1 / 46

Peptic Ulcer Disease Therapy

Peptic Ulcer Disease Therapy. Peptic Ulcer Disease Collaborative Care. Medical regimen consists of Adequate rest Dietary modification Drug therapy Elimination of smoking Long-term follow-up care . Peptic Ulcer Disease Collaborative Care. Aim of treatment program

clare
Download Presentation

Peptic Ulcer Disease Therapy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Peptic Ulcer Disease Therapy

  2. Peptic Ulcer DiseaseCollaborative Care • Medical regimen consists of • Adequate rest • Dietary modification • Drug therapy • Elimination of smoking • Long-term follow-up care

  3. Peptic Ulcer DiseaseCollaborative Care • Aim of treatment program • ↓ degree of gastric acidity • Enhance mucosal defense mechanisms • Minimize harmful effects on mucosa

  4. Peptic Ulcer DiseaseCollaborative Care • Generally treated in ambulatory care clinics • Requires many weeks of therapy • Pain disappears after 3 to 6 days

  5. Peptic Ulcer DiseaseCollaborative Care • Healing may take 3 to 9 weeks • Should be assessed by means of x-rays or endoscopic examination • Moderation in daily activity is essential • NSAIDs that are COX-2 inhibitors are used

  6. Peptic Ulcer DiseaseDrug Therapy • Includes use of • Antacids • H2R blockers • PPIs • Antibiotics • Anticholinergics • Cytoproctective therapy

  7. Peptic Ulcer DiseaseDrug Therapy • Recurrence of peptic ulcer is frequent • Interruption or discontinuation of therapy can have detrimental results • No drugs, unless prescribed by health care provider, should be taken • Ulcerogenic effect

  8. Peptic Ulcer DiseaseDrug Therapy • Histamine-2 receptor blocks (H2R blockers) • Used to manage peptic ulcer disease • Block action of histamine on H2 receptors • ↓ HCl acid secretion • ↓ conversion of pepsinogen to pepsin • ↑ ulcer healing

  9. Peptic Ulcer DiseaseDrug Therapy • Proton pump inhibitors (PPI) • Block ATPase enzyme that is important for secretion of HCl acid • Antibiotic therapy • Eradicate H. pylori infection • No single agents have been effective in eliminating H. pylori

  10. Peptic Ulcer DiseaseDrug Therapy • Antacids • Used as adjunct therapy for peptic ulcer disease • ↑ gastric pH by neutralizing acid • Anticholinergic drugs • Occasionally ordered for treatment • ↓ cholinergic stimulation of HCl acid

  11. Peptic Ulcer DiseaseDrug Therapy • Cytoprotective drug therapy • Used for short-term treatment of ulcers • Tricyclic antidepressants • Serotonin reuptake inhibitors

  12. Peptic Ulcer DiseaseNutritional Therapy • Dietary modifications may be necessary so that foods and beverages irritating to patient can be avoided or eliminated • Nonirritating or bland diet consisting of 6 small meals a day during symptomatic phase

  13. Peptic Ulcer DiseaseNutritional Therapy • Include a sample diet with a list of foods that usually cause distress • Hot, spicy foods and pepper, alcohol, carbonated beverages, tea, coffee, broth • Foods high in roughage may irritate an inflamed mucosa

  14. Peptic Ulcer DiseaseNutritional Therapy • Protein considered best neutralizing food • Stimulates gastric secretions • Carbohydrates and fats are least stimulating to HCl acid secretion • Do not neutralize well

  15. Peptic Ulcer DiseaseNutritional Therapy • Milk can neutralize gastric acidity and contains prostaglandins and growth factors • Protects GI mucosa from injury

  16. Peptic Ulcer DiseaseTherapy Related to Complications • Acute exacerbation • Treated with same regimen used for conservative therapy • Situation is more serious because of possible complications of perforation, hemorrhage, gastric outlet obstruction • Accompanied by bleeding, ↑ pain and discomfort, nausea, vomiting

  17. Peptic Ulcer DiseaseTherapy Related to Complications • Acute exacerbation (cont.) • Recurrent vomiting, gastric outlet obstruction • NG tube placed in stomach with intermittent suction for about 24 to 48 hours • Fluids and electrolytes are replaced by IV infusion until patient is able to tolerate oral feedings without distress

  18. Peptic Ulcer DiseaseTherapy Related to Complications • Acute exacerbation (cont.) • Management is similar to that for upper GI bleeding • Blood or blood products may be administered • Careful monitoring of vital signs, intake and output, laboratory studies, signs of impending shock

  19. Peptic Ulcer DiseaseTherapy Related to Complications • Acute exacerbation (cont.) • Endoscopic evaluation reveals degree of inflammation or bleeding and ulcer location • 5-year follow-up program is recommended

  20. Peptic Ulcer DiseaseTherapy Related to Complications • Perforation • Immediate focus to stop spillage of gastric or duodenal contents into peritoneal cavity and restore blood volume • NG tube is placed into stomach • Placement of tube as near to perforation site as possible facilitates decompression

  21. Peptic Ulcer DiseaseTherapy Related to Complications • Perforation (cont.) • Circulating blood volume must be replaced with lactated Ringer’s and albumin solutions • Blood replacement in form of packed RBCs may be necessary • Central venous pressure line, indwelling urinary cater should be inserted and monitored hourly

  22. Peptic Ulcer DiseaseTherapy Related to Complications • Gastric outlet obstruction • Decompress stomach • Correct any existing fluid and electrolyte imbalances • Improve patient’s general state of health • NG tube inserted in stomach, attached to continuous suction to remove excess fluids and undigested food particles

