Perforated Peptic Ulcer Disease (PPUD)

The term peptic ulcer usually refers to an ulcer in the lower esophagus, stomach, or duodenum. A peptic ulcer is a break, or ulceration, in the protective mucosal lining of the lower esophagus, stomach, or duodenum. Such breaks expose submucosal areas to gastric secretions and autodigestion. Peptic ulcers can be acute or chronic, superficial or deep. Superficial ulcerations are erosions because they erode the mucosa but do not penetrate the muscularis mucosae. True ulcers extend through the muscularis mucosae and damage blood vessels, causing hemorrhage, or perforate the gastrointestinal wall.

Classifications:

Stomach (called gastric ulcer) Duodenum (called duodenal ulcer) Esophagus (called esophageal ulcer) Meckel's Diverticulum (called Meckel's Diverticulum ulcer)

**A rare condition called Zollinger-Ellison syndrome where there is increased production of the hormone gastrin. Usually, a small tumor (gastrinoma) in the pancreas or small intestine produces the high levels of gastrin in the blood. Exams and Tests Esophagogastroduodenoscopy (EGD or upper endoscopy) is a special test performed by a gastroenterologist. A thin tube with a camera on the end is inserted through your mouth into the GI tract to see your stomach and small intestine. Upper GI is a series of x-rays taken after you drink a thick substance called barium. Hemoglobin blood test to check for anemia Stool occult blood test to test for blood in your stool

Types:

Type I: Ulcer along the lesser curve of stomach Type II: Two ulcers present - one gastric, one duodenal Type III: Prepyloric ulcer Type IV: Proximal gastro esophageal ulcer Type V: Anywhere along gastric body, NSAID induced

Characteristics of Gastric and Duodenal Ulcers Characteristics Gastric Ulcer Duodenal Ulcer INCIDENCE Age at onset 50-70 yr 20-60 yr Family history Usually negative Positive Gender (prevalence) Equal in women and Greater in men Stress factors men Average Increased Increased use CLINICAL MANIFESTATIONS Pain Located in upper abdomen Not relieved food; burning Clinical course by Located in epigastrium mid

Medical Treatment

1. 2. 3. 4.

Proton Pump Inhibitors (PPI)- Omeprazole, Pantoprazole, Lansoprazole H2 Antagonists- Cimetidine, Ranitidine, Famotidine, Nizatidine Antacids- Magnesium, Aluminium, Sodium bicarbonate, Calcium carbonate Other Drugs- H. pylori antibiotics- Clarithromycin, Amoxicillin, Metronidazole, Tetracycline

Cramping; relieved by food Pattern of remissions and exacerbation for years Heals more quickly

Surgical Treatment 1. Vagotomy- In this surgery the vagus nerve, which transmits messages from the brain to the stomach, is cut. Interrupting these messages reduces acid secretion. Antrectomy- In this surgery, the lower part of the stomach (antrum) is removed. This section of the stomach produces a hormone that stimulates the stomach to secrete digestive juices.

Chronic ulcer without pattern of remission and exacerbation Heals more slowly

2.

SYMPTOMS:

Abdominal pain is a common symptom but it doesn't always occur. The pain can differ a lot from person to person. Feeling of fullness -- unable to drink as much fluid Hunger and an empty feeling in the stomach, often 1 - 3 hours after a meal Mild nausea (vomiting may relieve symptom) Pain or discomfort in the upper abdomen Upper abdominal pain that wakes you up at night

Pyloroplasty- This surgery enlarges the opening to the duodenum and small intestine (pylorus), which enables stomach contents to pass more freely out of the stomach. Nursing Intervention @ Relieve pain by administering antacid as prescribed. @ Encourage patient to promote a healthy lifestyle: 1. The client may eat anything that he can tolerate when he is asymptomatic. 2. Liberal bland diet is recommended during exacerbation. 3. Advise client to eat slowly and to chew food properly. 4. Small, frequent feedings during exacerbation. 5. Encourage the client to quit smoking 6. Enhance coping through stress therapy 7. Avoid the ff: fatty foods, coffee, tea, chocolate, cola cringes, spices, red/black pepper, alcohol, bed time snacks, binge eating, large quantities of milk 8. Schedule care so that the patient gets plenty of rest. 9. Assess the patients nutritional status and the effectiveness of measures used to maintain it. Weigh him regularly. 10. Review the proper use of prescribed medications, discussing the desired actions and possible adverse effect of each drug. 11. Warn the patient to avoid aspirin containing drugs because they irritate gastric mucosa.

