine your upper digestive system (endoscopy) During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus, stomach and small intestine. Using the endoscope, your doctor looks for ulcers. If your doctor detects an ulcer, small tissue samples (biopsy) may be removed for examination in a lab. A biopsy can also identify the presence of H. pylori in your stomach lining. Your doctor is more likely to recommend endoscopy if you are older, have signs of bleeding, or have experienced recent weight loss or difficulty eating and swallowing. X-ray of your upper digestive system Sometimes called a barium swallow or upper gastrointestinal series, this series of X-rays creates images of your esophagus, stomach and small intestine. During the X-ray, you swallow a white liquid (containing barium) that coats your digestive tract and makes an ulcer more visible.
How can you prevent PUD?
Life style changes. See Patient Education Tips.
What are signs/ Symptoms of PUD?
No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Most ulcers are caused by an infection with a type of bacteria called Helicobacter pylori (H. pylori). Factors that can increase your risk for ulcers include: Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, some types of Midol, and others), and many others available by prescription; even safety-coated aspirin and aspirin in powered form can frequently cause ulcers. Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output (seen in Zollinger-Ellison syndrome) Excessive drinking of alcohol Smoking or chewing tobacco Serious illness Radiation treatment to the area
What is PUD : Peptic Ulcer Disease?
Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum. What Causes Ulcers? No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Most ulcers are caused by an infection with a type of bacteria called Helicobacter pylori (H. pylori).
Identify the differences between a gastric ulcer and a duodenal ulcer.
There are two different types of peptic ulcers. They are: Gastric ulcers, which form in the lining of the stomach. Duodenal ulcers, which form in the upper small intestine. Both types of peptic ulcers are most commonly caused either by infection with Helicobacter pylori (H. pylori) bacteriaHelicobacter pyloriH. pylori or by frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs). The symptoms of gastric ulcers and duodenal ulcers are similar, except for when pain occurs. Pain from a gastric ulcer often occurs when food is still in the stomach, shortly after eating. Pain from a duodenal ulcer often occurs when the stomach is empty, several hours after eating, and may improve after eating. Pain also may wake you in the middle of the night. Symptoms alone cannot be used to distinguish a gastric ulcer from a duodenal ulcer. Tests such as an endoscopy or an upper gastrointestinal (UGI) series may need to be used to find out the location of an ulcer. Gastric ulcers often heal more slowly than duodenal ulcers. A gastric ulcer that does not respond to treatment could be cancer. Your doctor will most likely recommend a biopsy of a gastric ulcer before beginning treatment. The biopsy will make sure there is no cancer hiding in the ulcer.
