Peptic Ulcer Disease

Zollinger-Ellison syndrome

hypersecretion of gastric acid that produces peptic ulcers as a result of a non-beta-cell tumor of the pancreatic islets

Pyloric obstruction

the blocking or narrowing of the opening between the stomach and the duodenum

Sequence of events from the causative agent to ulceration in which order?

1. The causative agent is introduced into the gastrointestinal tract (i.e., H. pylori infection) 2. These bacteria break down the mucosal barrier 3. This allows acid to enter the mucosal cells 4. Then destroy the mucosal cells. 5. Next, this causes an increased release of acid and pepsin 6. Which destroy the blood vessels 7. And cause ulceration.

Which medications relieve gastric ulcer pain through their effects on afferent pain fiber transmission? Select all that apply. 1 Tofranil 2 Bismuth 3 Doxepin 4 Misoprostol 5 Pantoprazole

1.3. Tofranil and doxepin are TCAs that provide overall pain relief through their effects on afferent pain fiber transmission. NOT 2. Bismuth is included in quadruple-drug therapy for the treatment of Helicobacter pylori (H. pylori) infection 4. Misoprostol is prescribed to prevent gastric ulcers caused by NSAIDs and aspirin 5. Pantoprazole reduces hydrochloric acid secretion

Which complication would the nurse suspect due to a patient's loss of intrinsic factor after gastrectomy? 1 Bile reflux gastritis 2 Pernicious anemia 3 Dumping syndrome 4 Postprandial hypoglycemia

2. Pernicious anemia is a complication that occurs in a patient after undergoing a partial gastrectomy. It occurs due to loss of intrinsic factor, which is required to produce vitamin B12. NOT 1. Bile reflux gastritis occurs as a complication of gastric surgery of the pylorus 3. Dumping syndrome occurs as a complication after surgical removal of the stomach and pylorus 4. Postprandial hypoglycemia is a variant of dumping syndrome that occurs due to uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestine.

Which procedure involves severing a nerve for a patient with a peptic ulcer that is unresponsive to medical management? 1 Billroth I 2 Billroth II 3 Vagotomy 4 Pyloroplasty

3. A vagotomy is the severing of the vagus nerve either totally (truncal) or selectively (highly selective vagotomy). These procedures are done to decrease gastric acid secretion

Which diagnostic test is best suited to help identify gastric outlet obstruction? 1 Endoscopy 2 Urea breath test 3 Rapid urease testing 4 Barium contrast study

4. A barium contrast study is used to diagnose gastric outlet obstruction in patients with peptic ulcer disease. NOT 1. An endoscopy is performed to determine the degree of ulcer healing after the treatment of ulcer 2. A urea breath test is a noninvasive method used to detect active infection 3. Rapid urease testing is used to check for a Helicobacter pylori infection.

Serum Amylase (blood test)

An enzyme produced in the pancreas and salivary glands; helps to digest carbohydrates. Expected range 30-220 units/L Elevated levels: Caused by pancreatitis, pancreatic cancer, cholecystitis, or salivary gland infection.

Bile salts

Bile salts (cholesterol derived) break down larger fat globules in food into small droplets of fat. Smaller fat droplets are easier for the digestive enzymes from the pancreas to process and break down. The bile salts also help the cells in the bowel to absorb these fat droplets

Prostaglandins (PGs) function

Necessary for secretion of protective gastric mucus Group of lipids made at sites of tissue damage or infection that are involved in dealing with injury and illness. They control processes such as inflammation, blood flow, the formation of blood clots and the induction of labour

Duodenal ulcer: Pain location /characteristic / onset

The discomfort generally associated with gastric ulcers is located high in the epigastrium and occurs about one to two hours after meals. The pain is described as "burning" or "gaseous." A patient with a gastric ulcer will experience pain one to two hours after meals. If the ulcer has eroded through the gastric mucosa, food tends to aggravate rather than alleviate the pain. For some patients, the earliest symptoms are caused by a serious complication, such as perforation.

gastric emptying

the process by which food leaves the stomach and enters the small intestine

Bile reflux gastritis

- Surgery involves the pylorus --> reflux of bile into the stomach CONTINUOUS EPIGASTRIC DISTRESS, OCCURS AFTER A MEAL - Prolonged exposure to bile damage to gastric mucosa, chronic gastritis, & recurrence of PUD cholestyramine (Questran)

