PEPTIC ULSER

NUR 2134
Integrated Nursing Sciences 2:
Peptic ulcer
And
Nursing Interventions

SFMS





? Peptic ulcer

• Referred to a gastric, duodenal or esophageal ulcer
depending on its location

• A peptic ulcer is a hole in the gut lining of the stomach,
duodenum, or esophagus

• An ulcer occurs when the lining of these organs is corroded by
the acidic digestive juices which are secreted by the stomach
cells.

• Erosion may extend deeply into the muscular layer to the
peritoneum



 Duodenal ulcer

• Higer incidence than the gastric ulcer
• Usually occurs withi 1.5 cm of the pylorus and characterised

by high gastric acid secreations
• Food increased the high secreation such as high protein

diet,alcohol consumptions and vagal stimulations

• Patient with duodenal ulcers has more rapid gastric emptying
due to hyper secretions of gastric juice that increase gastric
emptying.

-this will result in large acid load in the stomach

 Gastric ulcer

 also called a stomach ulcer, is a raw, eroded area in the lining
of the stomach.

 Chronic gastric ulcer-lesser curvature near the pylorus
 develops when stomach acids and digestive juices breaks the

protective mucosal barrier of the stomach’s lining
 Most of it occur in the duodenum
 Incompetence of pylorus sphincter allows reflux of the bile

acid from the duodenum into the stomach.

 Esophageal ulcers

• due to reflux HCl (GERD)

Causes of peptic ulcers?

 infection of the stomach by "Helicobacter pyloridus" (H.
pylori)-leading to ulcer disease in 10 % to 15% of those
infected.

-H. pylori is found in more than 80% of patients with gastric and
duodenal ulcers.

 use of anti-inflammatory medications, commonly referred to
as NSAIDs including aspirin.

 Cigarette smoking
 Stress and anxiety
 Zollinger –Ellison Syndrome/ZESS(tumor malignan of panceas-

increased gastrin hormone



ZESS

Helicobacter pylori

Helicobacter pylori Bacteria stick on to the stomach wall

Patophysiology

Hyper secretion and increased concentration of gastric juice

decreased mucosal resistance

Damage mucosal cannot secrete enough mucus to protect/act as
barrier to the Hcl

Erosion-ulcer

Clinical manifestations

 Dull pain
 Or burning sensation at the mid epigastrium or at the back-

due to increased acid content erode the lessions and stimulate
the expose nerve endings.
 Pyrosis(heart burn)
 Vomiting-due to obstruction of the pylorus orifice –muscular
spasm,scarring,acute swelling of the inflammed mucus
membrane
 Constipations
 Diarrhea
-due to diet and medications

other possible symptoms
include

• Weight loss
• Fatigue
• indigestion, belching
• Chest pain
• haematemasis
• Melena or dark tarry stools

Complications

• Bleeding internally
• Perforation of the intestine and peritonitis
• Bowel obstruction

Diagnostic investigation

 An upper GI -- a series of x-rays taken with barium meal
 An esophagogastroduodenoscopy (EGD)/OGDS -- a special test

performed by a gastroenterologist in which a thin tube is
inserted through your mouth into the gastrointestinal tract to
look at your stomach and small intestines.
-biopsy taken from the wall of the intestines to test for H. pylori.
 Hbto check for anemia

Medical Treatment

 Antibiotics to treat Helicobacter pylori invasion
10 – 14 days triple therapy consisit of 2 a/biotic and others drugs.
-Flagyl
-amoxyl
Clarithromycin
PLUS
 Acid blockers (like cimetidine, ranitidine, or famotidine)
 Proton pump inhibitors (such as omeprazole)
 Medications that protect the tissue lining (like sucralfate)
 Bismuth (may help protect the lining and kill the bacteria)

Surgical intervention

 Indication for surgical intervention:
 Intractable ulcer-do not heal after 12-16 week of medical

treatment.
 Life threatening haemorrage
 Perforation pepetic ulcer
 Obstruction e.g obstructed pylorus orifice
 ZESS -A large amount of excess acid is produced in response to

the overproduction of the hormone gastrin, which in turn is
caused by tumors on the pancreas or duodenum. These
tumors are usually malignant, must be removed and acid
production suppressed to relieve the recurrence of the ulcers.

