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 Disorders: GERD, Gastritis, & Peptic Ulcer Disease Pt 5

In this portion of our lecture, we will be talking about the common GI disorders, namely: gastroesophageal reflux disease (GERD), gastritis, and peptic ulcer.

There’s one thing in common when it comes to these three GI disorders: increased acid production. So, whether it’s GERD, gastritis or peptic ulcer, the cause is the same.

Anatomy and Physiology – Stomach

The normal physiology of your stomach regarding ingestion is first, food has to be swallowed down to the esophagus then passes through the esophageal-gastric sphincter muscle. The esophageal-gastric sphincter muscle is basically the muscle that “clamps up” to prevent stomach contents and acid from traveling back into the esophagus. Another sphincter is located at the base of your stomach. So, whenever a client undergoes a lap-band surgery, the lap-band squeezes both sphincters to make clients feel like they’re full.

Acid Production Affectation

Whether it’s gastritis, GERD, or peptic ulcer, you have to remember that they all relate to one cause: too much acid production inside the stomach. Differentiation of each disorder entirely depends on where the acid production acts on and the effects on the areas of the digestive tract.

GERD

If acid production creeps up to the GI tract and “burns away” the esophagus, gastroesophageal reflux disease (GERD) or what is also known as heartburn, occurs. Some of the causes of heartburn or GERD are:

  • Coffee due to caffeine
  • Meats
  • Alcohol
  • Smoking

Therefore, to avoid suffering from heartburn, you have to inform your clients to:

  • Limit the coffee and alcohol intake
  • Cease smoking
  • Lessen meat in the diet

As for medication, GERD clients are given Tums or anti-acids to decrease and neutralize acid production and preventing it from creeping up into the esophagus.

Gastritis and Peptic Ulcer

Gastritis merely is the inflammation of the lining of your stomach. In GERD, it’s about the lining of the esophagus, whereas with gastritis, it’s focused on the mucous membrane of the stomach that is gradually being eroded by too much acid. Because of this, clients who have gastritis experience severe stomach pain.

However, if the acid becomes increasingly high, that’s when ulcer or peptic ulcer occurs. Peptic ulcer is just a fancy term meaning the acid has eaten away or broken down the lining of the stomach, causing a hole or a tear. When this happens, the client will start to bleed out due to the corrosion caused by the acid on the lining of the stomach.

Prevention and Treatment

With GERD clients, anti-acids are given to neutralize the condition.

With gastritis, the goal is to protect the lining of the stomach. Therefore the parietal cells that are responsible for acid production inside the stomach must be blocked or stopped which is why H2 blockers are administered. H2 blockers block the histamine production of the inflammatory response of the gastric lining. In a way, H2 blockers protect the stomach from ulcers.

Aside from H2 blockers, clients with gastritis are given proton pump inhibitors (PPI). Proton pump inhibitors aids in decreasing secretions inside the GI tract.

The Difference between Medications

Proton pump inhibitors work longer than anti-acids; their duration is similar to Lantus, a kind of long-acting insulin. PPIs can provide almost 24 hours of protection, which is not going to be effective in acute situations like GERD. Therefore, if your clients have GERD and you administered a PPI, the effects won’t be immediate. On the other hand, if you give anti-acids on your clients with GERD, the outcome would be quick, much like rapid-acting insulin that is frequently used for diabetic clients.

The analogy of these GI disorder medications is also similar to asthmatic clients. If they use an albuterol inhaler, the effects are immediate; whereas, if they use a steroid, it will take time for the effects to be experienced.

Remember, if you have a GERD client, instant neutralization is important; therefore, you give anti-acids. PPIs and H2 blockers are like Lantus for diabetes or steroids for asthma – their effects are not immediate but have longer duration and effects. Basically, what PPIs and H2 blockers do is decrease secretions created by the GI tract to prevent gastric lining irritation and peptic ulcer disease.

At SimpleNursing.com, PPIs and H2 blockers have been included in the Pharmacology Boot Camp. Here, Mike has elaborately explained and have given depth to the effects the said medications.

If you want to know more about those medications or just want to find out about other useful nursing information, drop by SimpleNursing.com.