Which medications increase the risk of ulcer development? Select all that apply. 1 Aspirin 2 Misoprostol 3 Bethanechol 4 Corticosteroids 5 Metoclopramide

1. 4. Aspirin and corticosteroids are ulcerogenic drugs that inhibit the synthesis of prostaglandins, increase gastric acid secretion, and reduce the integrity of the mucosal barrier. These medications increase the risk of ulcer development. NOT 2. Prevent gastric ulcers caused by NSAIDs 3. Can stimulate the lower GI tract, producing defecation 4. Can treat GERD. It can also treat gastroparesis (delayed gastric emptying) in patients with diabetes

Which characteristics are common with gastric ulcers? Select all that apply. 1 Lesions are superficial. 2 They predominantly occur in antrum. 3 They cause increased gastric secretion. 4 They cause pain one to two hours after meals. 5 They manifest as burning, cramping midepigastric pain.

1. Gastric ulcer lesions are superficial, round, oval, or cone shaped. 2. 4. They predominantly occur in antrum (portion before the outlet, which is lined by mucosa and does not produce acid) and cause pain one to two hours after meals. NOT 3. Gastric ulcers decrease gastric secretion, whereas duodenal ulcers increase gastric secretion 5. In gastric ulcers, there is a burning, cramping pain in the high left epigastrium.

Which histamine-receptor blocker is available only for oral administration? 1 Nizatidine 2 Ranitidine 3 Cimetidine 4 Famotidine

1. Nizatidine (H2 blocker) is available only for oral administration but not for IV administration; the medication is used to promote ulcer healing. NOT 2.3.4. Ranitidine, cimetidine, and famotidine are histamine (H2) blockers that can be given orally or through IV.

Which medication's action reduces hydrochloric acid (HCl) secretion? 1 Ranitidine 2 Sucralfate 3 Tetracycline 4 Aluminum hydroxide gel

1. Ranitidine (histamine-receptor blocker) reduces HCl secretions by blocking histamine, a hormone responsible for HCl secretion. NOT 2. Sucralfate acts by forming a protective layer around the ulcer and serves as a barrier against acid, bile salts, and enzymes in the stomach. 3. Tetracycline is an antibiotic prescribed concurrently with proton pump inhibitors 4. Aluminum hydroxide gel is an antacid that neutralizes gastric HCl secretion.

The nurse is caring for a patient with suspected posterior duodenal ulcer penetration of the pancreas. Which laboratory study would diagnose the patient's condition? 1 Liver enzyme studies 2 Serum amylase determination 3 Complete blood count (CBC) test 4 Serum gastrin level determination

2. Serum amylase determination is done to determine pancreatic function in a patient with suspected posterior duodenal ulcer penetration of the pancreas NOT 1. Liver enzyme studies are performed to detect any liver problems that may complicate ulcer healing 3. CBC test may indicate anemia secondary to ulcer bleeding 4. Serum gastrin levels are used to determine possible gastritis.

Which enzyme activates the immune response to Helicobacter pylori with antibody production and the release of inflammatory cytokines? 1 Pepsin 2 Urease 3 Bile salts 4 Serum amylase

2. Urease activates the immune response with body antibody production and the release of inflammatory cytokines, resulting in mucosal edema NOT 1. Pepsin is an enzyme released in the stomach that degrades food particles into peptides 3. Bile salts are released by liver cells, which bind with cholestyramine and cause gastric irritation 4. Serum amylase levels determine pancreatic function

Two days after a patient has had gastric surgery, the nurse suspects that the patient's nasogastric tube is not in the correct position. Which action would the nurse take? 1 Remove the tube and insert a new nasogastric tube. 2 Notify the health care provider immediately. 3 Monitor for evidence of local inflammation and edema. 4 Irrigate the nasogastric tube with NS solution.

2. because there is a danger of either perforation of the gastric mucosa or a disruption of the suture line NOT 1. The nurse should not remove or insert a new tube without the order of the primary health care provider. 3. Monitoring for the symptoms of edema and inflammation delays action and will put the safety of the patient at risk 4. Irrigating the tube with normal saline solution is helpful in preventing tube clogging, but if the tube is malpositioned, the irrigation might cause additional injury

Which entries in a patient's list of current medications would indicate specific treatment for Helicobacter pylori (H. pylori)? Select all that apply. 1 Cimetidine 2 Amoxicillin 3 Famotidine 4 Omeprazole 5 Clarithromycin

2.5. Antibiotics such as amoxicillin and clarithromycin are used to treat H. pylori infection, which is a common cause of peptic and duodenal ulcers. NOT 1.3. Cimetidine and famotidine are histamine-receptor blockers that decrease acid production 4. Omeprazole reduces gastric secretion.

