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Peptic Ulcer – Diagnosis, Medical Management

ASSESSMENT AND DIAGNOSTIC FINDINGS

  • Physical examination reveal pain, epigastric tenderness, abdominal distention
  • Blood test
  • Barium study of the upper GI tract
  • Endoscopy allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained.
  • X-ray studies
  • Stools test for occult blood
  • Gastric secretory studies for achlorhydria and ZES
  • pylori infection by biopsy and histology with culture
  • Urea breath tests detect the presence of Helicobacter pylori. The patient takes a capsule of carbon labeled urea and then provides a breath sample 10 to 20 minutes later. Because pylori metabolizes urea rapidly, the labeled carbon is absorbed quickly; it can then be measured as carbon dioxide in the expired breath to determine whether H. pylori is present.

MEDICAL MANAGEMENT

PHARMACOLOGIC THERAPY

The most commonly used therapy in the treatment of ulcers is a combination of antibiotics, proton pump inhibitors and bismuth salts that suppresses or eradicates H. pylori; histamine 2 (H2) receptor antagonists and proton pump inhibitors are used to treat NSAID-induced and other ulcers not associated with H. pylori ulcers.

Table provides details about pharmacologic therapy

AGENT ACTION NURSING CONSIDERATION
Antibiotics and Bismuth SaltsTetracycline (plus metronidazole) 

 

 

 

Amoxicillin (plus clarithromycin)

 

 

 

Metronidazole (Flagyl); use with

clarithromycin

 

Clarithromycin (Biaxin)

 

 

Exerts bacteriostatic effects to eradicate Helicobacter

pylori bacteria in the gastric mucosa

 

A bactericidal antibiotic that assists with eradicating

  1. pylori bacteria in the gastric mucosa

An amebocide that assists with eradicating

  1. pylori bacteria in the gastric mucosa

Exerts bactericidal effects to eradicate H. pylori bacteria in the gastric mucosa

 

May cause photosensitivity reaction. Use with caution in patients with renal or hepatic impairment. Milk or dairy products may reduce medication effectiveness.

May cause diarrhea.

Do not use in patients allergic to penicillin.

 

 

Administer with meals to decrease GI distress.

Administer with other antibiotics and proton pump inhibitors.

May cause GI upset.

Histamine 2 (H2) Receptor AntagonistsCimetidine (Tagamet) 

 

 

 

Ranitidine (Zantac)

 

 

 

 

 

Famotidine (Pepcid)

 

Inhibits acid secretion by blocking the action of

histamine on the histamine receptors of the parietal cells in the stomach

Inhibits acid secretion by blocking the action of

the histamine on the histamine receptors of the parietal cells in the stomach

Inhibits acid secretion by blocking the action of

histamine on the histamine receptors on the parietal cells in the stomach

 

May cause confusion, agitation, or coma in the elderly or those with renal or hepatic insufficiency.

Long-term use may cause gynecomastia, impotence,

and diarrhea.

Prolonged drug half-life in patients with renal and hepatic insufficiency.

Rarely causes constipation, diarrhea, dizziness,

and depression.

Best choice for critically ill patient

Does not alter medication metabolism in the liver.

Prolonged half-life in patients with renal insufficiency.

Rarely causes constipation or diarrhea.

Proton (Gastric Acid) Pump InhibitorOmeprazole (Prilosec) 

 

 

 

 

Lansoprazole (Prevacid)

 

 

 

Rabeprazole (Aciphex)

 

 

Decreases gastric acid secretion by slowing the

hydrogen-potassium adenosine triphosphatase

(H+, K+-ATPase) pump on the surface of the

parietal cells

Decreases gastric acid secretion by slowing the H+, K+-ATPase pump on the surface of the parietal cells.

Decreases gastric acid secretion by slowing the

H+, K+-ATPase pump on the surface of the

parietal cells

 

Long-term use may cause gastric tumors and bacterial invasion.

May cause diarrhea, additional pain, and nausea.

 

 

 

A delayed-release capsule that is to be swallowed whole and taken before meals.

 

 

A delayed-release tablet; swallow whole.

 

 

 

 

 

 

 

 

STRESS REDUCTION AND REST

• Reduce environmental stress by physical and psychological modifications as well as the aid and cooperation of family members and significant others.
• The patient need help in identifying situations that are stressful or exhausting. Discourage a rushed lifestyle and an irregular schedule that may aggravate symptoms and interfere with regular meals taken in relaxed settings and with the regular administration of medications.
• The patient benefit from regular rest periods during the day.
• Biofeedback, hypnosis, or behavior modification may be helpful.

SMOKING CESSATION

• Smoking decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum.
• Continuing to smoke cigarettes may significantly inhibit ulcer repair.
• Therefore, patient is strongly encouraged to stop smoking.
• Smoking cessation support groups and other smoking cessation approaches are helpful.

DIETARY MODIFICATION

• Avoid extremes of temperature and overstimulation from consumption of meat extracts, alcohol, coffee (including decaffeinated coffee, which also stimulates acid
• secretion) and other caffeinated beverages, and diets rich in milk and cream (which stimulate acid secretion).
• Encourage three regular meals a day.
• Small, frequent feedings are not necessary as long as an antacid or a histamine blocker is taken.
• Eat foods that can be tolerated and avoid those that produce pain.

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