TABLE 1:THE DIFFERENCES AND SIMILARITES BETWEEN GASTRIC AND DUODENAL ULCERS
|GASTRIC ULCER||DUODENAL ULCER|
|2. Pain occurs half to an hour after meal||2. Pain occurs two to three hours after meal|
|3. Food increases the pain||3. Food relieves the pain|
|4. Pain do not often occur in sleep||4. Pain awakes client from sleep usually in the middle of the night 1-2am|
|5. There is weight loss||5. There is increase in weight|
|6. Vomiting is common||6. Vomiting is uncommon|
|7. Malignancy occurs occasionally||7. Malignancy do not occur|
|8. There is hematemesis||8. There is melaena stool|
|9. Less likely to perforate||9. More likely to perforate|
|GASTRIC ULCER||DUODENAL ULCER|
|10. There is diarrhoea or constipation and flatulence||10. There is diarrhoea or constipation and flatulence|
|11. Heartburns||11. Heartburns|
|12. Abdominal tenderness||12. Abdominal tenderness|
- Physical examination may reveal pain or tenderness or abdominal distension.
- Endoscopy may reveal the presence of ulcers.
- Barium meal or swallowing may reveal the presence of ulcer.
- Biopsy to rule out cancer of the stomach or duodenum.
- Gastric secretion analysis or studies is done to evaluate gastric function.
- Lab analysis of stool may reveal occult blood in stool.
- Stool antigen test and urea breath test is done to isolate the bacteria Helicobacter pylori.
- Plain x-ray of the abdomen reveals abnormalities in the mucosa.
- Full blood count may reveal low haemoglobin level and elevated white blood cells. (Smeltzer, 2010)
- Proton pump inhibitors example omeprazole is given to reduce gastric acid secretion.
- Antacids example sodium carbonate is given to neutralize hydrochloric acid.
- Antibiotics example metronidazole is given to prevent further infection.
- Histamine receptor antagonist example cimetidine is given to reduce gastric secretion.
- Sedatives example diazepam may also be given to reduce stress.
- Analgesics example paracetamol is given to relieve pain. (Smeltzer, 2010)
Surgery is indicated for perforation, suspected cancer and other complications, depending on the site and extent of the disorder. Surgical procedures adopted include;
- Bilateral vagotomy: This is the division or incision of the vagual nerve that stimulate the acid secreting cell which supply the stomach and duodenum. It’s an operation of choice for most duodenal ulcers.
- Pyloroplasty: This is done to widen the opening in lower part of the stomach, that is the pylorus, so that the stomach can empty into the duodenum.
- Gastrectomy: It can be sub-total or partial. In this procedure a portion of the stomach including the area of ulcer and part of the parietal cells are removed. Subtotal gastrectomy involves partial removal of the stomach.
Total gastrectomy is the removal of the stomach, with anastomosis of the oesophagus to the jejunum.
- Billroth I: In this procedure a part of the distal portion of the stomach is removed including the antrum.
- Billroth II: In this procedure resection involves anastomosis of the proximal jejunum. Because these secretions are necessary for digestion, a route to the intestine must preserved them. Recurrent ulceration develops less frequently with this procedure. (Smeltzer,2010)
Client with peptic ulcer disease become scared at their illness and diagnostic procedures that are associated with the condition. Client and relatives are assured that necessary nursing care would be provided to allay her fear and anxiety.
Client is made to assume a comfortable position which is not contraindicated to her health, example supine position. This helps the client to relax and reduce pain since muscle spasm is reduced and pressure and tension are redistributed on the other body parts.
The client is positioned with care to prevent neck and join stiffness.
REST AND SLEEP
A calm and quiet environment is provided for client to rest, conserve energy and aid in her healing process. Beds are made free from creases. Warm bath is given in order to relax the client and to induce sleep.
Warm drinks may also be served. Good ventilation is also ensured and bright lights are put off to induce sleep.
Vital signs such as temperature, pulse, respiration and blood pressure are monitored four (4) hourly to assess whether condition is improving or deteriorating. Mental orientation is assessed to know whether client is oriented to time, people and place.
Intake and output is monitored to know the clients fluid and electrolyte status. The site of intravenous cannula is also assessed, if it is dripping through the veins or surrounding tissues.
Client’s ability to perform her personal hygiene needs is also observed. All findings are documented.
Client is given assisted bathroom bath twice daily to prevent offensive odour and to remove dirt from the skin. The bed linens are changed when dirty or wet to prevent bad odour and infections like decubitus ulcer. Mouth care is done twice daily to prevent harbouring of microbes. This is done to prevent oral infection. Client’s hands and feet are cared for by soaking them in water and trimming nails with nail clippers as well as washing and brushing of the hand and feet to prevent harbouring of microbes and causing injury to client.