PEPTIC ULCER DEFINITION. Peptic ulcers are open sores in the upper part of the digestive tract that can cause stomach pain or stomach upset, and that can lead to.Stomach and duodenal ulcer diet, herbs, vitamins, natural treatment with diet, supplements and home remedy by Ray Sahelian, M.D. April 10 2016. It usually remains for five to seven days and heals within two weeks with no scarring. Arterial and venous ulcers are quite different and require different modes of treatment. Venous stasis ulcers occur as a result of venous insufficiency in the lower limb. The insufficiency is due to deep vein thrombosis and failure of the one- way valves that act during muscle contraction to prevent the backflow of blood. Chronic varicosities of the veins can also cause venous stasis. Patient Care. Stasis ulcers are difficult to treat because impaired blood flow interferes with the normal healing process and prolongs repair. Patient care is concerned with preventing a superimposed infection in the ulcer, increasing blood flow in the deeper veins, and decreasing pressure within the superficial veins.
Marginal ulcers are a frequent complication of surgical treatment for peptic ulcer; they are difficult to control medically and often require further surgery. A wide variety of insults may produce ulcers, including trauma, caustic chemicals, intense heat or cold, arterial or venous stasis, cancers, drugs (such as nonsteroidal anti- inflammatory drugs . If it persists for longer than 2 weeks, it should be biopsied to rule out cancer. Synonym: aphthous stomatitis; canker sore See: illustration. Etiology. Aphthous ulcers are found in stomatitis, Beh. Buruli ulcer. An infection of the skin and underlying tissues with Mycobacterium ulcerans. The infection, common in the tropics and subtropics, develops slowly from a painless or minimally painful nodule on the skin into underlying bone, which it gradually destroys. The spread of the disease may be prevented with bacille Calmette- Gu. Patient care. To prevent irritation and ulceration of the mucous membranes of the mouth, denture wearers should clean dentures daily and remove them while sleeping. Poorly fitting dentures should be reconstructed or padded by a denturist. Diabetic foot infection. An open sore on the mucosa of the first portion of the duodenum, most often the result of infection with Helicobacter pylori. It is the most common form of peptic ulcer. An ulcer in which the granulations protrude above the edges of the wound and bleed easily. An ulcer caused by a fungus. Etiology. Common causes are NSAIDs, use of alcohol or tobacco, and infection with H. See: peptic ulcer. Hunner ulcer. Interstitial cystitis. A nearly painless ulcer usually found on the leg, characterized by an indurated, elevated edge and a nongranulating base. An ulcer caused by diminished blood flow through an artery, esp. These ulcers are usually found in patients with peripheral vascular disease. They may result in loss of digits as a result of gangrene. Peptic ulcer disease is a common illness, affecting about 1. Curling ulcer; Helicobacter pylori; stress ulcer; Zollinger- Ellison syndrome; Etiology. Common causes of peptic ulcer are factors that increase gastric acid production or impair mucosal barrier protection, e. NSAIDs, smoking, H. Ulcers occur in men and women and occur most frequently in patients over age 6. U. S. The relationship between peptic ulcer and emotional stress is not completely understood. Symptoms. Patients with peptic ulcers may be asymptomatic or have gnawing epigastric pain, esp. At times, heartburn, nausea, vomiting, hematemesis, melena, or unexplained weight loss may signify peptic disease. Food intake often relieves the discomfort. Peptic ulcers that perforate the upper gastrointestinal tract may penetrate the pancreas, causing symptoms of pancreatitis (severe back pain) and chemical peritonitis followed by bacterial peritonitis or an acute abdomen as irritating gastrointestinal (GI) contents and bacteria enter the abdominal cavity. Bacterial peritonitis can lead to sepsis, shock, and death. Diagnosis. Endoscopy (esophagogastroduodenoscopy) provides the single best test to diagnose peptic ulcers because it allows direct visualization of the mucosa and permits carbon–1. H. During endoscopy, tissue can be excised, vessels ligated, or sclerosants injected. Barium swallow or upper GI x- ray series may also be used to provide images for diagnosis or follow- up and may be the initial test for patients whose symptoms are not severe. Treatment. H. Bismuth or other coating agents may be used as a barrier to protect the duodenal mucosa. Peptic ulceration of the stomach may be treated with the same medications if biopsies or breath tests reveal H. When patients have ulcers caused by the use of NSAIDs or tobacco, withholding these agents and treating with an H2 blocker, e. The prostaglandin analogue misoprostol may also be used to suppress or prevent peptic ulcer caused