Med-Surg - Gastrointestinal System, part 5: Gastritis and Peptic Ulcer Disease
by Cathy Parkes November 26, 2021 Updated: January 17, 2022 5 min read
Hi. I'm Cathy, with Level Up RN. In this video, I am going to talk about gastritis and peptic ulcer disease. At the end of the video, I'm going to give you guys a quiz to test your knowledge of some of the key points I'll be making in this video. If you have our Level Up RN medical, surgical, nursing flashcards, definitely pull those out so you can follow along with me, and pay particular attention to the red, bold text, which you will find lots of as it pertains to peptic ulcer disease, because those particular points are going to be especially important for you to know.
First up, we have gastritis, which is inflammation of the gastric mucosa. So any time you see itis, that means inflammation. So with gastritis, we have inflammation of that gastric mucosa. Risk factors with gastritis include H. pylori, which is a bacteria that can not only cause gastritis, it can result in peptic ulcer disease, which we're going to talk about next. Other risk factors include long term NSAID use, smoking, stress, as well as heavy alcohol use. Signs and symptoms can include dyspepsia, which is a fancy name for heartburn or indigestion. Other symptoms include nausea and vomiting, stomach pain, bloating, and lack of appetite. In addition, if gastritis gets really bad, it can lead to the formation of ulcers which can bleed, which in turn can cause anemia. In terms of labs and diagnostic tools that we can use in the diagnosis of gastritis, we can use an EGD, and obtain a biopsy during that EGD. We can also use an upper GI series. We may perform a fecal occult blood test. So this is going to test for the presence of blood in the patient's stool, which may be present if the patient has an ulcer. In addition, we could do a urea breath test to test for the presence of H. pylori, that bacteria that can cause gastritis, as well as peptic ulcer disease. In terms of treatment, we want to advise the patient to make some lifestyle modifications and avoid alcohol, quit smoking, and reduce stress if possible. Medications that can be helpful include PPIs, H2 antagonist, as well as antacids. And then if the patient has an H. pylori infection, they will require antibiotics as well.
Next, let's talk about peptic ulcer disease, or PUD, which is a disorder that you will need to know inside and out for nursing school. And then if you work on a med surg floor after school, you will see this condition a lot. So with peptic ulcer disease, we have an erosion in the mucosa of the stomach, esophagus, or the duodenum, which is the first part of that small intestine. A key risk factor for peptic ulcer disease is an H. pylori infection. Other risk factors include chronic NSAID use, as well as the use of corticosteroids. Signs and symptoms of PUD can include epigastric pain, so that's going to be pain in the upper abdomen. In addition, the patient may have nausea and vomiting, bloating, hematemesis, which means they'll have bloody vomit or bloody emesis. So if the patient's emesis looks like coffee grounds, so coffee grounds emesis, that is indicative that there may be blood in that vomit. In addition, the patient may have melena, which is a term for bloody stools.
In terms of the pain that the patient will experience with PUD, the pain will vary a little bit, depending on whether the patient has a gastric ulcer or a duodenal ulcer. If the patient has a gastric ulcer, they will have pain about 15 to 30 minutes after consuming a meal. The pain will be worse during the day, and it will be worse with eating. This is differentiated from a duodenal ulcer, where the patient will have pain about two to three hours after a meal, so a little longer, and their pain will be worse at night, and it will actually feel a little better with eating. The gold standard for diagnosing peptic ulcer disease is using an EGD, or esophagogastroduodenoscopy. In terms of treatment, if the patient has an H. pylori infection, they are going to be required to take multiple antibiotics over a prolonged amount of time in order to prevent antibiotic resistance. Other medications that can be used include H2 blockers, PPI's, antacids, as well as sucralfate. And if you're not familiar with any of those medications, definitely check out my pharmacology video playlist because I have a video that is devoted to providing details of all of those medication classes. In terms of patient teaching, we want to advise our patient to avoid NSAIDs, caffeine, smoking, and alcohol. Complications of PUD can include hypovolemic shock. So if the patient's ulcer is bleeding extensively, that can cause hypovolemic shock. Signs and symptoms include hypotension, tachycardia, tachypnea, as well as decreased urine output. Treatment of hypovolemic shock will include the administration of blood products, as well as IV fluids.
Another complication of PUD is perforation. So with the ulcer, if it erodes through the entire mucosa, we can end up with contamination of the peritoneal cavity with gastric contents. And this will cause signs and symptoms such as severe pain, fever, and a rigid, board-like abdomen, which means the patient likely has peritonitis, which is inflammation of that peritoneal cavity. So treatment of perforation and that peritonitis is with emergency surgery. So the surgeon will have to open the patient all the way up and do a wash out of the abdomen. So a peritoneal lavage. And then in all likelihood, the patient will need a wound VAC, and if they're at my hospital, then I will be the one taking care of their abdominal wound VAC.
All right. It's time for quiz. First question. What type of bacterial infection is a key cause of gastritis and peptic ulcer disease? The answer is an H. pylori infection. Question number two is actually a multipart question. I'm going to give you a symptom, and you tell me whether that is indicative of a gastric ulcer or a duodenal ulcer. First symptom, pain two to three hours after a meal. That is a duodenal ulcer. Pain is decreased with eating. That is also a duodenal ulcer. Pain is worse in the daytime. That is a gastric ulcer. Okay. Question number three. What complication of peptic ulcer disease can cause severe pain and a rigid board-like abdomen? The answer is perforation, which results in peritonitis. Okay. That's it for this video. I hope it's been super helpful. If so, be sure to like the video, leave me a comment, and be sure to tell your classmates and friends in nursing school about our channel. Take care, and good luck with studying.
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