3.

Other possible symptoms include: Bloody or dark tarry stools Chest pain Fatigue Vomiting, possibly bloody Weight loss

CAUSES & RISK FACTORS: Helicobacter pylori (H.pylori). Most people with peptic ulcers

have these bacteria living in their gastrointestinal (GI) tract. Yet, many people who have such bacteria in their stomach do not develop an ulcer. Drinking too much alcohol Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) Smoking cigarettes or chewing tobacco Radiation treatments Advanced age Chronic diseases, such as emphysema, rheumatoid arthritis, cirrhosis, and diabetes

Prepared by: Rene John Francisco BN4-A --------------------- Bright Future nurses-----------------------

Post-Test (Perforated Peptic Ulcer Disease [PPUD]) General Instructions: Please read the questions carefully. Choose the best answer. Answer in SMALL LETTERS before the number. Dont cheat! If you are caught cheating, automatic a 60% grade in your posttest. Goodluck and Godbless! I.
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inserted through your mouth into the GI tract to see your stomach and small intestine. a. b. c. d.
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Lower Endoscopy Middle endoscopy Lateral endoscopy upper endoscopy Ms. Amalayer is experiencing abdominal pain, episodic vomiting and weight loss, her physician suspected that she has PPUD and order a stool occult examination. What is the purpose of this test?

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Multiple Choice Is a break, or ulceration, in the protective mucosal lining of the lower esophagus, stomach, or duodenum. a. Gastric Ulcer b. Peptic Ulcer c. Esophageal Ulcer d. Duodenal Ulcer The following are the three classifications of peptic ulcer, except: a. Meckels diverticulum ulcer b. Gastric ulcer c. Peptic ulcer d. Decubitus ulcer A type of ulcer which is induced by NSAID a. Type I b. Type II c. Type III d. Type IV e. Type V Common initial sign experienced in client with peptic ulcer disease? a. Hematemesis b. Melena c. Headache d. Abdominal pain A causative agent which listed as the primary factors in developing PUD? a. E.Coli b. H.Pylori c. H.Enterobium d. E. Americanus The following are barriers/defenses present in the GIT lining except: a. Bicarbonate b. Blood c. Water d. Mucus A rare condition where there is increased production of the hormone gastrin caused by a gastrinoma in the pancreas. a. Guillain Barre Syndrome b. Syndrome of inappropriate anti-diuretic hormone c. Zollinger-Ellison syndrome d. Kegels Syndrome Is a special test performed by a gastroenterologist where a thin tube with a camera on the end is

a. To know if the patient had fecaliths in the appendix b. To gather the stool of patient for laboratory examination c. To note for presence of blood in the stool d. To verify the existence of helicobacter pylori infection
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A surgery that enlarges the opening to the duodenum and small intestine, which enables stomach contents to pass more freely out of the stomach. a. Polypectomy b. Pylorography c. Pylorectomy d. Pyloroplasty

II. Enumeration 1-5. Give at least 5 clinical manifestations of PPUD 6-10. Nursing intervention for patients with PPUD. III. Identify if the following pertains to DUODENAL ULCER or GASTRIC ULCER 1. Affects ages 50-70 years old 2. Greater in men than in women 3. Located in the upper abdomen 4. Located in the mid epigastrium 5. Not relieved by food 6. Abdominal cramping 7. Relieved by food 8. Burning sensation in the stomach 9. Heals more slowly 10. Heals more quickly