Peptic ulcer : Types, Diagnosis, management, Complications

Peptic ulcer

A peptic ulcer is an ulcerative lesion in the mucus of the lower esophagus, stomach, pylorus and duodenum.

The types of peptic ulcer can be divided into 3 types according to the place if affects.

1.     Gastric ulcer

2.     Duodenal ulcer

3.     Marginal ulcer

Etiology:

Peptic ulcer occurs four times more commonly in men than in women.

Duodenal ulcer occurs five to then times more often than gastric ulcer.

Most common between 20 - 60 years of age.

Causes:

1.     Hyper secretion of gastric fluid.

2.     Non-steroidal anti-inflammatory drugs (NSAIDS) induced ulcer.

3.     Helico bacterium pylori injection (  H  pylori)

Signs and symptoms:

1.     Pain occurring in the epigastric region

2.     Pain may be described as dull, aching, gnawing.

3.     Nocturnal pain may also be present.

4.     Pain may increase when the stomach is empty.

5.     Patient may report relief from pain after eating or taking antacids. ( common in duodenal ulcer)

6.     Nauseas and anorexia. (common in  gastric ulcer)

7.     Weight loss and vomiting

Diagnosis:

1.     Endoscopy

2.     Stool examinations for occult blood.

3.     Gastric secretion analysis.

4.     Serum test for presence of H . Pylori antibody.

Treatment:

1.     Symptomatic treatment

2.     Treatment to heal the ulcer

Treatment to prevent recurrence

Medical Management:

1.     Antacids, eg. gelusil

2.     H₂ receptor antagonists eg ranitidine, cimetidine,

3.     Antimicrobial , eg. flagyl.

4.    Antidiarrheal  affects of Bismuth and salicylate.

5.    Anticholigics.

Surgical Management:

Types of surgeries are

1.     Gastrojejunostomy and vagotomy.

2.     Subtotal gastrectomy.

3.     Vagotomy and pyloroplasty.

Emergency surgery is necessary when a peptic ulcer perforates and causes peritonitis or crodes a blood vessels, causing severe haemorrhage.

Nursing management:

1.     Maintain adequate hydration by Administer intravenous fluids and blood transfusion.

2.     Intubate nasogastric tube( Ryle' s tube)  for gastric decompression

3.     Maintaining intake and output  accurately

4.     Observe stool for occult blood.

5.     Minimise pain

6.     Encourage bed rest.

7.     Provide small frequent meal to prevent gastric distension, if not in NPO.

8.     Administering  prescribed medication.

9.     Maintain adequate nutrition by Providing small and frequent feeding on time.

10.            Avoiding coffee and other caffeinated beverages.

11.            Avoiding extreme hot/cold, spicy food or fluids.

12.            Educate about the treatment and all procedures to reduce anxiety.

13.            Diet and food to avoid.

Complications:

Gastro intestinal hemorrhage.

Ulcer perforation

Gastric outlet obstruction.