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Peptic ulcer disease definition:
Ulcerated lesion in the mucosa of the stomach or duodenum
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Stomach defense systems:
- Mucous layer: coats stomach; first line of defense
- Bicarb: neutralizes acid
- Prostaglandins: keeps blood vessels dilated; thought to stimulate mucus and bicarb
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Risk factors for peptic ulcer disease:
- Gender: duodenal PUD increasing in older women
- Family hx of PUD
- Smoking
- Acidic drinks
- Medications
- H. pylori infection
- Age: duodenal 30-55; gastric 55-70
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Drugs that may contribute to PUD:
- Theo-Dur
- Caffeine: stimulates hydrochloric acid production
- Corticosteroids
- NSAIDs
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s/s of gastric PUD:
- Pain that occurs 30-60 minutes after meals
- Pain is made worse by the ingestion of food
- May be malnourished
Risk for malignancy
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s/s of duodenal ulcers:
- Pain that occurs 2-3 hours after meals; often awakens pt between 1-2 am
- Pain relieved by ingestion of food
Very little risk for malignancy
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Stress ulcer definition:
Acute gastric mucosal lesions associated with major surgery, head injury, burns, respiratory failure, shock, and sepsis
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s/s of general PUD:
- Epigastric tenderness
- - Gastric: epigastrium; left of midline
- - Duodenal: mid to right of epigastrium
- Sharp, burning, aching, gnawing pain
- Dyspepsia (indigestion)
- N/V
- Belching
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Complications of PUD:
- Hemorrhage
- Perforation
- Narrowing and obstruction (pyloric)
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How is PUD diagnosed?
- Esophagogastrodueodenoscopy (EGD) - most common
- Upper gastrointestinal series (UGI)
- Urea breath testing
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Goals for PUD patient:
- Pain relief
- Eradicate H. pylori infection
- Heal ulcer
- Prevent recurrence
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Diet therapy for PUD:
- Bland diet may relieve symptoms
- Avoid coffee, bedtime snacks, alcohol, and tobacco
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Key features of GI bleeding:
- GI:
- - Coffee ground vomit
- - Tarry stools
- - Nausea
- CV:
- - Low BP
- - Increased weak, thready pulse
- - Decreased H&H
- Neuro:
- - Vertigo, dizziness, syncope, lightheadedness
- Older adult:
- - Acute confusion
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Non-surgical tx of GI bleeding:
- Endoscopic therapy
- Acid suppression
- NG tube placement and saline lavage
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Post-op care for GI surgery:
- NG tube: care and management, I/O
- Monitor for post-op complications
- Pain management
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Post-op complications of GI surgery:
- Bleeding
- Duodenal stump leak
- Gastric retention
- Dumping syndrome
- Anemia
- Malabsorption of fat
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What is dumping syndrome?
- Early: diarrhea 30 minutes after meals
- Late: diarrhea 90 minutes to 3 hours after meals
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s/s of dumping syndrome:
Vertigo, tachycardia, syncope, sweating, pallor, palpitations, weakness, diarrhea
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How is dumping syndrome controlled?
- Decrease carb intake
- Eat slowly
- Avoid fluids during meals
- Increase fat
- Eat small frequent meals
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Hiatal hernia definition:
Protrusion of the stomach upward into the mediastinal cavity through the esophageal hiatus of the diaphragm
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Sliding hiatal hernia:
Part of the stomach moves up through the hiatus of the diaphragm
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Paraesophageal hiatal hernia:
The fundus and possible portions of the stomach's greater curvature, rolls through the esophageal hiatus and into the thorax beside the esophagus
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How are hiatal hernias diagnosed?
- Barium swallow
- CXR
- Endoscopy with biopsy
- CBC
- Stool for quiac
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Key features of sliding hiatal hernia:
- Heartburn
- Regurgitation
- Chest pain
- Dysphagia
- Belching
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Key factors of paraesophageal hernia:
- Feeling of fullness and breathlessness after eating
- Feeling of suffocation
- Chest pain that mimics angina
- Symptoms worse in recumbent position
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Hiatal hernia risk factors:
Increased intra-abdominal pressure: obesity, pregnancy, bending, coughing, weight lifting
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