消化性潰瘍英文

1、消化性潰瘍英文消化性潰瘍英文第1頁Learning Objectives To master the cause of peptic ulcer clinical manifestations and complications; To master the peptic ulcer nursing intervention and health education; Be familiar with the key points of the pathogenesis and treatment of peptic ulcer; 消化性潰瘍英文第2頁Definition A circumsc

2、ribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection. (Uphold & Graham, )消化性潰瘍英文第3頁P(yáng)eptic Ulcers: Gastric & Dudodenal消化性潰瘍英文第4頁P(yáng)eptic Ulcers: Gastric & Duodenalgastric ulcer : the ulcer that occurs in the

3、 stomach lining ,some of them may be malignant.duodenal ulcer : most often seen in first portion of duodenum .消化性潰瘍英文第5頁GU消化性潰瘍英文第6頁DU消化性潰瘍英文第7頁消化性潰瘍英文第8頁P(yáng)UD Demographics （流行病學(xué)）Lifetime prevalence is 10%. The incidence of duodenal is 4 times as common as gastric ulcermost common in middle age peak 3

4、0-50 yearsMale to female ratio4:1 消化性潰瘍英文第9頁Etiology（病因?qū)W）Helicobacter pylori（HP）消化性潰瘍英文第10頁Etiology（病因?qū)W）nonsteriodal anti-inflammatory drugs (NSAID）Acid and pepsinOthers 消化性潰瘍英文第11頁disease characteristicsChronic processperiodical attackRhythmic abdominal pain消化性潰瘍英文第12頁main symptom(1)abdominal pain：

5、the classic symptom of PUD. Pain”gnawing”, “aching”, or“burning”“hungerlike” （鈍痛、脹痛、灼痛或饑餓痛）(2)rhythmicity:GU Eating- pain-relief DU pain-eating-relief(3)cyclicity：Attack more in autumn or winter 消化性潰瘍英文第13頁gastric ulcerduodenal ulcertimepositionnature ruleoccurs 0.51 hour after a meal and relief unt

6、il next meal,may not awaken patient from sleep.median or left of Subxiphoidburning pain or crampy painEating- pain-reliefoccurs 3-4 hours after a meal and may awaken patient from sleep.Midline or right of epigastrichungerlike pain or burning painpain-eating-reliefPain characteristics of peptic ulcer

7、消化性潰瘍英文第14頁Clinical manifestationOther symptoms of digestive system ：Nausea, vomiting, belching, bloating, chest discomfort may also occur. 消化性潰瘍英文第15頁Clinical manifestationsign Epigastric tenderness消化性潰瘍英文第16頁Complications hemorrhage 消化性潰瘍英文第17頁Complications Perforation消化性潰瘍英文第18頁Complications obst

8、ruction pyloric stenosis消化性潰瘍英文第19頁Complications Gastric carcinoma. (not duodenal carcinoma)消化性潰瘍英文第20頁Hemorrhage: hematemesis ,black or tarry stools 消化性潰瘍英文第21頁Gastric carinomaGU 1% can become cancerous A chronic, GU history 45 years of age or older The more symptoms stubbornly Continuous and occul

9、t blood(+) 消化性潰瘍英文第22頁EndoscopyBarium meal contrast x-rayBiopsy bacteria & malignancyStool for fecal occult bloodH.Pylori:(13)C-urea Breath Test.PUD - Diagnosis消化性潰瘍英文第23頁Endoscopy消化性潰瘍英文第24頁 Barium meal contrast x-ray消化性潰瘍英文第25頁Treatment PlanMedicationstreat with Proton Pump Inhibitors or H2 recept

10、or antagonists to assist ulcer healingH2: Tagament, Pepcid, Axid, or Zantac for up to 8 weeksPPI: Prilosec, Prevacid, Nexium, Protonix, or Aciphex for 4-8 weeks.DU：PPI 46wGU: PPI 68w消化性潰瘍英文第26頁SurgeryPeople who do not respond to medication, or who develop complications消化性潰瘍英文第27頁Nursing diagnosisPai

11、n related to gastric and duodenal injuryAltered Nutrition: less than body requirements related to nausea消化性潰瘍英文第28頁nursing interventionRelieve pain Medication and care Diet RestMonitorPsychotherapy and heath education消化性潰瘍英文第29頁Relieve pain DU:Eat alkalescent food in pain or before pain (such as sod

12、a biscuit, etc.); The local hot compress 消化性潰瘍英文第30頁Medication and care Antacids: should be 1h after the meal or before bed.Aluminium Hydroxide Gel: cause phosphorus deficiency, loss of appetite, weakness消化性潰瘍英文第31頁Medication and care H2RA: It should be taken at meals or after meals, or at bedtime.P

13、PI: Effective in acidic environment, take 1 hour before meal.Bismuth agent: Because it works in acidity, it is taken before meal. It can make the feces black.消化性潰瘍英文第32頁Diet Eating little but often and regularly . Avoid eating raw, cold, hard and strong irritant food.Select easily digestible and nut

14、ritious food. Eating pasta, adequate skim milk during active period . After the symptoms is alleviated,you should return to normal meal diet timely.Nutrition monitoring (such as :body weight, hemoglobin)消化性潰瘍英文第33頁RestThe light symptom: appropriate activities to distraction the attentionThe heavy sy

15、mtom : stay in bed for a few days to 1 2 weeks, relieve pain symptoms 消化性潰瘍英文第34頁MonitorVital signMeasuring weight on a regular basis, monitoring nutritional indexes such as serum albumin and hemoglobin 消化性潰瘍英文第35頁P(yáng)sychotherapy and heath educationInformation about the relationship between peptic ulc

16、er and factors such as Hp, NSAIDs, smoking, alcohol intake ,stress. 消化性潰瘍英文第36頁P(yáng)sychotherapy and heath educationEducation about both therapeutic and preventive strategies.Lifestyle managementAvoid the use of steroid, caffeine , aspirin and other NSAIDs .消化性潰瘍英文第37頁P(yáng)sychotherapy and heath educationInstruction about the medication regimen prescribed and how to take the drugs. Teach the client the sy