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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

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Peptic Ulcer Disease Therapy

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  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

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