ASA, NSAIDS, corticosteroids, anticoagulants and some SSRIs (Prozac)
Aspirin & NSAIDs effects on mucosa?
inhibit synthesis of prostaglandins = ↑ gastric acid secretion & ↓ integrity of mucosal barrier
↓ rate of mucosal cell renewal thereby ↓ protective effects
bacterium colonizes epithelial cells in the mucosal layer → produces urease which activates immune response with antibodies and the release of cytokines
ETOH causes acute lesions as well as ↑'s acid secretions; coffee is a strong stimulant of gastric acid secretion; psychologic distress (stress & depression) negatively influences healing of ulcers once they've developed; smoking OF COURSE!
Gastric ulcer mostly found in
Gastric ulcer etiology
H. Pylori, medications, smoking and bile reflux are RF
Duodenal ulcers most common cause?
H. pylori (90-95% of all cases)
severe peptic ulceration, gastric acid hypersecretion elevated serum gastrin levels and gastrinoma of pancreas or duodenum
partial gastrectomy (upper 2/3) with re-connection to duodenum
Gastrojejunostomy (Bilroth 2)
partial gastrectomy (upper 2/3 with re-connection to jejunum
"de-nerve" all or part of stomach: combo of vagotomy with Bilroth I or II will remove ulcer and stimulus for additional secretions
repair (expand) pyloric opening
Dumping syndrome is direct result of
surgical removal of a large portion of stomach and pyloric sphincter and ↓reservoir capacity of stomach
dumping syndrome: chyme is thicker (doesn't break down as much) so...
will pull water and move it out of bowel faster!
absorption is a problem, what will be happening to patient's stools?
liquid (less calories in, weight loss, B12 deficiency bc intrinsic factor is required)
Dumping syndrome nursing interventions
seperate fluids from food (smaller and more frequent meals; avoid bulk (fiber) avoid fluid with meals (expands foods); avoid high carb diet
Dumping syndrome manis
pain in perianal area (could get TPN if bad enough)
variant of dumping syndrome d/t less absorption: bolus of fluid high in carbs goes into SI →pancreas doesn't realize you aren't going to absorb it all and releases excessive amount of insulin into circulation
PUD gerontological considerations
↑ use of NSAIDs; 1st sign can be flank pain or ↓ Hct