Causes/risk factors for PUD?
- Infection from Helicobacter pylori
- Excessive secretion of HCL (r/t stress (life, hospitilization, sepsis), milk, caffinated beverages, smoking, ETOH
Chronic use of:
-NSAID’s
-ETOH
-Excessive smoking
? Familial tendency
? People with Type O bloodIn which population does PUD NOT generally occur?
Women of childbearing age
How does NSAIDs contribute to formation of PUD?
-NSAID inhibit the secretion of mucous to protect the gastric mucosal layer.
How is H pylori spread?
Food + water
-Can also be caused through person-person transmission of the bacteria (close contact and exposure to emesis)
Do all of those infected with H Pylori get ulcers?
NO
- more than 50% of the worlds’ population harbor H. Pylori in their upper GI tract
- 80% of people are asymptomatic (?may play a role in natural stomach ecology)
- It is not known why HP infection does not cause ulcers in all people
- most likely, predisposition to ulcer formation depends on certain factors like type of HP
WHere in the world is infection with H pylori more prevalent?
in developing countries
How does a urea breath test work?
-based upon the ability of HP to convert urea to ammonia and CO2; pt swallow urea labelled with an uncommon isotope (radioactive carbon-14 or non-radioactive carbon-13 10-30 minutes: detection of isotope-labelled CO2 in breath indicates the urea was split indicates that urease (enzyme that HP uses to metabolize urea) is present in the stomach HP bacteria are present
How is PUD treated?
Treatment: one week “triple therapy” consisting of PPI (omeprazole); and antibiotics clarithromycin and amoxicillin (or metronidazole for pen allergies)
Clinical manifestations of PUD?
- Symptoms may differ depending on the location of the ulcer (duodenal vs gastric)
- Pain (or not, dull or burning)
- Pyrosis (heartburn)
- Eructation (burping)
- Vomiting
- Constipation
- Diarrhea
- Bleeding (occult and/or melena)
Assessments for pt with PUD?
Does the patient have any history of potential causes/risk factors? RQRST related to pain? Medications (prescribed and OTC)
- describe pain and methods to relieve pain
- characteristics of vomitus (?red; ?coffee grounds)
- 24hour diet record/food habits
- lifestyle habits (?smoking; ?NSAID’s; ?stress)
- palpate for localized tenderness
What would you potentially find or not during the physical assessment?
-Episgastric tenderness, abdo distention; tachycardia/hypotension (?anemia from GI bleeding)
Labs important in PUD?
Hgb for bleeding (platelets, ptt PTINR)
Na, K, renal function for vomiting/diarrhea ,decreased oral intake, medication use
Key aspects of medical management of PUD?
What meds, lifestyle changes, sx
Medications: antibiotics, proton pump inhibitors, bismuth salts, histamine 2 receptor antagonists (adherence to regime important)
Lifestyle changes: stress reduction, dietary changes, smoking cessation
Surgical intervention: for intractable ulcers, life threatening haemorrhage, perforation or obstruction
4 main potential problems for PUD?
hemmorrhage
- perforation
- penetration
- pyloric obstruction
Key planning/goals for nursing intervention in PUD?
- relief of pain
- reduce anxiety
- maintenance of nutritional requirements
- knowledge about management and prevention of ulcer recurrence
- absence of complications
Goals in changing diet with pUD?
- Avoid over-secretion of acid
- Minimize hypermotility
What ending indicates a proton pump inhibitor?
-prazole
Pantoprazole (Pantoloc) Esomeprazole (Nexium) Lansoprazole (Prevacid) Omeprazole (Losec) Rabeprazole (Pariet EC)
PPIs
New or old?
What are they used for?
What do they do?
Relatively new
Widely used for the treatment of PUD and GERD
Block the gastric proton pump found in the gastric parietal cells targets the terminal step in acid production
Example: Omeprazole (Losec)
H2RA
How do they work?
When are they used?
H2 receptors are responsible for increasing acid secretion in the stomach
Effective at suppressing the volume/acidity of stomach acid
Also used pre-operatively
Example: Ranitidine (Zantac)
H2RA
What kind of dietary consideration is required for these drugs?
Other adverse effects?
can cause Vitamin B12 deficiency (stomach acid helpful in absorption)
- MS changes in elderly
- can also cause UTOX to come back positive for amphetamines!
Antacids
What are they made from?
Examples?
Made from: aluminum/magnesium/calcium/potassium/sodium hydroxide or bicarbonate
Example: Maalox; MOM; TUMS
Maalox = Aluminum bicarbonate
MOM = Magnesium hydroxide
Tums = Calcium carbonate
Pink Lady – Maalox and viscous xylocaine Why use it?
used for GERD in an acute pain episode, not given routinely.
xylocaine = lidocaine = anesthetic
Who are antacids contraindicated in? Which are less harmful in this regard?
-contraindicated for people with renal failure (aluminum may accumulate to toxic levels)
–calcium based formulas pose less risk
What antibiotics are used in PUD?
Carithromycin and amoxicillin (or metronidazole for penicillin allergies)
