消化性溃疡(英文)

PepticUlcerdisease(PUD)byAnruiZhengfromhuangshicentralhospitalLearningObjectivesTomasterthecauseofpepticulcerclinicalmanifestationsandcomplications;Tomasterthepepticulcernursinginterventionandhealtheducation;Befamiliarwiththekeypointsofthepathogenesisandtreatmentofpepticulcer;DefinitionAcircumscribedulcerationofthegastrointestinalmucosaoccurringinareasexposedtoacidandpepsinandmostoftencausedbyHelicobacterpyloriinfection.(Uphold&Graham,2003)PepticUlcers:Gastric&DudodenalPepticUlcers:Gastric&Duodenalgastriculcer:theulcerthatoccursinthestomachlining,someofthemmaybemalignant.duodenalulcer:mostoftenseeninfirstportionofduodenum.GUDUPUDDemographics（流行病学）Lifetimeprevalenceis~10%.Theincidenceofduodenalis4timesascommonasgastriculcermostcommoninmiddleagepeak30-50yearsMaletofemaleratio—4:1Etiology（病因学）Helicobacterpylori（HP）Etiology（病因学）nonsteriodalanti-inflammatorydrugs(NSAID）AcidandpepsinOthersdiseasecharacteristicsChronicprocessperiodicalattackRhythmicabdominalpainmainsymptom(1)abdominalpain：theclassicsymptomofPUD.Pain—”gnawing”,“aching”,or“burning”“hungerlike”（钝痛、胀痛、灼痛或饥饿痛）(2)rhythmicity:GUEating-pain-reliefDUpain-eating-relief(3)cyclicity：Attackmoreinautumnorwintergastriculcerduodenalulcertimepositionnatureruleoccurs0.5~1hourafteramealandreliefuntilnextmeal,maynotawakenpatientfromsleep.medianorleftofSubxiphoidburningpainorcrampypainEating-pain-reliefoccurs3-4hoursafteramealandmayawakenpatientfromsleep.Midlineorrightofepigastrichungerlikepainorburningpainpain-eating-reliefPaincharacteristicsofpepticulcerClinicalmanifestationOthersymptomsofdigestivesystem：Nausea,vomiting,belching,bloating,chestdiscomfortmayalsooccur.ClinicalmanifestationsignEpigastrictendernessComplicationshemorrhageComplicationsPerforationComplicationsobstruction–pyloricstenosisComplicationsGastriccarcinoma.(notduodenalcarcinoma)Hemorrhage:hematemesis,blackortarrystoolsGastriccarinomaGU1%canbecomecancerousAchronic,GUhistory45yearsofageorolderThemoresymptomsstubbornlyContinuousandoccultblood(+)EndoscopyBariummeal–contrastx-rayBiopsy–bacteria&malignancyStoolforfecaloccultbloodH.Pylori:(13)C-ureaBreathTest.PUD-DiagnosisEndoscopyBariummeal–contrastx-rayTreatmentPlanMedications—treatwithProtonPumpInhibitorsorH2receptorantagoniststoassistulcerhealingH2:Tagament,Pepcid,Axid,orZantacforupto8weeksPPI:Prilosec,Prevacid,Nexium,Protonix,orAciphexfor4-8weeks.DU：PPI4~6wGU:PPI6~8wSurgeryPeoplewhodonotrespondtomedication,orwhodevelopcomplicationsNursingdiagnosisPainrelatedtogastricandduodenalinjuryAlteredNutrition:lessthanbodyrequirementsrelatedtonauseanursinginterventionRelievepainMedicationandcareDietRestMonitorPsychotherapyandheatheducationRelievepainDU:Eatalkalescentfoodinpainorbeforepain(suchassodabiscuit,etc.);ThelocalhotcompressMedicationandcareAntacids:shouldbe1hafterthemealorbeforebed.AluminiumHydroxideGel:causephosphorusdeficiency,lossofappetite,weaknessMedicationandcareH2RA:Itshouldbetakenatmealsoraftermeals,oratbedtime.PPI:Effectiveinacidicenvironment,take1hourbeforemeal.Bismuthagent:Becauseitworksinacidity,itistakenbeforemeal.Itcanmakethefecesblack.DietEatinglittlebutoftenandregularly.Avoideatingraw,cold,hardandstrongirritantfood.Selecteasilydigestibleandnutritiousfood.Eatingpasta,adequateskimmilkduringactiveperiod.Afterthesymptomsisalleviated,youshouldreturntonormalmealdiettimely.Nutritionmonitoring(suchas:bodyweight,hemoglobin)RestThelightsymptom:appropriateactivitiestodistractiontheattentionTheheavysymtom:stayinbedforafewdaysto1~2weeks,relievepainsymptomsMonitorVitalsignMeasuringweightonaregularbasis,monitoringnutritionalindexessuchasserumalbuminandhemoglobinPsychotherapyandheatheducationInformationabouttherelationshipbetweenpepticulcerandfactorssuchasHp,NSAIDs,smoking,alcoholintake,stress.PsychotherapyandheatheducationEducationaboutboththerapeuticandpreventivestrategies.LifestylemanagementAvoidtheuseofsteroid,caffeine,aspirinandotherNSAIDs.PsychotherapyandheatheducationInstructionaboutthemedicationregimenprescribedandhowtotakethedrugs.Teachtheclientthesymptomsthatmayindicateacomplication,suchasincreasedabdominalpainordistention,vomiting,blackortarrystools,orfainting.QuestionWhichtypeofPUDwillhaveabdominalpainatnight?HowcanwediagnosistheinfectionofHp?