  23. Peptic Ulcer DiseaseTherapy Related to Complications • Gastric outlet obstruction (cont.) • Continuous decompression allows • Stomach to regain its normal muscle tone • Ulcer can begin to heal • Inflammation and edema subside • When aspirate falls below 200 ml, within normal range, oral intake of clear liquids can begin

  24. Peptic Ulcer DiseaseTherapy Related to Complications • Gastric outlet obstruction (cont.) • Watch patient carefully for signs of distress or vomiting • IV fluids and electrolytes are administered according to degree of dehydration, vomiting, electrolyte imbalance

  25. Peptic Ulcer DiseaseNursing Management • Overall Goals • Comply with prescribed therapeutic regimen • Experience a reduction or absence of discomfort related to peptic ulcer disease

  26. Peptic Ulcer DiseaseNursing Management • Overall Goals (cont.) • Exhibits no signs of GI complications • Have complete healing • Lifestyle changes to prevent recurrence

  27. Peptic Ulcer DiseaseNursing Implementation • Health Promotion • Identify patients at risk • Early detection and ↓ morbidity • Encourage patients to take ulcerogenic drugs with food or milk • Teach patients to report symptoms related to gastric irritation to health care provider

  28. Peptic Ulcer DiseaseNursing Implementation • Acute Intervention • Patient generally complains of ↑ pain, nausea, vomiting, and some bleeding • May be maintained on NPO status for a few days, have NG tube inserted, fluids replaced intravenously • Physical and emotional rest are conducive to ulcer healing

  29. Peptic Ulcer DiseaseNursing Implementation • Hemorrhage • Changes in vital signs, ↑ in amount and redness of aspirate signal massive upper GI bleeding • ↑ amount of blood in gastric contents ↓ pain because blood helps neutralize acidic gastric contents • Keep blood clots from obstructing NG tube

  30. Peptic Ulcer DiseaseNursing Implementation • Perforation • Sudden, severe abdominal pain unrelated in intensity and location to pain that brought patient to hospital

  31. Peptic Ulcer DiseaseNursing Implementation • Perforation (cont.) • Indicated by a rigid, boardlike abdomen • Severe generalized abdominal and shoulder pain • Shallow, grunting respirations

  32. Peptic Ulcer DiseaseNursing Implementation • Perforation (cont.) • Ensure any known allergies are reported on chart • Antibiotic therapy is usually started • Surgical closure may be necessary if perforation does not heal spontaneously

  33. Peptic Ulcer DiseaseNursing Implementation • Gastric outlet obstruction • Can occur at any time • Likely in patients whose ulcer is located close to pylorus • Gradual onset • Constant NG aspiration of stomach contents may relieve symptoms • Regular irrigation of NG tube

  34. Peptic Ulcer DiseaseAmbulatory and Home Care • General instructions should cover aspects of disease, drugs, possible lifestyle changes, regular follow-up care • Patient motivation ↑ when they understand why they should comply with therapy and follow-up care

  35. Peptic Ulcer DiseaseSurgical Therapy • < 20% of patients with ulcers need surgical intervention • Indications for surgical interventions • Intractability • History of hemorrhage, ↑ risk of bleeding • Prepyloric or pyloric ulcers

  36. Peptic Ulcer DiseaseSurgical Therapy • Indications for surgical interventions (cont.) • Multiple ulcer sites • Drug-induced ulcers • Possible existence of a malignant ulcer • Obstruction

  37. Peptic Ulcer DiseaseSurgical Therapy • Surgical procedures • Gastroduodenostomy • Gastrojejunostomy • Vagotomy • Pyloroplasty

  38. Peptic Ulcer DiseaseSurgical Therapy B. Billroth II Procedure A. Billroth I Procedure Fig. 40-16

  39. Peptic Ulcer DiseasePostoperative Complications • Dumping syndrome • Postprandial hypoglycemia • Bile reflux gastritis

  40. Peptic Ulcer DiseaseDumping Syndrome • Direct result of surgical removal of a large portion of stomach and pyloric sphincter • ↓ reservoir capacity of stomach

  41. Peptic Ulcer DiseaseDumping Syndrome • Associated with meals having a hyperosmolar composition • Experienced by one-third to one-half of patients after peptic ulcer surgery

  42. Peptic Ulcer DiseasePostprandial Hypoglycemia • Considered a variant of dumping syndrome • Result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into small intestine • Release of excessive amounts of insulin into circulation

  43. Peptic Ulcer DiseaseBile Reflux Gastritis • Prolonged contact of bile causes damage to gastric mucosa • Administration of cholestyramine relieves irritation • Also, aluminum hydroxide antacids

  44. Peptic Ulcer DiseaseNutritional Therapy • Start as soon as immediate postoperative period is successfully passed • Patient should be advised to eliminate drinking fluid with meals

  45. Peptic Ulcer DiseaseNutritional Therapy • Diet should consist of • Small, dry feedings daily • Low in carbohydrates • Restricted in sugars • Moderate amounts of protein and fat • 30 minutes of rest after each meal • Interventions are diet instruction, rest, and reassurance

  46. Peptic Ulcer DiseaseGerontologic Considerations • ↑ patients > 60 years of age • ↑ use of NSAIDs • First manifestation may be frank gastric bleeding or ↓ hematocrit • Treatment similar to younger adults • Emphasis placed on prevention of both gastritis and peptic ulcers

More Related