The nurse is completing a health history on a patient diagnosed with peptic ulcer disease. Which questions would the nurse ask to assess the patient's cognitive-perceptual health pattern? Select all that apply. 1 "Do you experience hematemesis?" 2 "Do you have any black, tarry stools?" 3 "Do you experience any nocturnal pain?" 4 "Do you experience epigastric pain after eating?" 5 "Do you have a family history of peptic ulcer disease?"

3. 4. While assessing the effect of peptic ulcer disease on a patient's cognitive-perceptual pattern, the appropriate questions to ask are whether the patient has experienced any nocturnal pain and epigastric pain 1-2hrs PC NOT 1. determines the nutritional-metabolic pattern in the patient. 2. Assesses the elimination pattern in the patient 5. helps assess the patient's health history

Which surgical procedure involves the removal of two-thirds of the stomach and anastomosis of the gastric stump to the duodenum? 1 Vagotomy 2 Pyloroplasty 3 Billroth I operation 4 Billroth II operation

3. A Billroth I operation, also known as a gastroduodenostomy, is a partial gastrectomy in which the distal two thirds of the stomach is removed and there is an anastomosis of the gastric stump to the duodenum. NOT 1. A vagotomy is the severing of the vagus nerve totally or selectively (done to decrease gastric acid secretion). 2. A pyloroplasty is the surgical enlargement of the pyloric sphincter (opening that allows passage of food from stomach into small intestine) in order to facilitate easy passage of contents from the stomach 4. A Billroth II operation is called a gastrojejunostomy; it is the removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the jejunum.

Which therapy is used to treat pyloric obstruction? 1 Vagotomy 2 Gastrojejunostomy 3 Endoscopic dilation 4 Gastroduodenostomy

3. An endoscopy with balloon dilations is used in the treatment of pyloric obstruction. NOT 1. the severing of the vagus nerve either totally or selectively to decrease gastric acid secretion 2. A gastrojejunostomy (Billroth II) involves a partial gastrectomy with removal of two thirds of the stomach and an anastomosis of the gastric stump to the jejunum 4. Gastroduodenostomy (Billroth I) is a partial gastrectomy with removal of two thirds of the stomach and an anastomosis of the gastric stump to the duodenum.

The nurse is connecting a nasogastric (NG) tube to suction for a patient who underwent abdominal surgery. Which treatment would the nurse expect to continue? 1 Adjuvant therapy 2 Triple-drug therapy 3 IV therapy 4 Cobalamin replacement therapy

3. IV therapy includes adding potassium and vitamin supplements to the infusion until oral feedings are resumed. NOT 1. Adjuvant therapy includes surgical resection and chemotherapy for stomach cancer 2. Triple-drug therapy that includes PPI, amoxicillin, and clarithromycin is prescribed for H pylori infection 4. Cobalamin (Vitamin B12) replacement therapy is prescribed for pernicious anemia (can be r/t stomach lining which helps absorb B12).

A patient reports pain in the upper abdomen after eating. The health records indicate that the patient recent underwent pyloric valve surgery. Which medication would the nurse expect the health care provider will prescribe? 1 Fluticasone 2 Misoprostol 3 Cholestyramine 4 Isosorbide dinitrate

3. Pain in the upper abdomen after eating is known as epigastric distress. It occurs due to reflux of bile into the stomach in patients who underwent gastric surgery involving the reconstruction or removal of the pylorus. Cholestyramine is a bile acid sequestrant that binds bile in the gastrointestinal tract to prevent its reabsorption. NOT 1. Fluticasone is a corticosteroid used to treat eosinophilic esophagitis 2. Misoprostol is used to treat gastric ulcers caused by NSAIDs and aspirin. 4. Isosorbide dinitrate is used to treat dysphagia.