by use of NSAIDs. GI bleeding is managed initially with passage of a nasogastric tube and iced saline lavage, possibly with norepinephrine added. Gastroscopy then allows visualization of the bleeding site and laser or cautery coagulation. When conservative medical treatment is ineffective, vagotomy and pyloroplasty may be used to reduce hydrochloric acid secretion and enlarge the pylorus to enhance gastric emptying. More extreme surgical therapy (including subtotal gastric resection) may be needed in rare instances of uncontrollable hemorrhage or perforation occurring as a result of peptic ulcer disease. Patient care. The ambulatory patient is educated about agents that increase the risk for peptic ulceration and given specific instructions to avoid them. Instruction should include the importance of adhering to prescription drug therapies, adverse reactions to H2- receptor antagonists and omeprazole (dizziness, fatigue, rash, diarrhea), and the need for follow- up examination and care. For the hospitalized patient with ulcer- related bleeding, careful monitoring of vital signs, fluid balance, hemoglobin levels, and blood losses may enhance early recognition of worsening disease. Intravenous (IV) access is established, and IV opiates are administered as prescribed for pain control. The patient is kept nil per os (NPO). Electrolytes and fluids are replaced as needed. Endoscopic or other diagnostic and treatment procedures are explained to the patient, and the effects of prescribed therapies or transfusions are carefully assessed. All patient care concerns apply after major surgery. The patient is assessed for possible complications: hemorrhage, shock, malabsorption problems (iron, folate, or vitamin B1. To avoid these problems, the patient is advised to drink fluids between meals rather than with meals, eat 4 to 6 small, high- protein, low- carbohydrate meals daily, and lie down after eating. Before and after discharge, health care professionals should help the patient to develop coping mechanisms to relieve anxiety. Patients are taught to recognize signs and symptoms of disease recurrence (e. Patients who use antacids and have a history of cardiac disease or whose sodium intake is restricted for any reason are warned to take only those antacids that have low amounts of sodium. The need for ongoing medical care is stressed. An ulcer that erodes through an organ, e. Tropical ulcer. postpolypectomy ulcer. An erosion through the lining of the gastrointestinal tract resulting from endoscopic removal of a tumor. Pressure ulcers typically occur in patients who are bedridden or chair bound. Patients with sensory and mobility deficits (such as patients with spinal cord injury, stroke, or coma); malnourished patients; patients with peripheral vascular disease; hospitalized elderly patients; and nursing home residents are all at risk. Some evidence also suggests that incontinence is a risk factor. Synonym: bed soredecubitus ulcerpressure sore See: Norton scale for table. The most common sites of skin breakdown are over bony prominences (the sacrum and the trochanters, the heels, the lateral malleoli and also the shoulder blades, ischial tuberosities, occiput, ear lobes, elbows, and iliac crests). The combination of pressure, shearing forces, friction, and moisture leads to tissue injury and occasionally necrosis. If the ulcer is not treated vigorously, it will progress from a simple red patch of skin to erosion into the subcutaneous tissues, eventually extending to muscle or bone. Deep ulcers often become infected with bacteria and develop gangrene. See: illustration. Treatment and Prevention. The most important principle is to prevent the initial skin damage that promotes ulceration. In patients at risk, aggressive nursing practices, such as frequent turning of immobile patients and the application of skin protection to bony body parts, are frequently effective. Gel flotation pads, alternating pressure mattresses, convoluted foam mattresses and sheepskins or imitation sheepskins may be employed. Specialized air- fluid beds, waterbeds, or beds with polystyrene beads provide expensive but effective prophylaxis. If the patient develops an ulcer, topical treatments with occlusive hydrocolloid dressings, polyurethane films, absorbable gelatin sponges, collagen dressings, wound- filter dressings, water- vapor permeable dressings, and antibiotic ointments aid the healing of partial- thickness sores. Deeper lesions may need surgical d. Skin- damaging agents such as harsh alkaline soaps, alcohol- based products, tincture of benzoin, hexachlorophene, and petroleum gauze should be avoided. Consultation with a wound care specialist is advantageous. Patient care. The skin is thoroughly cleansed, rinsed, and dried, and emollients are gently applied by minimizing the force and friction used, esp. Patients who are not able to position themselves are repositioned every 1–2 hr to prevent tissue hypoxia resulting from compression. A turning sheet or pad is used to turn patients with minimal skin friction. Care providers should avoid elevating the head of the bed higher than 3. Range- of- motion exercises are provided, early ambulation is encouraged, and nutritious high- protein meals are offered. Low- pressure mattresses and special beds are kept in proper working order. Peptic Ulcer: Causes, Treatment, & Prevention. Medically Reviewed by Steven Kim, MD. October 1. 