PEPTIC ULCER DISEASE

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PEPTIC ULCER DISEASE:

PEPTIC ULCER DISEASE KIRAN RANDHAWA ARMY COLLEGE OF NURSING

INTRODUCTION:

INTRODUCTION PUD is most common ulcer of G.I Tract. Extremly painful. Caused by H.Pylori and Some drugs

DUODENAL ULCER:

DUODENAL ULCER Duodenal sites are 4x as common as gastric sites Most common in middle age peak 30-50 years Male to female ratio—4:1 Genetic link: 3x more common in 1 st degree relatives More common in patients with blood group O Associated with increased serum pepsinogen H. pylori infection common up to 95% Smoking is twice as common

GASTRIC ULCERS:

GASTRIC ULCERS common in late middle age incidence increases with age Male to female ratio—2:1 More common in patients with blood group A Use of NSAIDs - associated with a three- to four-fold increase in risk of gastric ulcer Less related to H. pylori than duodenal ulcers – about 80% 10 - 20% of patients with a gastric ulcer have a concomitant duodenal ulcer

DEFINITION:

DEFINITION A circumscribed ulceration of G.I mucosa occuring in areas exposed to pepsin and acid and most often caused by H. pylori It is defined as the erosion of mucosal layer equal to or >.5cm that leads to bleeding and pain.

CLASSIFICATION:

CLASSIFICATION By region/location. By modified johnson classification.

CONT…..:

CONT….. By Region/location Duodenum Esophagus Stomach

CONT……:

CONT…… Modified johnson classification Type –l type- ll Type- lll Type-IV Type-V

CAUSES:

CAUSES Infection Status and poor hygiene Drugs Zollinger ellison disease Spicy food Gastritis Alcohol consumption Stress

CLINICAL MANIFESTATIONS:

CLINICAL MANIFESTATIONS abdominal pain bloating and abdominal fullness; W aterbrash Nausea , and copious vomiting; Loss of appetite and weight loss; hematemesis . melena Rarely , an ulcer can lead to a gastric or duodenal perforation, which leads to acute peritonitis. This is extremely painful and requires immediate surgery.

DIAGNOSIS:

DIAGNOSIS History Lab investigation Endoscopy Barium contrast x- rays Breath test

DIFFERENTIAL DIAGNOSIS:

DIFFERENTIAL DIAGNOSIS Gastritis Stomach cancer GERD Pancreatitis Hepatic conjestion Biliary colic Inferior myocardial infarction

TREATMENT:

TREATMENT Antiulcer and Antisecretory drugs. Bismuth compounds Antibiotics Syp Sucralfate

DRUG THERAPY:

DRUG THERAPY Medications: Triple therapy for 14 days is considered the treatment of choice. Proton Pump Inhibitor + clarithromycin and amoxicillin Omeprazole ( Prilosec ): 20 mg PO bid for 14 d or Lansoprazole ( Prevacid ): 30 mg PO bid for 14 d or Rabeprazole ( Aciphex ): 20 mg PO bid for 14 d or Esomeprazole ( Nexium ): 40 mg PO qd for 14 d plus Clarithromycin ( Biaxin ): 500 mg PO bid for 14 and Amoxicillin ( Amoxil ): 1 g PO bid for 14 d

SURGERY:

SURGERY People who do not respond to medication, or who develop complications: Vagotomy - cutting the vagus nerve to interrupt messages sent from the brain to the stomach to reducing acid secretion. Antrectomy - remove the lower part of the stomach ( antrum ), which produces a hormone that stimulates the stomach to secrete digestive juices. A vagotomy is usually done in conjunction with an antrectomy . Pyloroplasty - the opening into the duodenum and small intestine (pylorus) are enlarged, enabling contents to pass more freely from the stomach. May be performed along with a vagotomy .

COMPLICATIONS:

COMPLICATIONS Perforation & Penetration—into pancreas, liver and retroperitoneal space Peritonitis Bowel obstruction, Gastric outflow obstruction, & Pyloric stenosis Bleeding--occurs in 25% to 33% of cases and accounts for 25% of ulcer deaths. Gastric CA

PREVENTION:

PREVENTION Consider prophylactic therapy for the following patients: Pts with NSAID-induced ulcers who require daily NSAID therapy Pts older than 60 years Pts with a history of PUD or a complication such as GI bleeding Pts taking steroids or anticoagulants or patients with significant comorbid medical illnesses Prophylactic regimens that have been shown to dramatically reduce the risk of NSAID-induced gastric and duodenal ulcers include the use of a prostaglandin analogue or a proton pump inhibitor. Misoprostol ( Cytotec ) 100-200 mcg PO 4 times per day Omeprazole ( Prilosec ) 20-40 mg PO every day Lansoprazole ( Prevacid ) 15-30 mg PO every day

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