Gastrointestinal Nursing.pdf

The Stomach 49The effectiveness of diet manipulation in ulcer healing is unknown. Foodsknown to increase acid secretion include milk, alcohol and coffee.Surgical management of peptic ulcer diseaseSurgery was once the definitive treatment for peptic ulcer disease. However,the development of effective acid-suppressing drugs has made electivesurgery for peptic ulcer disease a rare event. Emergency gastric surgery isindicated for patients who do not adhere to medical therapy, and for pepticulcers which are refractive to medical therapy, or in extreme circumstances ofuncontrolled haemorrhage from a gastric ulcer. Three surgical procedures areindicated for the treatment of peptic ulcer disease: partial gastrectomy withgastroduodenostomy, partial gastrectomy with gastrojejunostomy, and highlyselective vagotomy.Complications of peptic ulcer diseaseThe main complications of peptic ulcer disease are perforation, gastric outletobstruction and bleeding.PerforationWhen perforation occurs, the contents of the stomach escape into the peritonealcavity, leading to peritonitis. Perforation occurs more commonly in duodenalthan in gastric ulcers, and usually in ulcers on the anterior wall.Although perforation may be the first sign of an ulcer, there is commonly ahistory of recurrent epigastric pain. The most striking symptom is sudden,severe pain; its distribution follows the spread of the gastric contents overthe peritoneum. Pain initially develops in the upper abdomen and rapidlybecomes degeneralised; shoulder tip pain is due to irritation of the diaphragm.The pain is accompanied by shallow respiration due to limitation of diaphragmaticmovements, and by shock. The abdomen is held immobile andthere is generalised ‘board-like’ rigidity. Vomiting is common. After somehours symptoms improve, although abdominal rigidity remains. Later thepatient’s condition deteriorates as general peritonitis develops.After initial resuscitation the acute perforation is usually treated surgically,either by simple closure or by closure combined with vagotomy and drainage.Patients who are found to be HP-positive should undergo eradication therapy.Perforation is more common in men and the outlook is worst for olderpatients with large perforations (Misiewicz and Punder 2000).Gastric outlet obstructionAnother complication of peptic ulcer disease is gastric outlet obstruction.Obstruction of the pyloric sphincter at the outlet of the stomach blocks theflow of gastric contents into the duodenum. Nausea, vomiting, gastric painand abdominal distension are the cardinal features of such obstruction. Thegastric pain is aggravated by eating and many patients with gastric outlet