GI Lecture: What is Peptic Ulcer Disease?

Welcome to another round of nursing lectures, featuring the gastrointestinal system. Right now, we will be focusing on peptic ulcer disease (PUD).

So, what is peptic ulcer disease and what does it do to the body? To adequately explain what PUD is, we’ll review its pathophysiology then delve into the nursing process of the disease.

Study Technique

An effective method when studying any subject, especially those that are within the scope of Medical-Surgical Nursing subject, is that, aside from knowing the keywords, you should also summarize the condition by following the nursing process. In this way, you will be able to gather the necessary keywords just by taking note of the D-A-R, which means:

  • Data – signs and symptoms, laboratory results, vital signs, and any form of physical assessment findings.
  • Action – drugs and client education (two most common nursing interventions)
  • Response – how the client reacts or feels after the interventions were given

Peptic Ulcer Disease: An Overview

A peptic ulcer is an ulcer inside the gastrointestinal tract. It is named as such because of the presence of an acid known as pepsin lingering inside the stomach. An overproduction of pepsin will result in deterioration of the gastrointestinal lining. Ulcers can happen either inside the stomach or in the duodenum.

Aside from that, we’ll also talk about how the bacteria, Helicobacter pylori (H. pylori), contributes to the occurrence of peptic ulcer disease.

Inside the Stomach

The stomach has a mucosal lining that protects itself from hydrochloric acid, pepsin, and other enzymes that can break down food into chyme. After food is converted into chyme, it will pass the duodenum (the first portion of the small intestine), then go into the jejunum, ileum, and large intestine. And finally, once chyme is transformed into feces, it will be excreted by defecation through the anus. So, this is what happens typically inside the gastrointestinal tract.

How Peptic Ulcer Occurs

The moment the mucosal membranes become eroded to the point wherein the epithelial cells are exposed, that’s the time the gastric juices start to “eat up” the epithelial cells. The epithelial cells are considered as the stomach’s skin. Continuous “eating up” of the epithelial cells will result in peptic ulcer and can lead to a perforated bowel.

Perforation of bowel means that there is a gaping hole or an opening where the nutrients and toxic wastes can leak and go into the peritoneal cavity. The peritoneal cavity is the space inside the abdomen that keeps the liver, stomach, and intestines intact.

The Peritoneal Cavity

In general, all the organs inside the body are covered with thin membranes that compartmentalize them and keep them safe within their specified location. The heart has a pericardium that protects it from trauma caused by collision against the ribcage or any event similar to that.  

The peritoneum or peritoneal cavity is the stomach’s protective covering just in case there will be direct blows or trauma happening around that area. The peritoneal cavity will prevent the bursting of bowels and other forms of internal conditions.

Peritonitis

If there’s bowel perforation, it can lead to infection. However, the entire body will not get infected immediately because the peritoneal cavity prevents it from spreading. On the other hand, since the infection is confined within the peritoneal cavity, a condition known as peritonitis will occur. Infection of the peritoneum is called peritonitis.

What happens when there’s peritonitis? The peritoneum is filled up and will manifest as distention. Peritonitis is just one of the primary complications of peptic ulcer.

Now that we’ve appropriately discussed what peptic ulcer disease is and its pathophysiology, we’ll proceed to the assessment findings regarding the data collection, whether the peptic ulcer occurs in the stomach or duodenum. Check it out on our succeeding videos via our SimpleNursing YouTube channel.

For more nursing-related topics that will surely come out of major school exams and the NCLEX®, drop by our SimpleNursing website.

Until next time!

GI Pharmacology for Antacids and H2-Blockers

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In this lecture, we will be going over gastrointestinal (GI) medications that are usually used for peptic ulcer disease, gastritis, heartburn or basically the overproduction of acid. To counter the effects of these conditions on the body and bring down acid production three types of medications that are given.

The Rule of Three

Just like any other medications given – insulins or pain medications, there’s always the rule of three. The rule of three is composed of therapeutic approaches ranging from mild, moderate, and severe. This is because, when considering pharmacology, the medical team always focuses on different treatment angles to deal with a specific manifestation.

For example, if there is increased blood pressure, a diuretic can be given to decrease the volume and relieve pressure from the heart. Then a beta-blocker to block the beta-adrenergic agents and calcium channel blocker to soften the heart are given. There are a lot of angles that are taken into consideration when dealing with increased blood pressure; this is similar when dealing with gastrointestinal issues.

The Antacids

Antacids or anti-acids are usually the first lines of approach when someone has an overproduction of acids. Antacids come in the form of Tums. Tums are calcium-based types of buffers decreasing acid production. You can think of Tums as the alkaline antacid that serves as fire extinguishers which put out the burning flame inside your GI tract.

Heartburn, also known as gastroesophageal reflux disease (GERD), is mainly a reflux disorder that causes pain mainly at the orifice between the stomach and esophagus. To neutralize the fires burning within antacids are given.

The good thing about antacids is that they work as quickly as 20 minutes. Make sure that before ingesting antacids, you have taken something that’s upsetting or harsh to the GI tract, for example, spices, meats, coffee, and dairy. After eating one of these leading causes of increased acid production, antacids must follow immediately. You can also compare antacids to fast-acting insulins with regards to their onset.

Peptic Ulcer

Before getting into the mechanism of action of H2 blockers, we will take a quick second to discuss peptic ulcers.

There are gastric parietal cells inside the GI tract that secrete acid which comes in the form of hydrochloric acid (HCL). Remember, hydrogen ions are very acidic. Histamines are then released causing inflammation, irritation, and breakdown which then leads to peptic ulcer disease. A peptic ulcer is just a fancy term of a hole in the lining of the stomach – perforation of the stomach. This condition is dangerous because the acids will get out and the peritoneal cavity will become infected, causing severe bleeding.

H2 Blockers

To prevent peptic ulcers from happening, and to bring down inflammation and protect the stomach lining or the GI tract, in general, the doctors will prescribe H2 blockers or histamine 2 blockers.

H2 blockers decrease HCL production which thereby decreases stomach acids. If your client has alcohol hypersensitivity, you have to instruct him or her to avoid alcohol when taking H2 blockers.

Recall Tip

How can you remember what H2 blockers are?

Think of H2 blockers as football players that are tasked as linemen to block the opposing team from attacking the quarterback. Now, football players have dirty jersey due to the sport, so their jerseys need Tide or “-tidine” to tidy up their soiled articles. And because football players love to play loud music, you will hear someone say, “Turn down the volume,” which can also be interpreted as H2 blockers decreasing the volume of acid being produced inside the stomach. Hope this works for making you remember what H2 blockers do and its suffix.

On our next lecture, we’ll be focusing on the third medication used for increased acid production – proton-pump inhibitor (PPI). See you there!