The nurse is caring for a patient with peptic ulcer disease. On a follow-up visit, the health care provider identifies spillage of gastric contents into the space between the abdominal cavity and the abdominal wall. Which complication may occur if the condition is untreated? 1 Pernicious anemia 2 Bile reflux gastritis 3 Bacterial peritonitis 4 Postprandial hypoglycemia

3. Spillage of gastric contents into the peritoneal cavity occurs in perforation postoperation of peptic ulcer disease. If the condition is untreated, bacterial infection can occur in the abdominal cavity and result in bacterial peritonitis. NOT 1. Pernicious anemia is a long-term complication of partial or total gastrectomy that occurs due to loss of intrinsic factor 2. Bile reflux gastritis is a complication of abdominal surgery of pylorus and is characterized by epigastric distress. 4. Postprandial hypoglycemia obstruction occurs as a complication after peptic ulcer disease surgery.

The patient with peptic ulcer disease is taking sucralfate. Which outcome would the nurse anticipate? 1 Healing of ulcer 2 Reduction in acid secretion 3 Protection of ulcer from acids 4 Neutralization of gastric acid secretion

3. Sucralfate acts by forming a protective layer around an ulcer that serves as a barrier against acid, bile salts, and enzymes in the stomach NOT 1. Histamine blockers are used to promote ulcer healing. 2. PPIs such as omeprazole reduce gastric acid secretion 4. Antacids increase gastric pH and neutralize gastric acid secretion.

A patient with a peptic ulcer begins vomiting. Which type of vomitus is associated with bleeding in the stomach? 1 Fecal 2 Bilious 3 "Coffee ground" 4 Undigested food

3. The appearance of blood exposed to hydrochloric acid and other digestive enzymes in the stomach is dark brown with a coffee-ground consistency. This should be reported by the nurse. NOT 1. Fecal vomitus would be experienced with a total bowel obstruction 2. 4. Bilious vomitus or undigested food may be seen with various GI disturbances, such as gallbladder disease, gastroenteritis, or gastritis.

A patient reports gastric distress that occurs two to five hours after meals, with "burning" and "cramping" pain just below the xiphoid process. Which disorder would the nurse suspect that the patient may have? 1 Esophagitis 2 Gastric ulcer 3 Duodenal ulcer 4 Chronic gastritis

3. The symptoms of duodenal ulcers occur when gastric acid comes in contact with the ulcers. With meal ingestion, food is present to help buffer the acid. Symptoms of duodenal ulcers occur generally 2-5hrs after a meal. The pain is described as "burning" or "cramplike." It is most often located in the midepigastric region beneath the xiphoid process. Duodenal ulcers also can produce back pain. NOT 1.2.4. Pain and burning two to five hours after meals are not symptoms of esophagitis or chronic gastritis.

Following a gastrectomy performed for peptic ulcer disease, the patient is ready for discharge. Which instructions would the nurse include in discharge teaching? 1 Take fluids along with meals. 2 Reduce protein and fats in the diet. 3 Divide meals into six small feedings. 4 Use concentrated sweets like honey, jam, and jelly.

3. To prevent dumping syndrome after gastrectomy, pt should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. NOT 1. Fluids should not be taken with meals (taken at least 30 to 45 minutes before or after meals) 2. should be increased (helps rebuild body tissue and to meet energy needs) 4. Concentrated sweets should be avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness.

The nurse is caring for a patient with suspected stress-related mucosal disease (SRMD). Which medication would be administered to neutralize gastric acid? 1 Ranitidine 2 Amoxicillin 3 Pantoprazole 4 Aluminum hydroxide

4. Aluminum hydroxide helps treat SRMD by decreasing basal acid secretions and secretions stimulated by histamine NOT 1. basal acid secretions and secretions stimulated by histamine. Ranitidine is a H-receptor blocker, which can be concurrently used with antacids to treat duodenal ulcers 2. Amoxicillin is included in triple-drug therapy to treat Helicobacter pylori (H. pylori) infection. 3. Pantoprazole is a PPI used concurrently with antibiotics to treat H. pylori infection

Which medication for peptic ulcer disease may cause hallucinations? 1 Nizatidine 2 Sucralfate 3 Omeprazole 4 Metoclopramide

4. Metoclopramide is a prokinetic agent that causes central nervous system side effects such as hallucinations and anxiety NOT 1. Nizatidine is a histamine (H2) receptor blocker that causes abdominal pain, headache, diarrhea, and constipation 2. Sucralfate is an antiulcer medication that causes constipation 3. Omeprazole is a PPI that causes nausea, abdominal pain, headache, diarrhea, and flatulence.

