PRESENTATION ON

GASTRIC ULCER
Prepared By:
Muna Subedi (Roll no. 13)
Nabina Bhandari (Roll no. 14)
PBNS 1st Year
Date: 2077/03/23
 CONTENTS
• Anatomy
• Introduction Of Peptic Ulcer
• Epidemiology
• Types
- Definition of Gastric ulcer
- Types
- Causes
- Risk Factors
- Pathophysiology
- Sign and Symptoms
- Diagnostic Evaluation
- Medical management
- Nursing Diagnosis
- Nursing management
- Complication
- Prognosis
- Prevention
Anatomy of Gastrointestinal System
WHAT IS PEPTIC ULCER?
Definition
• Peptic ulcer disease or PUD is an ulcer( defined as mucosal
erosions equal to or greater than 0.5cm) of an area of the
gastrointestinal tract exposed to acid and pepsin secretion.
• Erosion may subsequently occur into the lamina propria
and submucosa to cause bleeding.
Types of Peptic ulcer
• Acute or Chronic depending upon the degree of duration
of mucosal involvement
• Gastric Ulcer or Duodenal or Esophageal ulcer according to
location.
Acute Gastric Ulcer
 Acute gastric ulcer refer to ulceration of the gastric mucosa into the
submucosa immediately due to stomach acid secretion, ischemia to the
mucosa, or reduced mucosal defenses.
 Ulcers are usually multiple and can occur anywhere in the stomach typically
with little or no inflammation and resolves quickly.
Chronic Gastric Ulcer
 Chronic gastric ulcer is a mucosal defect which penetrates the submucosa
and lamina propria, produced by acid-pepsin excess secretion that lasts for
long duration.
 Mucosal erosion present continuously for many months or intermittently
throughout the life.
 Epidemiology
• Peptic ulcers are common and it has estimated that up to
10% of the population has an ulcer and annual incidence of
symptomatic peptic ulcer about 0.3%
• Duodenal ulcers usually first occur between the ages of 30-
50 years and are twice as common in men as in women.
• Gastric or stomach ulcer usually occur in people older than
60 years and are more common in women.
GASTRIC ULCER
 Gastric Ulcer
• DEFINITION: Gastric ulcers, which are also known as stomach
ulcers, is defined as a hole or a sores in the lining of the stomach
corroded by the acidic juices which are secreted by the stomach
cells.
Causes of Gastric ulcer
- Most common cause of gastric ulcer is infection with the bacterium Helicobacter pylori (H.
pylori)
- Medications
- NSAIDs: long term use if NSAIDs like Aspirin, Naproxen causes erosion of stomach
mucosa resulting in gastric ulcer.
- Corticosteroids: prednisone, dexamethasone, hydrocortisone
- Smoking: long term and frequent smoking increases gastric acid secretion. Acidic gastric
secretion eventually cause damage to superficial layer of stomach mucosa resulting in
gastric ulcer.
- Anxiety: Frequent and prolonged anxiety causes increased gastric acid secretion, which
follows development of mucosal superficial erosion resulting in gastric ulcer.
- Chronic alcohol consumers
- Hypercalcemia
- Injury or death of mucus-producing cells
- Chronic gastritis
Risk Factors
- Chronic gastritis
- Smoking, chewing tobacco
- Poor socio-economic status
- Diet: caffeine, alcohol and high spicy food and sour food
- Stress
- Certain medical conditions: hepatic biliary disease, crohn’s
disease.
- Domestic crowding
 Pathophysiology
H. Pylori (fecal oral route) inflammation Steriod, NSAID and other factors

Increased gastric acid production Interrupt system barrier

Excess acid load and thinning of mucosa Increased acid production and
damaged mucosa
Gastric ulcer
Continue….
1. Exposure to organism or any other etiologic factor.
2. Damage to mucosa results in inhibition of mucus secretion which act as a
barrier to HCL.
3. Under specific circumstances, the mucosal barrier is impaired and back
diffusion of acid occur when the barrier is broken.
4. HCL acid freely enters the mucosa and causes injury to the tissue, this
results in inflammation and cellular destruction.
5. As an inflammatory response epigastric pain ad other symptoms appear.
Sign and Symptoms
Diagnostic Evaluation
• History taking
• Physical examination
• Endoscopic examination and Biopsy
• Stool occult blood test
• Blood test
• Gastric secretion studies
• Urea breath test
• Computerized Tomography Scan
Medical Management
1. Antibiotics medication to kill H. pylori
- If H. pylori is found in the digestive system the combination of these
antibiotics are recommended to kill bacterium. These antibiotics include
Amoxicillin,Clarithromycin,Metronidazole,Tinidazole, Tetracycline, Levofloxacin.
2. Proton Pump Inhibitors
- These drug includes medicines like Omeprazole,Lansoprazole, Rabeprazole,
Someprazole and Pantoprazole.
3. Medicine to reduce acid production
- Femotidine (Pepcid)
- Cimetidine (Tagamet HB)
- Nizatidine (Acid AR)
4. Antacids that neutralizes/ reduces stomach acid.
5. Medications that protects the lining of stomach and small intestine
- Sucralfate
- Misoprostal
2. Pyloroplasty
It is a surgery to widen the opening in the lower part of stomach (pylorus) so
that stomach contents can empty onto a small intestine.The pylorus is a thick
muscular area. When it thickens,food cannot pass.
3. Antrectomy
Surgical removal of the wall
of an antrum, especially the
antrum of the stomach.
Nursing Management
Complication
• Haemorrhage
• Perforation
• Penetration
• Pyloric obstruction
 Prevention
• Avoid foods that irritate stomach; if it upset when you take food, avoid it.
Everyone is different but spicy foods, citrus fruits and fatty foods are common
irritants.
• Stop smoking. Heavy smokers are more likely to develop ulcers than
nonsmokers.
• Practice moderation. Heavy consumption of alcohol and has been shown to
contribute to the development of ulcers, so keep your intake to a minimum.
• Take NSAIDs with food, as they may decrease the risk of irritating the lining of
the stomach.
• Learn how to control the stress levels. Regular exercise and mind-body
relaxation techniques ( such as imagery and yoga ) are often helpful.
ANY QUESTIONS?
.
Reference
• Brunner and Suddharth’s ( 2018), Medical Surgical Nursing, South Asian
Edition, Wolters Kluwer, New Delhi.
• Sharma M. , Poudel K. and Gautam R. (2020), Comprehensive Textbook of
Medical Surgical Nursing, Third Edition, Samiksha publication Pvt. Ltd. ,
Ghattekulo, KTM.
• www.slideshare.net/GastricUlcer
• www.webmed.com/GastricUlcer
• www.mayoclinic.com/GastriUlcer
THANK YOU
HAVE A GOOD DAY