Term
PEPTIC ULCER DISEASE (PUD
WHAT GENDER IS MORE EFFECTED |
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Definition
| MEN > WOMEN (UNTIL MENOPAUSE THEN =), 5-10% AMERICANS |
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Term
PEPTIC ULCER DISEASE (PUD)
DEFINITION |
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Definition
EROSION OF TISSUE IN AN AREA OF THE GI TRACT WHICH IS IN CONTACT WITH HCL & PEPSIN
EROSION CAN EXTEND INTO OR PERFORATE THROUGH THE MUSCLE LAYERS OF THE GI WALL TO THE PERITONEUM LEADS TO PERITONITIS & HEMORRHAGE |
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Term
PEPTIC ULCER DISEASE (PUD)
COMPLICATIONS |
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Definition
HEMORRHAGE (GI BLEED)
PERFORATION ® PERITONITIS, DEATH
EROSION THROUGH & INTO ADJACENT ORGAN (ESP. PANCREAS) ORGAN DAMAGE & DYSFUNCTION
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Term
PEPTIC ULCER DISEASE (PUD)
PATHO
ESOPHAGUS
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Definition
R/T GERD BECAUSE ESOPHAGUS DOESN’T HAVE PROTECTIVE MUCOSAL LAYER TO PROTECT FROM ACIDS
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Term
PEPTIC ULCER DISEASE (PUD)
PATHO
GASTRIC, PYLORIC, DUODENAL
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Definition
R/T IMBALANCE BETWEEN MUCOSAL PROTECTIVE (PROSTAGLANDIN E) & MUCOSAL DESTRUCTIVE FACTORS ® MUCOSAL LAYER DISRUPTED GASTRIC ACIDS (HCL & PEPSIN) PENETRATE MUCOSAL LAYER DIGEST THE WALL HISTAMINE RELEASED HCL & PEPSIN INFLAMMATION CAPILLARY PERMEABILITY MUCOSAL EDEMA EASY BLEEDING
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Term
PEPTIC ULCER DISEASE (PUD)
RISK FACTORS
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Definition
H. PYLORI INFECTION (80-90%) **
SECRETES ENZYME THAT DEPLETES MUCOSAL PROTECTION
FAMILY HX., MALE GENDER AGE 40-60 Y/O, SMOKING, ETOH, ASA/NSAID USE (INHIBIT PROSTAGLANDINS), TYPE O BLOOD
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Term
PEPTIC ULCER DISEASE (PUD)
STRESS ULCERS (KURLING’S)
R/T
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Definition
SHOCK, ANXIETY, & TRAUMA ® EPI SECRETION ® VASOCONSTRICTION ®ISCHEMIC MUCOSA ®↓MUCOUS ®RISK OF EROSION & ULCERATION
COMMON IN PT. WITH HEAD INJURY OR BURNS
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Term
PEPTIC ULCER DISEASE (PUD)
STRESS ULCERS (KURLING’S) RISK
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Definition
| AGING, CHRONIC ETOH USE, & CHRONIC INFLAMMATION ® ATROPHY OF GLANDULAR EPITHELIUM OF STOMACH ®↓MUCOUS & INTRINSIC FACTOR ® ULCERATION & PERNICIOUS ANEMIA |
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Term
PEPTIC ULCER DISEASE (PUD)
CLINICAL MANIFESTATIONS |
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Definition
PAIN (DULL, GNAWING, BURNING) ABD. OR BACK, R. EPIGASTRIC TENDERNESS, HEART BURN
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Term
PEPTIC ULCER DISEASE (PUD)
DIAGNOSTIC TESTS
EGD PREFERRED.... |
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Definition
| SO BIOPSY CAN BE DONE TO CHECK FOR ABNORMAL CELLS & C&S FOR H. PYLORI, MAY BE ABLE TO CORRECT PROBLEM IF BLEEDING |
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Term
PEPTIC ULCER DISEASE (PUD)
DIAGNOSTIC TESTS
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Definition
UPPER GI SERIES
CBC (LOW RBC, HCT, HGB R/T CHRONIC BLOOD LOSS) |
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Term
PEPTIC ULCER DISEASE (PUD)
DIAGNOSTIC TESTS
DONE IN R/T VOMITING..
