1. PEPTIC ULCER DISEASE
Prepared by:
Maria Luisa Calica

2. Peptic Ulcer Disease
 an open sore or raw area in the lining of the stomach or intestine.
 the ulceration could be in the stomach or in the duodenum.

3. How does it happen?
IMBALANCE
Aggressive
Factors
Defensive
Factors
e.g. Gastric
Acid, Pepsin,
Oxidative Stress,
NSAIDS, H. Pylori
e.g. Mucus,
Bicarbonate,
Prostaglandins,
Antioxidant Enzymes
Hcl

4. What Causes PUD?
1. H. Pylori – most common cause (Bacterial infection)
2. Prolonged usage of NSAID’s
3. Diet – spicy/caffeinated drinks/alcohol/smoking.
4. Advancing age
5. Stress

5. Helicobacter Pylori (H.
Pylori)
 H. pylori is a type of bacteria that infects your stomach. It attacks
your stomach and the first part of your small intestine (duodenum).
 This can cause redness and swelling (inflammation).
 It can cause open sores called peptic ulcers in your upper digestive
tract.
Can H. pylori spread from person to person?
 H. pylori can spread from person to person. H. pylori are found in saliva,
plaque on teeth and poop. Infection can be spread through kissing and by
transferring the bacteria from the hands of those who have not thoroughly
washed them after a bowel movement.
Can H. pylori infection be prevented?
You can lower your risk of H. pylori infection if you:
• Drink clean water and use clean water during food preparation.
• Hand washing with soap and water before eating and after using the
bathroom.

6. Urea breath test Doctors may use a urea breath test to check for H. pylori infection. If
the test detects the labeled carbon atoms, the health care professional will confirm an H.
pylori infection in your digestive tract.
Stool test
Doctors may use stool tests to check for H. pylori infection.
Upper gastrointestinal (GI) endoscopy and biopsy- Golden Standard test.
Upper GI series
In some cases, doctors may order an upper GI serries to help diagnose peptic ulcers or
ulcer complications. Upper GI series uses x-rays and the patient will swallow barium to
view the upper GI tract.
Diagnostic
Procedure:

7. Endoscopic Image

8. Duodenal Ulcer Gastric Ulcer
1. Right side Epigastric discomfort. 1. Left side Epigastric discomfort.
2. Attacks 2-3 hours after meal (empty
stomach).
2. Attack immediately after meal (full
stomach).
3. Relieved by eating; increase food
intake
(They will have weight gain).
3. Relieved by emptying stomach
through vomiting / less food intake (they
develop weight loss).
4. Hematochezia – if bleeding.
4. Hematemesis / Melena (black tarry
stool).
5. Increased risk of malignancy (cancer).

9. Management
1. Modify diet – avoid GI irritants (spicy, caffeine, milk, alcohol, smoking)
2. Medications:
a. Antacids – balancing the acidity of the stomach (best taken after meal)
e.g., magnesium base – Maalox (can cause diarrhea)
aluminum base – amphojel (can cause constipation) advised to increase fiber and fluid intake
b. H2 Receptors Blockers (Tidine) – decreases the production of Hydrochloric acid (best taken before meals)
e.g., Ranitidine (“tidine”)
c. Proton Pump Inhibitors (PPI) – it should be given before meals
- action: blocks the release of Hydrochloric Acid
ex. “Prazole” – omeprazole, lansoprazole
d. Antibiotics (duration 7-14 days)
1st line = Metronidazole (antiprotozoal)
2nd line = Amoxicillin
3rd line = Clarithromycin (KLACID)

10. Surgical Management
Antrum – contains parietal cell which is responsible in producing:
1. Hydrochloric Acid - function; helps in digestion.
2. Intrinsic Factors – function is to aid in absorption of B12.
Pyloric
Antrum

11. Surgical Management
(GASTRIC RESECTION)
Billroth I - is the creation of an
anastomosis between the
duodenum and the gastric
remnant
(gastroduodenostomy).
Billroth II - operation is
constructed by sewing a loop of
jejunum to the gastric remnant
(gastrojejunostomy)

12. Post Operative Nursing Care
(Gastric Resection)
1. Maintain NPO until further order,
2. IVF & NGT (purpose: to decompress the stomach) to relieve pressure as it
can damage suture. never irrigate the NGT
3. Monitor v/s.
4. Monitor bleeding or signs of infection.
5. monitor flatus and bowel sound – inform doctor GI is functioning →diet
6. encourage early ambulation → it helps the GI to recover fast.
7. watch out for complications:

13. Possible complication of surgical management
1. Dumping Syndrome:
- Rapid gastric emptying time. Food can’t be hold for 2-3 hours
Indication: Diarrhea with abdominal cramps
 Decreased glucose absorption → Hypoglycemia (dizziness, diaphoresis, tremors).
Management:
1. Modify Diet – increase intake of protein and fats (will delay emptying time of stomach).
- Decrease carbs.
- Drink fluid in between meals (avoid drinking fluids with meals as can cause dumping syndrome).
2. Position after meals - lie down on your left side for 30 mins after meals.
3. Anti-cholinergic – atropine sulphate.

14. 2. Pernicious Anemia – low vitamin B12
Signs and Symptoms:
 red beefy tongue
 Paresthesia
 tingling sensation
Management:
B12 supplementation
Route: IM every month for life.
Possible complication of surgical management