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N72: Peptic Ulcer Disease

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Gastro esophageal Reflux Disease (GERD) Zollinger-Ellison Syndrome. Duodenal Ulcers ... Antacids neutralizes ston=mach acid, use for PUD & GERD. ... – PowerPoint PPT presentation

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Title: N72: Peptic Ulcer Disease


1
N72 Peptic Ulcer Disease
  • By
  • Susan Appel RN MN CCRN CS
  • July 2001

2
Definition
  • The term peptic ulcer disease (PUD) refers to a
    a group of upper GI disorders, characterized by
    varying degrees of erosion of the gut wall.

3
Prevalence of PUD
  • 10 of Americans have PUD
  • 4.5 new cases per year
  • Now known to be most commonly caused by an
    infection with Helicobacter pylori.

4
The Most Common causes of PUD in order are
  • Helicobacter Pylori
  • NSAIDs
  • Hypersecretion of Acid
    Zollinger-Ellison Syndrome

5
Pathogenesis of Peptic Ulcers
  • Develops when there is an imbalance between
    mucosal defensive factors and aggressive factors
  • See fig 73-1 p. 848 Lehne

6
An Imbalance between Defensive Aggressive
Factors leads to PUD
  • Defensive Factors
  • Mucus
  • Bicarbonate
  • Blood Flow
  • Postaglandins
  • Aggressive Factors
  • Helicobacter Pylori
  • NSAIDs
  • Gastric Acid
  • Pepsin
  • Smoking

7
Test for H-Pylori
  • Invasive Biopsy
  • Non-invasive
  • Breath Test
  • Serologic

8
Overview of Treatment
  • Drug Therapy
  • Antibiotics
  • Antisecretory agents H2 Blockers Proton Pump
    Inhibitors
  • Mucosal Protection
  • Antisecretory agents Cytotec
  • Antiacids
  • Avoidance of Risk Factors
  • NSAIDs
  • Smoking
  • Eat Pattern/ Diet
  • Alcohol if exacerbation occurs

9
Specific Treatments for H-pylori
  • American College of Gastroenterology recommended
    in 1998 the use of at least two antibiotics to
    miminize resistance.
  • Use of H2RA and PPI
  • 14-day course of treatment
  • See table 73-2 p. 851 Lehne

10
Antisecretory Agents
  • Histamine Receptor Blockers H2
    Blockers
  • Tagamet
  • Pepcid
  • Zantac
  • Over the counter (OTC) in low doses
  • Proton Pump Inhibitor
  • Prevacid
  • Prilosec
  • Most effective for suppression gastric acid
    secreation
  • New therefore still high cost

11
Management of other Upper GI Disorders
  • Gastro esophageal Reflux Disease (GERD)
  • Zollinger-Ellison Syndrome
  • Duodenal Ulcers
  • Aspiration Pneumonitis
  • Heart Burn, Indigestion and/ or Sour Stomach
  • Tagment is the drug of choice (DOC)
  • Interactions occur with coumadin, phenytoin,
    theophylline, and lidocaine
  • Their dosages should be reduced

12
Other Ulcer Medications
  • Carafate promotes healing of ulcers, forms
    protetective barrier
  • Misoprostol (Cytotec) only approved for
    preventing NSAIDs induced ulcers.
  • Antacids neutralizes stonmach acid, use for PUD
    GERD.
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