Peptic Ulcer disease (PUD),by Kellyminyi xu from Guangzhou Medical University,Learning Objectives,To master the cause of peptic ulcer clinical manifestations and complications;Be familiar with the key points of the pathogenesis and treatment of peptic ulcer; To master the peptic ulcer nursing intervention and health education;,Definition,A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection. (Uphold & Graham, 2003),Peptic Ulcers: Gastric & Dudodenal,Peptic Ulcers: Gastric & Duodenal,gastric ulcer : the ulcer that occurs in the stomach lining ,some of them may be malignant. duodenal ulcer : most often seen in first portion of duodenum .,GU,DU,PUD Demographics （流行病学）,Lifetime prevalence is 10%. The incidence of duodenal is 4 times as common as gastric ulcer most common in middle age peak 30-50 years Male to female ratio4:1,Etiology（病因学）,Helicobacter pylori（HP） nonsteriodal anti-inflammatory drugs (NSAID） Acid and pepsin Others,main symptom,(1)abdominal pain：the classic symptom of PUD.Pain”gnawing”, “aching”, or“burning”“hungerlike” （钝痛、胀痛、灼痛或饥饿痛）(2)rhythmicity:GU Eating- pain-reliefDU pain-eating-relief(3)cyclicity：Attack more in autumn or winter,Pain characteristics of peptic ulcer,Clinical manifestation,Other symptoms of digestive system ： Nausea, vomiting, belching, dyspepsia, bloating, chest discomfort, anorexia may also occur.,Clinical manifestation,sign Epigastric tenderness,Complications,hemorrhage Perforation obstruction pyloric stenosis Gastric carcinoma. (not duodenal carcinoma),Hemorrhage: hematemesis ,black or tarry stools,Gastric carinoma,GU 1% can become cancerous A chronic, GU history 45 years of age or older The more symptoms stubbornly Continuous and occult blood(+),Endoscopy Barium meal contrast x-ray Biopsy bacteria & malignancy Stool for fecal occult blood H.Pylori: (13)C-urea Breath Test.,PUD - Diagnosis,Endoscopy,Barium meal contrast x-ray,Treatment Plan,Medicationstreat with Proton Pump Inhibitors or H2 receptor antagonists to assist ulcer healing H2: Tagament, Pepcid, Axid, or Zantac for up to 8 weeks PPI: Prilosec, Prevacid, Nexium, Protonix, or Aciphex for 4-8 weeks. DU：PPI 46w GU: PPI 68w,Surgery,People who do not respond to medication, or who develop complications,Nursing diagnosis,Pain related to gastric and duodenal injury Altered Nutrition: less than body requirements related to anorexia, nausea,nursing intervention,Relieve pain Medication and care Diet Rest Monitor Psychotherapy and heath education,Relieve pain,DU:Eat alkalescent food in pain or before pain (such as soda biscuit, etc.); The local hot compress,Medication and care,抗酸剂：应在饭后或睡前1h，乳液要震动，应咀嚼片。不与衣服的酸 性饮料，避免与牛奶同服； 氢氧化铝凝胶：引起磷缺乏症表现食欲不振、无力长期服用引起便秘，可与氢氧化镁交替。 H2RA ：应在餐中或餐后服，也可把一日的剂量在睡前服用静脉给药应控制速度（过快低血压和心律失常） PPI类： 可引起头晕 硫糖铝：在酸性环境下有效，餐前1小时服用。不能与多酶片同服， 铋剂：因在酸性下起作用，故餐前服。可使粪便呈黑色。,Diet,Eating little but often and regularly . Avoid eating raw, cold, hard and strong irritant food. Select easily digestible and nutritious food. Eating pasta, adequate skim milk during active period . After the symptoms is alleviated,you should return to normal meal diet timely. Nutrition monitoring (such as :body weight, hemoglobin),Rest,The light symptom: appropriate activities to distraction the attention The heavy symtom : stay in bed for a few days to 1 2 weeks, relieve pain symptoms,Monitor,Vital sign Measuring weight on a regular basis, monitoring nutritional indexes such as serum albumin and hemoglobin,Psychotherapy and heath education,Information about the relationship between peptic ulcer and factors such as Hp, NSAIDs, smoking, alcohol intake ,stress. Education about both therapeutic and preventive strategies. Lifestyle management Avoid the use of steroid, caffeine , aspirin and other NSAIDs . Instruction about the medication regimen prescribed and how to take the drugs. Teach the client the symptoms that may indicate a complication, such as increased abdominal pain or distention, vomiting, black or tarry stools ,or fainting.,Question,Which type of PUD will have abdominal pain at night? How can we diagnosis the infection of Hp?,thank you !,