Peptic Ulcer

1. Anatomy and physiology of the esophagus, stomach, and duodenum.

1. The esophagus extends approximately 10 inches from the throat to the stomach.

2. The stomach is connected to the duodenum by the pyloric sphincter, which allows the partially digested food to pass only one direction.

3. The duodenum is the first portion of the small intestine.

4. The duodenum also receives secretions of the liver and pancreas.

2. Definition of "peptic ulcer."

1. It is a clearly defined break in the lining of the esophagus, stomach, or duodenum involving the mucosa, submucosa, or musculature layers.

2. The ulcer results from an imbalance in the secretion of hydrochloric acid and the resistance of the mucosal lining.

3. Factors that may increase the risk of a peptic ulcer.

1. Duodenal ulcer:

1. Type O blood.

2. Family history of ulcers.

3. Inability to deal with stress.

4. Seasons (highest in the spring and fall).

5. Cigarette smoking.

6. Alcohol abuse.

7. Sex (males have a 4:1 ratio to females).

8. Diseases such as liver cirrhosis, chronic renal failure, chronic obstructive lung disease, pancreatic disease, and hyperparathyroidism.

2. Gastric ulcer:

1. Malnutrition.

2. Sex (males have a 2:1 ratio to females).

3. History of gastritis.

4. Drugs such as aspirin,corticosteroids,indomethacin, phenylbutazone, and

5. reserpine.

6. Cigarette smoking.

7. Alcohol abuse.

8. Irritating foods.

9. Type A blood.

10. Incompetent pyloric sphincter.

4. Symptoms of peptic ulcer.

1. Burning, cramping type pain:

1. Usually occurs 1-2 hours after a meal or at night when stomach is empty.

2. Occurs in epigastric area and may radiate to upper abdomen or back.

3. Pain relieved or increased by food or liquids.

2. Weight loss.

3. Occasional nausea and vomiting.

5. Measures to prevent or control peptic ulcers.

1. Adjust diet to decrease pain and possibly of recurrence.

1. Eat regular, well-balanced, small, frequent meals. (Provide "Daily Food Guide" handout.)

2. Avoid foods that may be irritating such as caffeine and spicy foods.

3. Eat slowly, and chew food well.

4. Drink at least 6-8 glasses of water per day. (Water acts as an antacid.)

2. Control stress, especially at mealtime.

3. Avoid over-the-counter drugs without consulting a physician.

4. Plan regular rest periods.

5. Avoid smoking and alcohol, which are gastric irritants.

6. Take medications as ordered.

7. Have follow-up care as instructed.

6. Signs and symptoms of possible complications related to peptic ulcer.

1. Hemorrhage:

1. Rapid, shallow breathing.

2. Bloody or coffee-ground vomitus.

3. Restlessness or confusion.

4. Bloody or black, tarry stools.

2. Perforation:

1. Sudden, severe abdominal pain.

2. Rigid abdomen.

3. Perspiration.

3. Gastric outlet obstruction:

1. Loss of appetite.

2. Nausea after eating.

3. Vomiting of foul-smelling gastric contents.

4. Abdominal fullness after eating.

4.   Recurrence of ulcer.