Disorders of the Gastrointestinal System, 2nd Edition
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A gastric PUD attack usually begins as a dull burning pain often felt anywhere from the umbilicus to the chest. Eating may both cause and relieve pain depending on the site of the ulcer, but the pain is most likely to occur between meals and some- times in the middle of the night when the stomach is empty. If eating causes pain, weight loss may occur (Anand, 2021). In severe cases, there may be signifi - cant GI bleeding that can lead to hypo- volemic shock. Bloody vomitus or stools, low hemoglobin and hematocrit levels, tachycardia, and hypotension may signal this serious complication. Patients need emergency medical intervention for se- vere hemorrhage (Anand, 2021). | NURSING ALERT Nurses should be aware of signs and symptoms of ulcer perforation: Severe abrupt pain, a rigid abdomen, grunt- ing respirations, and diminished bow- el sounds. Patients should seek imme- diate medical help if these symptoms develop, as perforation is a leading cause of PUD morbidity and mortality (Sterns et al., 2022). PUD can also cause the gastric mucosa to become inflamed and edematous, po - tentially blocking passage into the small intestine. Blockages can cause stomach distension. As secretions build up in the stomach, there is bloating, indigestion, nausea, vomiting, feelings of fullness, and abdominal pain (Anand, 2021). Diagnosis is made by taking a careful patient history and evaluating the find - ings of certain diagnostic tests (Anand, 2021). ● Esophagogastroduodenoscopy : Verifies the existence of an ulcer and
| NURSING CONSIDERATION
Contrary to popular belief, stress, spicy foods, or a high-fat diet do not contribute to PUD development. Some foods can irritate the stomach lining and cause pain if a defect is present, but no food has been shown to cause ulceration (Stewart, 2020). Under normal circumstances, a thick layer of mucus and mucosal cells protects the stomach from chemical trauma, me- chanical trauma, and autodigestion. This mucus acts as a barrier that prevents the harmful effects of gastric acid and diges- tive enzymes. When the gastric mucosal barrier is damaged or destroyed, gastric ulcers can develop (Anand, 2021). The duodenum is protected by a mucoid al- kaline secretion of Brunner’s glands. This secretion neutralizes acid, but when there is an excessive production of acid that cannot be neutralized, duodenal ulcers can develop (Anatomy.co.uk, 2019). Causes of PUD include the following (Anand, 2021): ● Infection with pylori : Not everyone colonized with H. pylori will develop PUD, but of those diagnosed with PUD, more than 60% have H. pylori present in the ulcers. ● NSAIDs : These drugs facilitate the formation of ulcers by interfering with and causing changes in the mucosal lining of the stomach and duodenum, increasing susceptibility to ulcer formation. PUD related to the use of NSAIDs has a higher morbidity and mortality rate because of the comorbidities that are often present in those using NSAIDs long term.
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