PEPTIC ULCER DISEASE TREATMENT

PEPTIC ULCER DISEASE TREATMENT

PEPTIC ULCER DISEASE TREATMENT

PEPTIC ULCER DISEASE TREATMENT

This is the Ulceration of the gastrointestinal tract resulting from the combined action of HCL acid and pepsin. The term us a generic term and when used includes ulcers in the stomach or duodenum and atimes at the lower end of the oesophagus. It may also occur in the jejunum following gastro enterostomy or partial gastrectomy "Peptic Ulcer Disease Treatment".

Etiology / Cause

Not well understood though certain factors been recognized in most cases. These include factors that increase secretion of HCL acid by gastric mucosa or that decrease tissue resistance to the acid.

Such factors includes:

  1. Zollingea Ellison's Syndrome (i.e Tumours of the pancreas characterized by marked secretion of the gastrin that stimulates excessive secretion of HCL acid. Other features included in the syndrome are:
  • Pituitary adenoma
  • Thyroid and Parathyroid tumours and
  • Adrenal Cortex Adenoma
  1. Drugs: These reduce the tissue resistance and include those drugs as Asa, Indomethacin, Phenilbutazoladine, Steroids etc
  2. Age: Common in early adults and middle age but rare in children and old age
  3. Irregular Meals: 001,101,110
  4. Hereditary : The possibility of peptic ulcer developing in relative of the patient is 3 times. For example if a father has weak mucosal wall . People with blood group 'O' are prone to developing duodenal ulcer.

"Peptic Ulcer Disease Treatment".

  1. Occupation: Common with people with worrying occupation g. bank managers, businesss executives etc
  2. Psychosomatic (Body and Mind) Influence (e.g. A person who is always conscious of himself,; a man who after locking his door will go back and check if locked). Perfectionist, increased emotional tension and psychological conflicts may play an important role in peptic ulcer
  3. Sex: The incidence is same in both sexes but in gastric ulcer it is 3-4times in male in duodenal ulcer.
  4. Smoking, alcohol and spices food do not cause peptic ulcer rather they prolong the healing tendencies, cause exacerbation and increase risk of complications
  5. Tension e.g. in Police men
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"Peptic Ulcer Disease Treatment".

Pathophysiology

This could be as a result of increase in the amount of HCL so that it becomes destructive or there is weakness of the mucosal wall causing the mucosa to be eaten up by the HCL or pepsin causing erosion.

As a rule ulcer usually occur singly through multiple duodenal and stomach ulcer (2cm to 1cm in diameter respectively). The margins of the ulcer are sharp and the mucosa surrounding it may be normal or inflamed. The crater floor is clean and at-times consist of a thin layer of exudate overlying a layer of granulation tissue. During the process of ulceration, a gastric vessel may be eroded leading to bleeding. There could be also a rapid progression tearing a muscular coat of the stomach resulting in perforation as the ulcer become chronic, the muscular layer is replaced by the fibrous tissue. Healing of the ulcer occurs by scaring, filling the crater floor or leaving a smooth surface devoid of mucosal glands.

Clinical Manifestations

  1. Burning or Gnawing epigastric pain usually related to taking of food. Before meals or after meals
  2. Heart Burn (Noctural pain)
  3. Gastric distension
  4. Nausea and vomiting, anaemia due to haemorrhage, flatulence (dyspepsia) excessive salivation, anorexia, diarrhea and weight loss

"Peptic Ulcer Disease Treatment".

Investigation

  • History taking / clinical presentation
  • Physical examination may reveal slight tenderness in the epigastrum on palapation
  • Stool study for occult blood (The patient would be advised not to take meat for three days before taking the blood because presence of iron is being examined and meat contains iron)
  • Fractional test meal
  • Gastric juice analysis
  • Barium mill Xray
  • Gastroscopy and Oesaphagoscopy
  • Gastric Function test
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"Peptic Ulcer Disease Treatment".

Treatment

Aim: To afford symptomatic relief of pain , To heal the ulcer and prevent re-occurance

  1. Measures to neutralize or buffer HCL acid and reduce the action of pepsin and HCl should be For example:
  • Regulation of diet by use of bland food and restriction of irritating substances such as Nicotine, Coffee, Alcohol and Spices etc
  • Antacids should be taken to reduce acidity
  • Group and cross match blood to keep in readiness should gastric haemorrhage occur
  • Drugs such as the following should be administered
  • Antacids e.g:Aluminium hydroxide, mixt mag, Gellucil
  • Anti spasmodic /anti secretary e.g. atropine, belladona, buscopan and targamet
  • Anti-coalinegic e.g. probantin or (probaterine), Scopalamine (Skopyl)
  • Sedatives: Phenobarb and valium
  • Analgesics: Novalgin and pethidine, paracetamol
  • Anti-emetic: Phenegan and Avomine
  • Drugs that encourage healing e.g. Biogastrone or caveds

"Peptic Ulcer Disease Treatment".

  1. Ensure adequate bed rest: This will lower physical activity
  2. Encourage client to seek counseling or psychotherapy to explore the emotional components of his illness
  3. Naso-gastric tube is inserted and ice saline lavages done should gastric hemorrhage occur. Also irrigations with drugs that cause vaso-constrictions e.g Adrenaline could be done i.e. irrigation
  4. When no response occurs or reoccurance in the face of adequate medical treatment exists surgical treatment could be resorted to. Also patients with perforation, massive hemorrhage, pyloric stenosis are candidates for surgery. Surgery could be : Pyloroplasty or vagotomy or gastrectomy. Gastrectomy is done in billroth.

"Peptic Ulcer Disease Treatment".

Nursing Care

  1. The patient is given ample time to express feeling/concern
  2. Give drugs as adviced and monitor effects
  3. Monitor dietary manifestations- Eat at regular intervals
  4. Encourage copious fluid intake to reduce anticololinergic effects and dilute HCL
  5. Avoid drugs of acid content such as aspirin, phenyl, butazine and steroids
  6. Observe complications as haemorrhage, perforations, pyloric stenosis, pain and toxicity.
  7. The patient should be educated on hygiene and signs & symptoms of reoccurrence
  8. Eating too hot or cold foods should be stopped
  9. Other stimulants such as smoking, alcohol and spices should also be avoided.
  10. Patient should be encourage to take milk
  11. Maintain regularity in ADL and continue medical supervision
  12. Plan enough emotional support and adequate resting periods.
  13. Adequate comfort and peace
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"Peptic Ulcer Disease Treatment".

Complication

  • Perforation Peritonitis
  • Pyloric Stenosis
  • Anaemia
  • Massive haemorrage and obstruction
  • Resistance of drug may go malignant

Should Surgery be done?

Stomach, ulcer, dumping syndrome, epigastric fullness, Bullons vomiting, Diarrhoea, Nutritional consequences as with loss, anaemia and protein deficiency

"Peptic Ulcer Disease Treatment".

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