Ep132: Peptic Ulcer Disease (video episode)

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Podcast Transcription

Okay. When we’re talking about peptic ulcer disease, it’s important to know that this is a pretty common occurrence. A lot of people might experience peptic ulcer disease at one point in their life. Let’s talk about what it is. It’s really just a break in the mucosal lining of the stomach or the pylorus or the duodenum or the esophagus that come in contact with gastric secretions. For example here, here would be the break in the mucosal lining. What happens is when gastric acid is secreted into the stomach, that touches the wall there where that break is in that lining, and that causes a lot of pain for the patient.

What are we going to see in our patients and how do we need to take care of this? What we’re going to see, first of all, is we’re going to see pain. Pain is going to be the number one thing because as that gastric acid is secreted into the stomach, if it touches, the actual tissue, it’s going to burn, it’s going to hurt greatly to these patients. If a patient has a gastric ulcer, we’re going to see this sharp nine pain 30 to 60 minutes after a meal. That makes sense because that’s about when we’re going to start digesting food. Right? If it’s a duodenal ulcer, it’s going to be 1.5 to 3 hours after eating. Okay?

It’s important to understand that if get a question on the NCLEX or in a test about timeframe of this, just think as the food passes where it’s at along this timeframe. If it’s 30 to 60 minutes after eating, we’re going to be talking about gastric. If we’re 1.5 to 3 hours after eating, we’re talking duodenal. Okay?

How do we assess this? First thing we’re going to do is we’re going to do an upper GI series, we’re going to EGD. The best way to see it is going to be actually do EGD. What an EGD is here’s our esophagus coming into our stomach, right, and here’s the duodenum. EGD actually takes a [inaudible 00:02:16] and it comes down with a little camera, and it can actually look at the stomach. Okay? We want our patients to [inaudible 00:02:24] for a little bit before this, we’re going to aspirate them, we also want to get a clean view. We actually insert that little camera down there, the physician does, the gastroenterologist, will insert a little camera down there and we can actually look at and identify these ulcers. Okay?

Other things we might see, we might see hematemesis with our patients, which is just vomiting blood, or we might see melena. Melena is going to be blood in stool. Okay? If we see the hematemesis, that’s going to be a sign of a gastric ulcer, and if we see the melena, that would be an indication of a duodenal ulcer. Again, just think if it’s coming up this end, it’s higher up in the GI track, if it’s coming out the other end, it’s a little bit lower down in the GI tract. Okay? Melena versus hematemesis. Okay?

How are we going to manage this? First thing we want to do is we want to teach patients about different foods that are going to cause additional irritation. Things like coffee, cola, tea, chocolate, high sodium, and spicy foods. You might notice that with [gird 00:03:39] and with a couple of other conditions we talked about here, that these are common foods that we want to have our patients avoid. Really, just teach them about these foods, teach them to avoid them. If they smoke, teach them to stop smoking, teach them to eat small and frequent meals. If they’re bringing less in, that’s going to result in less gastric acid secretion and so it might help with some of that pain there.

Teach them also to avoid aspirin and NSAIDs. The reason for that, of course, is that these can cause GI bleeding. Okay? If the patient already has compromised GI system or stomach, we really want to avoid causing that further stress on them. Then we’re also going to monitor H&H for bleeding, hemoglobin and hematocrit, and of course, we want to see if those numbers are going down, and if the patient might be bleeding somewhere that we can’t see.

Other things we’re going to want to do is medically, we can manage it with medications, and then surgically, there’s a couple of different options that we can do. First of all, we can do H2 receptor antagonists, histamine 2 receptor antagonists, and proton pump inhibitors. What both of these do is they decrease gastric acid secretion, they do it in different ways …