Question

Ms. George is a 32-year-old computer programmer. Over the last several months, she has had increased episodes of a burning sensation in the mid epigastrium and back. The pain subsides after eating. Based on her history, the physician orders an endoscopy that reveals several peptic ulcers. Treatment of the ulcers includes antibiotics, proton pump inhibitors, and bismuth salts. (Learning Objectives 1 and 3)

Questions:

a. Correlate Ms. George’s clinical presentation to the pathophysiology of peptic ulcers.

b. Ms. George asks why eating decreases her pain; how does the nurse respond?

c. Explain the rationale for the prescribed pharmacologic therapy.

Answer 1

Ans.

A) Pathophysiology of peptic ulcer -

Peptic ulcers are defects in the gastric or duodenal mucosa that extend through the muscularis mucosa. The epithelial cells of the stomach and duodenum secrete mucus in response to irritation of the epithelial lining and as a result of cholinergic stimulation. The superficial portion of the gastric and duodenal mucosa exists in the form of a gel layer, which is impermeable to acid and pepsin. Other gastric and duodenal cells secrete bicarbonate, which aids in buffering acid that lies near the mucosa. Prostaglandins of the E type (PGE) have an important protective role, because PGE increases the production of both bicarbonate and the mucous layer.

In the event of acid and pepsin entering the epithelial cells, additional mechanisms are in place to reduce injury. Within the epithelial cells, ion pumps in the basolateral cell membrane help to regulate intracellular pH by removing excess hydrogen ions. Through the process of restitution, healthy cells migrate to the site of injury. Mucosal blood flow removes acid that diffuses through the injured mucosa and provides bicarbonate to the surface epithelial cells.

B) eating decreases pain in peptic ulcers because the acids of the stomach are acting on the foods rather than the ulcer – it takes the attention away from the ulcer and focuses it on actively digesting the foods. That is why after digestion is complete and the food has moved on, the pain returns.

C) A variety of options are available for the medical treatment of peptic ulcer disease, including antacids, histamine2 receptor antagonists, omeprazole, prostaglandin analogues, and sucralfate and bismuth formulations. Seventy percent to 90% of peptic duodenal and gastric ulcers will heal after 4 to 8 weeks of therapy.

most common treatment for peptic ulcer -

The most common remedy is a combination of antibiotic drugs to kill the H. pylori bacteria and medications to get rid of acid in your stomach. These typically include proton pump inhibitors (like Aciphex or Nexium), and antibiotics. You'll take PPIs for several weeks.