4, 2. 01. Written by Valencia Higuera What Are Peptic Ulcers? Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine (the duodenum), usually as a result of inflammation caused by the bacteria H. Peptic ulcers are a fairly common health problem. There are three types of peptic ulcers: gastric ulcers: ulcers that develop inside the stomachesophageal ulcers: ulcers that develop inside the esophagusduodenal ulcers: ulcers that develop in the upper section of the small intestines, called the duodenum. Causes Causes of Peptic Ulcers. Different factors can cause the lining of the stomach, the esophagus, and the small intestine to break down. These include: Helicobacter pylori (H. In some cases, the pain may wake you up at night. Small peptic ulcers may not produce any symptoms in the early phases. Other common signs of a peptic ulcer include: changes in appetitenauseabloody or dark stools (melena)unexplained weight lossindigestionvomitingchest pain. Tests Tests and Exams for Peptic Ulcers. Two types of tests are available to diagnose a peptic ulcer. They are called upper endoscopy and upper gastrointestinal (GI) series. Upper Endoscopy. In this procedure, your doctor inserts a long tube with a camera down your throat and into your stomach and small intestine to examine the area for ulcers. This instrument also allows your doctor to remove tissue samples for examination. Not all cases require an upper endoscopy. However, this procedure is recommended for people with a higher risk of stomach cancer. This includes people over the age of 4. Upper GIIf you don’t have difficulty swallowing and have a low risk of stomach cancer, your doctor may recommend an upper GI test instead. For this procedure, you’ll drink a thick liquid called barium, and then a technician will take an X- ray of your stomach, esophagus, and small intestine. The liquid will make it possible for your doctor to view and treat the ulcer. Because H. If tests show that you have an H. The medications include antibiotics to help kill infections, and proton pump inhibitors (PPIs) to help reduce stomach acid. You may experience minor side effects like diarrhea or upset stomach from antibiotic regimens. If these side effects cause significant discomfort or don’t get better over time, talk to your doctor. If your doctor determines that you don’t have an H. These medications are available as a prescription and also over the counter in lower doses. Complications Complications of a Peptic Ulcer. Untreated ulcers can become worse over time and lead to other, more serious health complications, such as: Perforation: A hole develops in the lining of the stomach or small intestine and causes an infection. A sign of a perforated ulcer is sudden, severe abdominal pain. Internal bleeding: Bleeding ulcers can result in significant blood loss and thus require hospitalization. Signs of a bleeding ulcer include lightheadedness, dizziness, and black stools. Scar tissue: This is thick tissue that develops after an injury. This tissue makes it difficult for food to pass through your digestive tract. Signs of scar tissue include vomiting and weight loss. All three complications are medical emergencies that require surgery. Call your doctor if you feel dizzy or if symptoms return. Seek urgent medical attention if you experience the following symptoms: sudden, sharp abdominal painfainting, excessive sweating, or confusion, as these may be signs of shockblood in vomit or stoolabdomen that’s hard to the touch. Outlook Outlook for Peptic Ulcers. With proper treatment, most peptic ulcers heal. However, you may not heal if you stop taking your medication early or continue to use tobacco and pain relievers during treatment. Your doctor will schedule a follow- up appointment after your initial treatment to evaluate your recovery. Some ulcers, called refractory ulcers, don’t heal with treatment. If your ulcer doesn’t heal with the initial treatment, this can indicate: an excessive production of stomach acidpresence of bacteria other than H. These include: not drinking more than two alcoholic beverages a daynot mixing alcohol with medicationwashing your hands frequently to avoid infectionslimiting your use of ibuprofen, aspirin, and naproxen sodium. Maintaining a healthy lifestyle through a balanced diet rich in fruits, vegetables, and whole grains, and quitting smoking and other tobacco use will also help you prevent developing a peptic ulcer.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
November 2017
Categories |