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Definition
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Term
PEPTIC ULCER DISEASE (PUD)
DIAGNOSTIC TESTS
CAN TELL IF CURRENT INFECTION & IS NONINVASIVE
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Definition
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Term
PEPTIC ULCER DISEASE (PUD)
DIAGNOSTIC TESTS
CAN’T TELL WHETHER CURRENT OR PAST ERADICATED INFECTION
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Definition
| BLOOD TEST FOR ANTIBODY TO H. PYLORI |
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Term
PEPTIC ULCER DISEASE (PUD)
DIAGNOSTIC TESTS
STOOL ANTIGEN |
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Definition
| MONITORS PRESENCE & RX. OF H. PYLORI |
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Term
PEPTIC ULCER DISEASE (PUD)
MANAGEMENT
GOAL |
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Definition
| TO ERADICATE H. PYLORI & MANAGE ACID SECRETION |
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Term
PEPTIC ULCER DISEASE (PUD)
MANAGEMENT
DIETARY – AVOID
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Definition
ETOH, CAFFEINE, IRRITATING FOODS (FOODS THAT ACID: MILK & MILK PRODUCTS, COFFEE & DECAF), VERY HOT OR VERY COLD, MEAT EXTRACTS
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Term
PEPTIC ULCER DISEASE (PUD)
MANAGEMENT
MEDS FOR H. PYLORI
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Definition
ANTIBX FOR H. PYLORI (AMOXICILLIN, FLAGYL, BIAXIN, TETRACYCLINE)
BISMUTH TO SUPPRESS H. PYLORI (PEPTO-BISMOL |
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Term
PEPTIC ULCER DISEASE (PUD)
MANAGEMENT
MEDS FOR ACID CONTROL
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Definition
PROTON PUMP INHIBITORS & H2 BLOCKERS TO BLOCK ACID SECRETION
ANTACIDS TO BUFFER ACID
ANTICHOLINERGICS (PROBANTHINE) TO BLOCK ACETYLCHOLINE FROM VAGUS NERVE (STIMULATES ACID)
CARAFATE TO COAT & PROTECT ULCER FROM ACID (GIVE ON EMPTY STOMACH & 2 HR. AFTER OTHER MEDS OR THEY WON’T ABSORB)
CYTOTEC – PROSTAGLANDIN E ANALOG -- ¯ ACID SECRETION & QUALITY OF MUCOSA (OFTEN USED WITH NSAIDS TO PROTECT STOMACH)
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Term
PEPTIC ULCER DISEASE (PUD)
MANAGEMENT
NEW MEDS |
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Definition
| PREVPAC & HELIDAC = ANTIBX+ EITHER ACID REDUCER OR PROTECTOR |
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Term
PEPTIC ULCER DISEASE (PUD)
MANAGEMENT
NG TUBE |
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Definition
POSSIBLYTISSUE EDEMA MAY CAUSE OBSTRUCTION ® DISTENTION & VOMITING
ALLOWS EMPTYING OF BLOOD FROM STOMACH & NS LAVAGE IF HEMORRHAGE
IV FLUIDS TO RESTORE & MAINTAIN F&E BALANCE |
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Term
PEPTIC ULCER DISEASE (PUD)
EGD |
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Definition
INJECT EPI INTO ULCER ® VASOCONSTRICTION & SCLEROSIS OF VESSELS
LASER SCLEROSIS OF BLEEDING VESSELS
CAUTERIZE: MOST GI BLEEDS FIXED THIS WAY THESE DAYS
USU. DON’T RE-BLEED |
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Term
PEPTIC ULCER DISEASE (PUD)
SURGERY IS FOR.... |
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Definition
| PERSISTENT OR IF RE-BLEED |
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Term
PEPTIC ULCER DISEASE (PUD)
SURGERY VAGOTOMY |
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Definition
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Term
PEPTIC ULCER DISEASE (PUD)
SURGERY
PYLOROPLASTY |
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Definition
DONE WITH VAGOTOMY & IF SCARRING CAUSES GASTRIC EMPTYING
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Term
PEPTIC ULCER DISEASE (PUD)
SURGERY ANTRECTOMY |
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Definition
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Term
PEPTIC ULCER DISEASE (PUD)
SURGERY BILROTH I |
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Definition
VAGOTOMY, PARTIAL GASTRECTOMY, PYLORUS, PART OF DUODENUM – REMAINING STOMACH ANASTOMOSED TO REMAINING DUODENUM
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Term
PEPTIC ULCER DISEASE (PUD)
SURGERY BILROTH II |
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Definition
SAME AS BILROTH I BUT ALL DUODENUM REMOVED OR CLOSED OFF & REMAINING STOMACH ANASTOMOSED TO JEJUNUM
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Term
PEPTIC ULCER DISEASE (PUD)
SURGERY
TOTAL GASTRECTOMY
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Definition
USU. REMOVE STOMACH & DUODENUM & ANASTOMOSE ESOPHAGUS TO JEJUNUM (MAY USE THORACIC APPROACH)
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Term
PEPTIC ULCER DISEASE (PUD)
NURSING
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Definition
MONITOR I&O, F&E BALANCE, IV’s, TRANSFUSIONS, NG TUBE
MAINTAIN NPO STATUS AS ORDERED
EGD PRE (NPO) & POST CARE (CONSCIOUS SEDATION) |
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Term
PEPTIC ULCER DISEASE (PUD)
PT. TEACHING
DIETARY MODIFICATION
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Definition
AVOID ETOH, CAFFEINE, IRRITATING FOODS (FOODS THAT ACID: MILK & MILK PRODUCTS, COFFEE & DECAF), VERY HOT OR VERY COLD, MEAT EXTRACTS
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Term
PEPTIC ULCER DISEASE (PUD)
PT. TEACHING
MEDS |
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Definition
| CAUTION NOT TO STOP MEDS WHEN FEELS BETTER IN ABOUT 1 WEEK OR PROBLEM WILL RETURN |
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Term
PEPTIC ULCER DISEASE (PUD)
PT. TEACHING
STRESS REDUCTION
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Definition
HELP ID CAUSE, REFER FOR BIOFEEDBACK, BEHAVIOR MOD
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Term
PEPTIC ULCER DISEASE (PUD)
PT. TEACHING
GENERAL
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Definition
– REGULAR MEAL TIMES
– SMOKING CESSATION
– CLOSE F/U X AT LEAST 1 YR
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