Ulcer emergencies

Gastroscopy procedure

placing of an endoscope (a
small flexible tube with a
camera and light) into the
stomach and duodenum to
search for abnormalities.
Tissue samples may be
obtained to check for H.
pylori bacteria, a cause of
many peptic ulcers.

 An actively bleeding ulcer
may also be cauterized
(blood vessels are sealed
with a burning tool) during

a gastroscopy procedure.

• Toreduced gastric acid
secretions-diminish
cholinergic stimulations to
the parietal cell-less
responsive to gastrin
hormone.

• Effects-dumping syndrome,
feeling fullness, diarrhea.

Nursing assessment for patient
with peptic ulcer

 Pain and method used to relief the pain-antacid or with food
 Prescribed as burning pain and occurs 2 hrs after meal
 Characteristic of the vomitus and frequency

-coffee ground,undigested food
 Any changes in the stool colour-maleana
 Eating habit and food consume
 Lifestyle
 Medication-NSAIDS
 Psychological factors-stress

Objective data

• Vital sign-hypotension –indicate anemia-bleeding peptic ulcer
• Investigation:
-stool ocult blood
• Physicsl examination: abdominal palpation to identified

localised tenderness

Potential
problems/complication

• Hemorrhage

-most common manifested by hematemasis or malaena

-vomitus of coffee ground colour
• Perforation
• Penetration
• Pyloric obstruction

Management for potential
complication

 Hemorrhage
 Observe for faintness,dizziness,vomiting
 Monitor vital sign-tachycardia,hypotension and tacypnea
 Observe stool/vomitus characteristic
 Monitor urine output

Management of upper GIT bleeding

 Blood loss must be replaced by blood transfusion.
Nursing intervention include:
o Insert iv line- n/saline, ringers lactate
o Preparation for insertion if central venous catheter
o Insert of r/tube-distinguish fresh blood, coffee ground, aspiration

of clots and gastric acid, prevent nausea and vomiting, monitoring
further bleeding
o Gastric lavage -room temperature of n/saline solution if indicated
o Insert CBD and monitor urine output
o Monitor vital sign and oxygen saturation-administer oxygen
therapy
o Positioning-recumbent with elevated legs

If bleeding still persist and
uncontroll

• Tran endoscopic coagulation by laser,heat probe,medication
and sclerosing agent can be used as combination.

• Selective embolization-autologus blood clot (gelfoam)-through
atreial catheter direct on to the bleding lesion.

-nurses have to abserve for rebleeding occurance.

Perforation and penetration

 Erosion of the ulcer through the gastric serosa into the peritoneal
cavity and adjacent organ such as pancreas,billiary tract or gastro
hepatic omentum-requires emergency operation and abdominal
cavity lavage needed urgently because leads to peritonitis

 Post operative:
-stomach content drainage via r/tube
 Observed for localized infection and sign of

peritonitis(fever,abdominal pain and distended,increased or absent
bowel sound)
 Monitor fluids and electrolytes balance
 i/o chart strictly
 Administer a/biotic as ordered

Pyloric obstruction

 GOO/gastric outlet obstruction-area distal to pyloric sphincter
edematouse or spasm due to stenosis and scarred tissued.

 Treatment;
 r/tube insertion to decompressed the stomach
 Assist the fluid aspirated > 400mls indicate obstructions
 Balloon dilatation via endoscopy
Surgical intervention:
 Gastrojejunostomy,antrectomy

Clinical manifestation

• Sudden severe upper abdominal pain-persisiting and
increasing intensity

-radiated to right shoulder due to irritation of the sphrenic
nerve

Vomiting –collapse tender and rigid abdomen
Tachycardia, hypotension-indicate shack

Nursing diagnosis

• Pain r/t effect of gastric acid and damage tissue
• Anxiety r/t acute illness
• Nutritional imbalance r/t changes in diet
• Deficient knowledge r/t prevention and management of the

symptom