Peptic Ulcer Disease Nursing, Pathophysiology, Treatment | Gastric Ulcer vs Duodenal Ulcer Part 1

Peptic ulcer disease nursing lecture review on pathophysiology, treatment, symptoms, causes (h. pylori) and complications. Peptic ulcer disease is the formation of ulcers in the lining of the upper GI tract that affects mainly the mucosal lining of the stomach, duodenum, or esophagus. There are various types of peptic ulcers such as gastric ulcers which are located in the stomach and duodenal ulcers which are located in the duodenum.

Gastric ulcer vs duodenal ulcer include the following characteristics: Patients who have gastric ulcers tend to experience pain with food intake (approximately 1-2 hours after a meal). While with duodenal ulcers, food tends to relieve pain. Therefore, the patient may have pain 3-4 hours after eating when the stomach is empty.

In addition, duodenal ulcers can cause epigastric pain in the middle of the night while gastric ulcers do not. Patients with gastric ulcers describe the pain as dull or aching, while patients with duodenal ulcers describe the pain as gnawing.

What causes peptic ulcer disease? The most common causes of PUD are an h. pylori infection or regular NSAID usage. Helicobacter pylori are spiral-shaped bacteria that invade the GI mucosa. They can live in the acidic conditions of the stomach because it secretes urease which breakdowns down urea and this produces ammonia which neutralizes the stomach's acid. H. pylori most likely spreads from consuming something contaminated with the bacteria as in fecal to oral or oral to oral transmission.

Another cause is NSAIDs usage which breakdowns the defense system of the stomach's lining. NSAIDs work to decrease the production of prostaglandins. Prostaglandins allow us to feel pain, fever, or other types of inflammation. In addition, the stomach uses prostaglandins to keep the stomach protected by promoting the stomach cells to release mucous rich in bicarb, regulating acid amounts via parietal cells, and perfusion to stomach. When the defense system is altered it allows gastric acid to penetrate the lining and cause ulcer formation.

Signs and symptoms of PUD include indigestion and epigastric pain that can be felt from the breastbone to the belly button. It is typically described as a gnawing, aching, or dull pain.

Complications of peptic ulcer disease include: gastrointestinal bleeding, perforation which can lead to peritonitis, and obstruction of the pylorus which is a muscular section that connects the stomach and duodenum together and allows food to flow between these parts of the GI tract.

Treatment of peptic ulcer disease includes: medications such as proton-pump inhibitors, histamine receptor blockers, antacids, muscosal healing drugs, antibiotics, bismuth salisalycylates, surgery such as gastric resection, vagotomy, or pyloroplasty.

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