Saint Louis University School of Nursing Bonifacio Street, Baguio City
CASE REPORT (Peptic Ulcer Disease)
Submitted By: Agonoy, John Philip Cervantes, Mel Joritz Grace Esteban, Carren Louise (BSN 3-C3) SLU SN
Submitted To: Mrs. Sharon Hogat
Date Submitted: May 19, 2011
PEPTIC ULCER DISEASE DEFINITION:
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.
Characteristics INCIDENCE Age at onset Family history Gender (prevalence) Stress factors Ulcerogenic drugs Cancer risk PATHOPHYSIOLOGY Abnormal mucus Parietal cell mass Acid production Serum gastrin Serum pepsinogen Associated gastritis Helicobacter pylori
CLINICAL MANIFESTATIONS Pain
Clinical course
Characteristics of Gastric and Duodenal Ulcers Characteristics Gastric Ulcer Duodenal Ulcer
50-70 yr Usually negative Equal in women and men Increased Normal used Increased
20-60 yr Positive Greater in men Average Increased use Not increased
May be present Normal or decreased Normal or decreased Increased Normal More common May be present (60%-80%) Stimulates reduced acid secretion , gastric atrophy, and risk of gastric cancer
May be present Increased Increased Normal Increased Usually not present Often present (95%-100%) Stimulates acid hypersecretion
Located in upper abdomen Intermittent Pain-antacid-relief pattern Food-pain pattern (when food in stomach) Chronic ulcer without pattern of remission and exacerbation Heals more slowly
Located in upper abdomen Intermittent Pain-antacid or food-relief pattern Nocturnal pain Pattern of remissions and exacerbation for years Heals more quickly
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) y y y
y y
Pain or discomfort in the upper abdomen Upper abdominal pain that wakes you up at night
Other possible symptoms include: Bloody or dark tarry stools Chest pain Fatigue Vomiting, possibly bloody Weight loss
y y y y y
CAUSES & RISK FACTORS:
Normally, the lining of the stomach and small intestines are protected against the irritating acids produced in your stomach. If this protective lining stops working correctly, and the lining breaks down, it results in inflammation (gastritis) or an ulcer. Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through the stomach or duodenum is called a perforation. A perforation is a medical emergency. The most common cause of such damage is infection of the stomach by bacteria called Helicobacter pylori ( H. H. pylori) 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. RISK FACTORS: Peptic Ulcer Drinking too much alcohol Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs). Taking aspirin or NSAIDs once in awhile is safe for most people. Smoking cigarettes or chewing tobacco Being very ill, such as being on a breathing machine Radiation treatments Advanced age Alcohol intake Chronic diseases, such as emphysema, rheumatoid arthritis, cirrhosis, and diabetes **A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers. Persons with this disease have a tumor in the pancreas that releases high levels of a hormone, which causes an increase in stomach acid. y y
y y y y y y
PATHOPHYSIOLOGY OF PEPTIC ULCER DISEASE Contributory factor: y Diet: caffeine intake y Alcohol and smoking y Presence of Helicobacter pylori infection
Precipitating factors: y Age: 50-70 years old y Gender: male
Increase hydrochloric acid (HCL) production
Irritation of the lining (mucosal) of the stomach, duodenum, proximal of small intestines
Damaged mucosal barrier
Decreased function of mucosal cells Decreased quality of mucus Loss of tight junctions between cells
Inflammatory Inflammato ry process
S/Sx: Abdominal
Back diffusion of acid into gastric mucosa
Conversion of pepsinogen to pepsin
Formation of liberation of histamine Increase acid secretion
Further mucosal erosion Destruction of blood
Mucosal injury
Ulceration
Local vasodilation Stimulation of cholinergic intramural plexus, causing muscle spasm
Bleeding/ Hemorrhage
Decreased oxygen carrying capacity as manifested by decreased hemoglobin and hematocrit level
S/Sx: Pallor, Lightheadedness, and weakness
S/Sx: black tarry stools, vomiting with the presence of blood
Increase capillary permeability Loss of plasma proteins Mucosal edema Loss of plasma into gastric lumen
INTERVENTIONS:
Peptic ulcers are controlled with regular meals and medications such as cimetidine. Cimetidine is one of a class of drugs that are histamine receptor antagonists that blocks secretion of hydrochloric acid. Clients are encouraged to avoid foods that increase stomach acidity, such as caffeine, frequent milk, citric acid juices, and certain seasonings (black peppers, chili powders, and hot chili peppers). Smoking, alcohol, and aspirin are also discouraged.
