DUODENAL ULCER

By, Sumit dey

Bsc nsg IIND YR

Definition Ulcers that occur in the upper area of the

small intestine, which is called the duodenum, are calledduodenal ulcer.

CausesHelicobacter pyloriUse of anti-inflammatory drugs Other factor-Other causes are rare. For

example, the Zollinger-Ellison syndrome. In this rare condition, much more acid than usual is made by the stomach. Other factors such as smoking, stress, and drinking heavily may possibly increase the risk of having a duodenal ulcer. However, these are not usually the underlying cause of duodenal ulcers.

Risk factorLong term use of anti-inflammatory drugsLiver diseaseCoPDTrauma such as sever burn,brain injuryAge (more common in people over the age of 50)Alcohol use Family history of

Sign and symptoms Abdominal distension Pain or nausea Loss of appetite Weight loss Hematemesis

Phathophysiology Due to etiological factor

Erosion occurs which is caused by the increased concentration or activity of acid pepsin or by decreased resistance of mucosa.

A damage mucosa cannot secretes enough mucus to act as a barrier against hcl

Patient with duodenal ulcer disease secretes more acid then normal.

Cont……………..

Damage to the gastroduodenal mucosa allows for decreased resistence to bacteria.

Thus infection occurs from h.pylori.

Dignostic evaluationGastroscopy (endoscopy) is the test that can confirm a duodenal ulcer . In this test a doctor or nurse looks inside your stomach and the first part of your small intestine (duodenum). They do this by passing a thin, flexible telescope down your gullet (oesophagus). They can see any inflammation or ulcers. A test to detect the H. pylori germ (bacterium) is

usually done if you have a duodenal ulcer. If H. pylori is found then it is likely to be the cause of the ulcer. Briefly, it can be detected in a sample of stools (faeces), or in a breath test, or from a blood test, or from a biopsy sample taken during an endoscopy.

ManagementPhysical examination (epigastric tenderness, abdominal distention).distention).Endoscopy (preferred, but upper gastrointestinal [GI] barium study may be done).Acid-suppressing medication-The most common use medication is proton pump inhibitor for example-esomeprazole ,lansoprazole, omeprazole , pantoprazole andrabeprazole. If your ulcer was caused by H. pylori-Antibiotic should

also be give with acid suppressing medicin

Surgical management

If recommended, surgery is usually for intractable ulcers (particularly with Zollinger–Ellison syndrome), lifethreatening hemorrhage, perforation, or obstruction. Surgical procedures include vagotomy, vagotomy with pyloroplasty, or Billroth I or II.

Nursing AssessmentAssess pain and methods used to relieve it; take a thorough history, including a 72hour food intake history.

If patient has vomited, determine whether emesis is bright red or coffee ground in appearance. This helps identify source of the blood.

Ask patient about usual food habits, alcohol, smoking, medication use (NSAIDs), and level of tension or nervousness.

Ask how patient expresses anger (especially at work and with family), and determine whether patient is experiencing occupational stress or family problems.

Obtain a family history of ulcer disease.

Assess vital signs for indicators of anemia (tachycardia, hypotension).

Assess for blood in the stools with an occult blood test. Palpate abdomen for localized tenderness.

Nursing DiagnosisAcute Pain related to the effect of gastric acid secretion on damaged tissue

Anxiety related to coping with an acute disease

Imbalanced Nutrition related to changes in diet Deficient Knowledge about preventing symptoms

and managing the condition