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1. Peptic Ulcer
Muhammad Aurangzeb
Institute of nursing sciences
Khyber Medical University
Peshawar

2. Objectives
• At the end of this presentation the student will
be able to define:
• Define peptic ulcer.
• Identify causes & factors for the development of
peptic ulcer.
• Enlist signs/symptoms and complication of peptic
ulcer.
• Discuss diagnosis and treatment of peptic ulcer.
• Apply nursing intervention for peptic ulcer.

3. Peptic Ulcer
• An Ulcer is …
 Erosion in the lining of the stomach or the
first part of the small intestine, an area
called the duodenum.
Ulcers damage the mucosa of the alimentary
tract, which extends through the muscularis
mucosa into the sub mucosa or deeper.

4. Ulcers that form in the stomach are called gastric ulcers; in the
duodenum, they are called duodenal ulcers. Both types are
referred to as peptic ulcers.

5. Peptic UlcerPeptic Ulcer

6. • The gastroduodenal mucosal integrity is
determined by protective (defensive) &
damaging (aggressive) factors.

7. Mucosal damage  erosions & ulcerations

8. Causes gastric and duodenal ulcer
• In the past it was believed lifestyle factors, such as
stress and diet caused ulcers. Later, researchers
determined that stomach acids -- hydrochloric acid
and pepsin -- contributed to ulcer formation.
• Today, research shows that most ulcers (80 percent
of gastric ulcers and 90 percent of duodenal ulcers)
develop as a result of infection with a bacterium
called Helicobacter pylori (H. pylori).
• It is believed that, although all three of these factors
-- lifestyle, acid and pepsin, and H. pylori -- play a
role in ulcer development, H. pylori is considered to
be the primary cause.

9. Cont…

10. Factors in the development of peptic
ulcers
• Factors for the development of peptic ulcers include:
• Helicobacter pylori
Research shows that most ulcers develop as a result
of infection with bacterium called Helicobacter pylori
(H. pylori). The bacterium produces substances that
weaken the stomach's protective mucus and make it
more susceptible to the damaging effects of acid and
pepsin, as well as produce more acid.

11. Conti….
• Smoking:
Studies show smoking increases the chances of
getting an ulcer, slows the healing process of existing
ulcers, and contributes to ulcer recurrence.
• Caffeine:
Caffeine seems to stimulate acid secretion in the
stomach, which can aggravate the pain of an existing
ulcer. However, the stimulation of stomach acid
cannot be attributed solely to caffeine

12. Conti…
• Alcohol
no proven link between alcohol consumption and
peptic ulcers, ulcers are more common in people
who have cirrhosis of the liver, a disease often linked
to heavy alcohol consumption.
• Stress
Although emotional stress is no longer thought to be
a cause of ulcers, people with ulcers often report
that emotional stress increases ulcer pain.

13. Conti…
• Acid and pepsin
It is believed that the stomach's inability to defend
itself against the powerful digestive fluids,
hydrochloric acid and pepsin, contributes to ulcer
formation.
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
These drugs (such as aspirin, ibuprofen, and
naproxen sodium) make the stomach vulnerable to
the harmful effects of acid and pepsin. They are
present in many non-prescription medications used
to treat fever, headaches, and minor aches and
pains.

14. Symptoms of gastric and duodenal ulcer
• The following are the most common symptoms for
ulcers, however, each individual may experience
symptoms differently.
• Belching
• Nausea
• Vomiting
• Poor appetite
• Loss of weight
• Feeling tired and weak

15. Complication of ulcer
• Bleeding.
• Perforation.
• Narrowing and
obstruction.

16. Diagnosis
• Diagnostic procedures include:
• Barium Swallow
• Endoscopy - a small flexible instrument with a
camera on the end is inserted through the mouth
into the esophagus, stomach, and duodenum to view
the entire upper GI tract.
• Blood tests - performed to detect the presence of H.
pylori.

17. Treatment
• Lifestyle changes: In the past, physicians
advised people with ulcers to avoid spicy,
fatty, or acidic foods.
• Smoking: Smoking has been shown to delay
ulcer healing and has been linked to ulcer
recurrence; therefore, people with ulcers
should not smoke.

18. Conti…
• Medications:
Physicians treat stomach and duodenal ulcers with
several types of medications, including:
• H2-blockers to reduce the amount of acid the
stomach produces by blocking histamine, a powerful
stimulant of acid secretion. E.g. Cimetidine,
Ranitidine, and Famotidine.
• Proton pump inhibitors to more completely block
stomach acid production by stopping the stomach's
acid pump -- the final step of acid secretion. E.g.
Omeprazol.

19. Cont…
• Mucosal protective agents to shield the stomach's
mucous lining from the damage of acid, but do not
inhibit the release of acid. E.g. Bismuth, Sucralfate
• When treating H. pylori, these medications are often
used in combination with antibiotics.
• Antibiotics: The discovery of the link between ulcers
and H. pylori resulted in a probable new treatment
option -- antibiotics for patients with H. pylori.

20. H. pylori Therapy:
• Triple therapy:
Proton pump inhibitor
Clarithromycin
Amoxicillin.

21. Surgery
• At present, surgery is performed to treat
ulcers. Types of surgery include:
• Vagotomy
• Pyloroplasty
• Antrectomy

22. Vagotomy
• Vagotomy: a surgical operation in which one
or more branches of the vagus nerve are cut,
typically to reduce the rate of gastric secretion
(e.g. in treating peptic ulcers).

23. Pyloroplasty
• Pyloroplasty is surgery to widen the opening
in the lower part of the stomach (pylorus) so
that stomach contents can empty into the
small intestine (duodenum). The pylorus is a
thick, muscular area. When it thickens, food
cannot pass through.

24. Antrectomy
• Surgical removal of the walls of an antrum,
especially the antrum of the stomach.

25. Nursing diagnosis
• Pain related to the wound in the stomach,
primary to HCl secretion.
• Vomiting related to indigestion of food.
• Loss appetite related to ulceration of the
stomach.
• Loss of weight related decreased nutrients
intake secondary to peptic ulcer.
• Stress and anxiety related to disease process.

26. Nursing interventions.
• Support the patient emotionally.
• Administer prescribed medications.
• Provide small meals a day or small hourly meals as
ordered.
• Schedule care so that the patient gets plenty of
rest.
• Monitor the effectiveness of administered
medications, and also watch for adverse reactions.
• Assess the patient’s nutritional status and the
effectiveness of measures used to maintain it.
Weigh him regularly.

27. Cont…
• Teach the patient about peptic ulcer disease, and
help him to recognize its signs and symptoms.
• Instruct the patient to take antacids 1 hour after
meals.
• Warn the patient to avoid aspirin containing drugs
because they irritate gastric.

28. THANK YOU