Gastrointestinal Alterations

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1. Pathophysiology of Peptic Ulcer Disease

Peptic ulcer disease (PUD) is a condition in which sores or ulcers develop in the lining of the stomach or duodenum (the first part of the small intestine). The stomach and duodenum are protected from the acidic digestive juices by a thick layer of mucus and bicarbonate. When this protective layer is damaged, the acid and digestive enzymes can irritate and erode the lining of the stomach or duodenum, resulting in an ulcer.

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      There are two main types of peptic ulcers: gastric ulcers and duodenal ulcers. Gastric ulcers occur in the stomach lining, while duodenal ulcers occur in the duodenal lining. Duodenal ulcers are more common than gastric ulcers. The most common cause of PUD is infection with the bacteria Helicobacter pylori (H. pylori). H. pylori bacteria can damage the protective layer of mucus in the stomach and duodenum, making it easier for acid and digestive enzymes to irritate and erode the lining. Other causes of PUD include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin
• Corticosteroids
• Smoking
• Heavy alcohol consumption
• Zollinger-Ellison syndrome, a rare condition that causes the body to produce too much stomach acid
• Genetics

Symptoms of PUD The most common symptom of PUD is a burning pain in the upper abdomen. The pain may be worse on an empty stomach and may improve after eating. Other symptoms of PUD include:

• Bloating
• Indigestion
• Nausea and vomiting
• Loss of appetite
• Unexplained weight loss

Diagnosis of PUD To diagnose PUD, the doctor will ask about the patient's medical history and symptoms. The doctor may also order a physical exam and blood tests. In some cases, the doctor may also order diagnostic tests such as:

• Upper endoscopy: A thin, flexible tube with a camera on the end is inserted through the mouth and into the stomach and duodenum. This allows the doctor to look for ulcers.
• Urea breath test: The patient drinks a liquid containing a harmless urea compound. If H. pylori bacteria are present in the stomach, they will break down the urea compound and release carbon dioxide. The patient then breathes into a bag, and the amount of carbon dioxide in the breath is measured. A high level of carbon dioxide in the breath indicates that H. pylori bacteria are present.
• Stool antigen test: A sample of the patient's stool is tested for the presence of H. pylori bacteria.

Treatment of PUD The treatment for PUD depends on the underlying cause. If H. pylori bacteria are present, the doctor will prescribe antibiotics to kill the bacteria. The doctor may also prescribe medications to reduce stomach acid production and promote healing of the ulcer. Other treatments for PUD include:

• Antacids: Antacids neutralize stomach acid and can provide relief from pain.
• H2 blockers: H2 blockers reduce stomach acid production.
• Proton pump inhibitors (PPIs): PPIs are more powerful than H2 blockers at reducing stomach acid production.
• Surgery: Surgery may be necessary to treat severe cases of PUD or PUD that does not respond to other treatments.

Cultural Implications Cultural factors can influence the development and presentation of PUD. For example, people who eat spicy foods or foods that are high in fat are more likely to develop PUD. Additionally, people who smoke or drink heavily are also at increased risk of PUD. Cultural factors can also influence the way that PUD is treated. For example, some cultures may prefer to use traditional remedies to treat PUD, while others may prefer to use Western medicine. It is important to be aware of the cultural factors that may influence the development, presentation, and treatment of PUD in order to provide the best possible care to patients. Financial Implications PUD can have a significant financial impact on patients. The cost of medications, diagnostic tests, and treatment procedures can be expensive. Additionally, the loss of work productivity due to PUD can also lead to financial hardship. Environmental Implications Environmental factors such as air pollution and water contamination can also contribute to the development of PUD. Air pollution can irritate the lining of the stomach and duodenum, making it more susceptible to damage. Water contamination can also lead to infection with H. pylori bacteria, which can cause PUD. Priority Nursing Interventions The following are 3-5 priority nursing interventions for the client after discharge home:

1. Educate the client about PUD and its management. This includes teaching the client about the causes of PUD, the signs and symptoms of PUD, and the treatment options for PUD. The client should also be taught how to avoid triggers for PUD, such as spicy foods, fatty foods, smoking, and heavy alcohol consumption.