PEPTIC ULCER DISEASE

ANATOMY AND PHYSIOLOGY OF DIGESTIVE SYSTEM

INGESTION AND SWALLOWING

ESOPHAGUS

LIVER

STOMACH

PANCREAS

SMALL INTESTINE

LARGE INTESTINE

PATHOPHYSIOLOGY
RISK FACTOR
Predisposing:

Precipitating:
Age: 40 and 60 years Gender: Male Familial Tendency: Blood type: O Lifestyle (Alcohol Ingestion) Burns (Curlings Ulcer) ICP (Cushings Ulcer) Helicobacter Pylori Stress Stimulants Smoking Irritants Drugs

TYPES OF PUD:
Gastric Ulcer (15 %)
Pain (Burning, Gnawing) Pain is experienced during meals (when food comes in contact with ulcers, pain occurs) Pain is not relieved by food intake (food may even

Duodenal Ulcer (80 %)

Pain (Burning, Gnawing) No pain during meal ( no ulcer in the stomach) Pain is relieved by food intake ( food in the stomach delays emptying of gastric acid into the duodenum)

worsen the pain when it comes in contact with ulcer)

Pain subsides after meal (food and acid empties into duodenum)

Pain experienced 2 to 3 hours after eating (when food

and acid in the stomach empties into the duodenum, the exposed duodenal ulcers causes pain) Melena (black tarry stool)

Hematemesis (vomiting of blood), nausea and vomiting

Weight loss (pain with meal causing decrease food intake)

Weight gain (food intake during meal maybe increased due to no pain during meals)

TRACING:

NURSING DIAGNOSIS

INCREASED RISK OF GI BLEEDING AND PERFORATION OF STOMACH, RELATED TO GASTRIC OR INTESTINAL WALL EROSION. INCREASED RISK OF PYLORIC OBSTRUCTION AS COMPLICATION OF THE PEPTIC ULCER. INCREASED RISK OF ANEMIA DUE TO ACUTE OR CHRONIC GI BLEEDING, RELATED TO ULCER.

PAIN AND HEARTBURN, RELATED TO DIAGNOSIS OF PEPTIC ULCER.

APPETITE CHANGES AND WEIGHT CHANGES DUE TO SYMPTOMS OF THE ULCER. INCREASED RISK OF ASPIRATION DUE TO VOMITING, RELATED TO ULCER. ANXIETY RELATED TO THE SYMPTOMS OF DISEASE AND FEAR OF THE UNKNOWN.

 PEPTIC ULCER BLEEDING IN PATIENTS WITH OR WITHOUT CIRRHOSIS

DIFFERENT DISEASES BUT THE SAME PROGNOSIS?

M. RUDLER, G. ROUSSEAU, H. BENOSMAN, J. MASSARD, L. DEFORGES, P. LEBRAY, T. POYNARD, D. THABUTDISCLOSURES

ALIMENT PHARMACOL THER. 2013;36(2):166-172.

ABSTRACT

BACKGROUND PHYSIOPATHOLOGY AND PROGNOSIS OF PEPTIC ULCER BLEEDING (PUB) HAVE NEVER BEEN DESCRIBED IN CIRRHOTIC PATIENTS.

AIM TO ASSESS RISK FACTORS AND OUTCOME OF PUB IN TWO GROUPS OF PATIENTS WITH PUB WITH OR WITHOUT CIRRHOSIS. METHODS WE INCLUDED PROSPECTIVELY ALL PATIENTS WITH PUB REFERRED TO OUR ICU OF HEPATOLOGY AND GASTROENTEROLOGY BETWEEN JANUARY 2008 AND MARCH 2011. ALL PATIENTS WERE TREATED ACCORDING TO INTERNATIONAL RECOMMENDATIONS. DIAGNOSIS OF CIRRHOSIS WAS BASED ON CLINICAL, BIOLOGICAL AND MORPHOLOGICAL EXAMS. AETIOLOGIES, CHARACTERISTICS AND OUTCOMES OF PUB WERE COMPARED IN CIRRHOTIC VS. NONCIRRHOTIC PATIENTS.

RESULTS A TOTAL OF 203 PATIENTS WITH PUB WERE INCLUDED PROSPECTIVELY. TWENTY-NINE PATIENTS HAD CIRRHOSIS (GROUP CIRR+), AND 174 PATIENTS HAD NO CIRRHOSIS (GROUP CIRR). DEMOGRAPHIC DATA WERE SIMILAR BETWEEN THE TWO GROUPS EXCEPT FOR AGE AND ALCOHOL CONSUMPTION. AETIOLOGY OF CIRRHOSIS WAS ALCOHOL IN 97% OF CIRRHOTIC PATIENTS. CHARACTERISTICS OF PUB WERE NOT DIFFERENT BETWEEN THE TWO GROUPS. NINETYTHREE PER CENT OF PATIENTS WITH CIRRHOSIS HAD ENDOSCOPIC PORTAL HYPERTENSION. AETIOLOGY OF PUB WAS DIFFERENT BETWEEN THE GROUP CIRR+ AND CIRR (HELICOBACTER PYLORI = 10.3% VS. 48.8%, P < 0.0001; NSAID'S = 17.2% VS. 54.0%, P < 0.0001; IDIOPATHIC PUB = 79.3% VS. 23.8%, P < 0.0001). OUTCOME WAS COMPARABLE CONCERNING RE-BLEEDING (7.0% VS. 6.9%, P = 0.31), NEED FOR ARTERIAL EMBOLISATION (10.3 VS. 8.6%, P = 0.76), NEED FOR SALVAGE SURGERY (0 VS. 1.7%, P = 0.31) AND MORTALITY (3.0% VS. 1.1%, P = 0.87).

CONCLUSIONS PHYSIOPATHOLOGY OF PUB SEEMS TO BE DIFFERENT IN PATIENTS WITH CIRRHOSIS. IN CIRRHOTIC PATIENTS, PUB OCCURS ALMOST ONLY IN ALCOHOLICS. IN OUR SERIES, PROGNOSIS WAS SIMILAR TO GENERAL POPULATION. PUB IN CIRRHOSIS MIGHT BE RELATED TO PORTAL HYPERTENSION AND/OR ALCOHOL.