PUD Outline

7/30/2019 PUD Outline

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UD

A. PUD- lesion of GI mucosa characterized by erosion from HCL & pepsin

1. Stomach protected by prostaglandins- increase stomachs resistance to ulceration

B. ETIOLOGY

1. Disruption mucosal barrierback diffusion HCL & pepsininflammation & cellular

destruction-->histamine release more HCL & pepsin release

2. Inflammatory agents- bile salts, NSAIDS, H. Pylori, acids, ischemia, & corticosteroids

C. GASTRIC ULCER

1. Decrease/N HCL & delayed gastric emptying

2. Females 55-60

3. Burning, gaseous pain high epigastrum, pain empty stomach, 1-2hrs after eating, aggravated

by food

D. DUODENAL ULCER

1. High HCL and increased gastric emptying

2. Males 34-45

3. Muscularis layer, scar4. Burning, cramp like pain mid-epigastrum, 90min-3hrs after eating, mid-morning, afternoon,

and @ nite (1-2a.m)

5. Relief w/ antacids & H2 blockers

E. DEFINITIVE DX: EGD

F. RISK FACTORS

1. NSAIDS

2. Smoking

3. Alcohol

4. H. Pylori5. Caffeine

6. Genetic predisposition

7. Psychologic stress

8. Altered gastric acid & serum gastric levels

G. DIAGNOSTICS

1. UPPER GI ENDOSCOPY-r/o gastric cancer

2. H. Pylori testing blood, breath, urine, tissues-IgG, IgM

3. CBC

4. Serum amylase

5. Urinalysis

6. Barium swallow

7. Liver enzymes: AST, ALT, bilirubin

8. Serum e-lytes

9. Gastric analysis- Zollinger-ellison syndrome

10. Guaiac stool


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H. S/S PUD

1. Gastric/duodenal pain

2. Melena

3. Vomiting

4. Orthostatic VS

5. Deficient fluid volume

6. Decreased HgB & HCT

7. Dyspepsia

8. Anorexia & weight loss

I. COMPLICATIONS PUD

1. Hemorrhage

2. Obstruction-long hx ulcer pain, worsens as day progresses, relieved by vomiting/belching

(foul odour), weight loss, thirst, unpleasant taste mouth, constipation, swelling upper

abdomen, loud & visible peristalsis

3. Perforation- rigid board like, guarding, absent bowel sounds, N&V

4. Intractable dx

J. MEDICAL/SURGICAL

1. ADEQUATE REST

2. DIETARY THERAPY

i. Avoid foods cause pain including milk & creamsii. 6 meals daily, decrease roughageraw fruits & veggies

iii. No aspirin or NSAIDS

3. Smoking cessation 7 avoid alcohol consumption

4. DRUG THERAPY

i. Antacids

ii. H2 blockers or PPIs

iii. Antibiotic therapy

1. Metronidazole (Flagyl)

2. Tertracycline

3. Amoxicillin

iv. Cholinergics- Metoclopranamide (Reglan)

v. Cytoprotective- Bismuth Subsalicylate (Pepto-bismol), Carafate (Sulcralfate)

vi. Tricyclic antidepressants

5. STRESS MANAGEMENT

6. ACUTE INTERVENTIONS

i. No complications

1. NPO

2. NG w/ sxn

3. Adequate rest

4. Smoking cessation

5. IV fluids6. Drug therapy

ii. w/ complications

1. NPO

2. NG sxn- cont aspiration obstruction

3. Bed rest

4. IV fluids: albumin, ringers lactate, PRBC- perforation & hemorrhage maintain

or increase rate

5. Gastric lavage (ice NS)

6. Repair perforation


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7. SURGERY

i. Gastroenterostomy

ii. Closure w/ omentum graft

iii. Vagotomy w/without pyloroplasty

iv. BilrothI/II

1. Post-op

a. Patency NG tube

b. Fluid & e-lyte balancec. Assess acute gastric dilation

d. Assess dumping syndrome

e. Manage dumping syndrome

i. Decrease amt food given

ii. High protein & fat

iii. Admin pectin powder

iv. Admin semi-recumbant/recumbent

v. Lay flat after eating

vi. Admin sedative & antispasmotic

f. Check alkaline reflux gastritis

g. Assess delayed gastric emptying

h. Assess afferent loop syndrome

i. Admin vit B12, folic acid, Fe3+ supps

K. POST-OP COMPLICATIONS

1. Dumping syndrome

2. Postpranadial hypoglycemia

3. Bile reflux gastritis

L. NURSING INTERVENTIONS

1. HEALTH PROMOTION

i. Id those at risk

ii. Encourage pts take drug w// milk or foodiii. Teach report s/s gastric irretation

2. Acute interventions

i. Approach in calm manner

ii. VSq15-30min

iii. NPO (stop all oral when perforation/hemorrhage)

iv. NG w/ sxn

1. Hemorrhage & decompression- cont sxn & decompression

2. Obstruction- cont aspiration, clamp


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3. HOME CARE

i. Explain dietary modification

ii. Smoking cessation, avoidance alcohol

iii. Avoid OTC substitutions of meds

iv. Take all meds as prescribed

v. Teach report: N&V, increased epigastric pain, bloody emesis or tarry stools

Documents

PUD Outline