Peptic Ulcers

Peptic ulcer disease is caused by helicobacter pylori infection that causes gastric secretions. The contributing factors are altered gastric acid and serum gastric levels, tobacco smoking and alcohol use, genetic, psychological factors such as stressful job and chronic anxiety. Peptic ulcer can occur in the duodenum or duodenal ulcer, the stomach or gastric ulcer and the distal esophagus and jejunum. Many persons may not have symptom at all but many will complain a progressing pain which is sometimes wake them at 2 AM when stomach is empty. Pain of duodenal ulcer is relieved by food while gastric ulcer is not relieved by food and the pain is progressing when food is ingested.

Peptic ulcer is manifested by burning, aching, right epigastria pain, pyrosis or heart burn, nausea and vomiting, GI bleeding and tenderness. The diagnostic tests for peptic ulcer are endoscopy that identifies inflammation of the gastric mucosa, ulcers, and lesions. Biopsy can determine the presence of helicobacter pylori. Barium swallow shows the ulcerated area.

In the first stage of peptic ulcer perforation, there is irritation of peritoneum due to leakage of gastric juice. This stage usually lasts for about 6 hours depending on the extent of the perforation. The second stage is the stage of reaction, as the irritant diluted with peritoneal exudates the intensity declines. Muscular rigidity will continue to be present and obvious. The final stage is the stage of chronic peptic ulcer and the recovery or the prognosis is already low.

For client who have peptic ulcer, always take prescribed medications such as antacids to lower the gastric level, anticholinergics that also helps decrease gastric secretion, histamine-receptor antagonists to block the receptors that control the secretion of hydrochloric acid, proton pump inhibitor to prevent the transportation of hydrogen into the gastric lumen and mucosal protective agents to protect the ulcer from destructive action of the digestive enzyme pepsin. It is also best to provide client and family teaching such as avoiding foods that are spicy and anything that can cause gastric irritation.

Eat regular meals a day and very necessary to avoid milk or dairy products because it inhibits the production of helicobacter infection and known to be acid stimulants. Instruct the client to quit smoking and other vices. Behavior modification is also needed to decrease the stressful environment.

Prepare the client for surgery because this is a life threatening disease if it is not prevented. The surgeries that are done to clients having peptic ulcer are Billroth I or gastroduodenostomy and Billroth II or the gastrojejunostomy. Other procedures are vagotomy, pyloroplasty or distal subtotal gastrectomy. For clients who are postoperative bed rest and discharge teaching should be done to add knowledge for continuous care.