Nursing Continuing Education Courses Online
Foucs: Peptic Ulcers
HealthCMI brings special FYI information on common questions in nursing continuing education and medicine.
Peptic ulcers are circumscribed breaks in the continuity of mucosa, extending below the epithelium. Strictly speaking, breaks in the mucosa not extending below are called erosions, although they are often referred to as ulcers. Chronic ulcers have scar tissue at the base. Peptic ulcers can be located in any part of the gastrointestinal tract exposed to the acid-pepsin gastric juice, including the esophagus, stomach, duodenum and after gastroenterostomy, the jejunum. Although the peptic digestive activity of the gastric juice is an important etiologic factor, there is evidence that this is only one of many factors in its pathogenesis. Both cortisone and aspirin produce qualitative changes in the gastric mucus which may facilitate its degradation by pepsin.
Aspirin, alcohol, bile salts, and other substances injurious to the gastric mucosa alter the permeability of the epithelial barrier, which allows back diffusion of hydrochloric acid with resultant injury to underlying tissues, especially blood vessels. Histamine is liberated, which stimulates further acid and pepsin secretion and increased capillary permeability to proteins. The mucosa becomes edematous, and large amounts of plasma proteins may be lost. The mucosal capillaries may be damaged, resulting in interstitial hemorrhage and bleeding. Severe stress, especially chronic, is another major cause of gastric ulcers. Overall, acidity is the major pathogenic factor, so that a malfunction of Brunner's glands, which produce a mucoid secretion that neutralizes the acid chyme, would lead to ulceration. If normal tissue resistance defense systems like this are overwhelmed- ulcer. Also important to tissue resistance is vascular supply, proper epithelial regeneration - normally replaced every 3 days. HealthCMI will feature food cures for nursing continuing education online courses on this topic- coming soon!
Other causes: Indomethacin, phenylbutazone, and corticosteroids, also- caffeine. Associated diseases: Liver cirrhosis, chronic pancreatitis, chronic lung dz, hyperparathyroidism, and Zollinger-Ellison syndrome. In addition, bile reflux from abnormal pyloric sphincter function disrupts the mucosal barrier.
CLINIC: upper abdominal pain usually 2 hours after a meal and is relieved by foods and antacids; sometimes pain in the middle of the night (duodenal ulcer), and weight loss (gastric ulcer).
COMPLICATIONS: intractability, hemorrhage, perforation, and pyloric obstruction. Some ulcers are malignant, others may lead to iron-deficiency anemia, shock in the case of bleeding. Perforation may lead to chemical peritonitis and therefore intense pain, a fear of moving and breathing, and a rigid abdomen. If the pancreas is involved, pain may radiate to the back. Obstruction may lead to anorexia, nausea, and bloating after eating and weight loss; also, sever pain and vomiting.
STRESS ULCER: Brain injury, shock, sepsis, burns and drugs