Which drug increases production of gastric mucus? 1 Tofranil 2 Sucralfate 3 Cimetidine 4 Misoprostol

4. Misoprostol, a synthetic prostaglandin analog prescribed to prevent gastric ulcers caused by NSAIDs, increases production of gastric mucus and mucosal secretion of bicarbonate. NOT 1. Tofranil is a tricyclic antidepressant that provides pain relief in peptic ulcer disease 2. Sucralfate forms a protective layer and serves as a barrier against acids, bile salts, and enzymes 3. Cimetidine is a histamine blocker that provides ulcer healing.

Which complication would the nurse anticipate for an older adult patient taking nonsteroidal antiinflammatory drugs (NSAIDs)? 1 Achalasia 2 Duodenal ulcer 3 Stomach cancer 4 Silent peptic ulcer

4. Silent peptic ulcers show no symptoms of ulcer disease until the presentation of their final, fatal illness. The ulcers occur in older patients or patients who take NSAIDs NOT 1. Achalasia is a primary motility disorder characterized by the absence of peristalsis and impaired relaxation of the lower esophageal sphincter (LES) in response to swallowing 2. Duodenal ulcers occur due to excessive alcohol ingestion and smoking that result in increased hydrochloric acid secretion 3. Stomach cancer begins with a nonspecific mucosal injury as a result of infection, autoimmune-related inflammation, and tobacco use.

A patient with severe burns is admitted in an emergency department. Which condition would the nurse suspect as a high risk for this patient? 1 Bile reflux gastritis 2 Dumping syndrome 3 Zollinger-Ellison syndrome 4 Stress-related mucosal disease

4. Stress-related mucosal disease, or physiologic stress ulcers, is a condition observed in patients with severe burns or trauma or major surgery. Patients with coagulopathy are at a high risk for stress-related mucosal disease NOT 1. Bile reflux gastritis is a complication associated with gastric surgery in which bile is refluxed into the stomach 2. Dumping syndrome is a postoperative complication of gastrectomy that involves weakness, sweating, dizziness, and palpitations 15 to 30 minutes after eating 3. Zollinger-Ellison syndrome involves severe peptic ulceration and hydrochloric acid secretion.

Which condition can be diagnosed by measuring fasting serum gastrin levels? 1 Acute gastritis 2 Pyloric obstruction 3 Gastric outlet obstruction 4 Zollinger-Ellison syndrome

4. Zollinger-Ellison syndrome can be diagnosed by measuring fasting serum gastrin levels, which will determine the amount of gastrin secreted by G cells of the stomach. Involves severe peptic ulceration and hydrochloric acid secretion. NOT 1. Acute gastritis is diagnosed by endoscopic examination with biopsy 2. Pyloric obstruction is diagnosed by performing an endoscopy with dilated balloons 3. Gastric outlet obstruction is diagnosed by performing a barium contrast study.

Which manifestations of peptic ulcer disease generally occur first in an older adult? Select all that apply. 1 Indigestion 2 Abdominal pain 3 Abdominal sounds 4 Frank gastric bleeding 5 Decrease in hematocrit

4.5. Frank gastric bleeding and a decrease in hematocrit are often the first clinical manifestations of peptic ulcer disease in elderly patients. NOT 1.2. Indigestion and abdominal pain are the clinical manifestations of stomach cancer 3. Abdominal sounds are the clinical manifestations of dumping syndrome, a complication of peptic ulcer disease surgery.

Dumping syndrome

A group of symptoms, including weakness, abdominal discomfort, and sometimes abnormally rapid bowel evacuation, occurring after meals in some patients who have undergone gastric surgery.

Gastroenteritis VS Gastritis

Gastroenteritis is inflammation (irritation) of the stomach and bowel, caused by an infection. Gastritis is inflammation of the stomach lining specifically, and not always caused by infection.

Vagus nerve

The tenth cranial nerve that innervates digestive organs, heart and other areas To test the vagus nerve, one can check the gag reflex

Gastric Outlet Obstruction (GOO)

any condition that mechanically impedes normal ; there is obstruction of the channel of the pylorus and duodenum through which the stomach empties