消化性溃疡(英文)课件

PepticUlcerdisease

(PUD)byAnruiZhengfromhuangshicentralhospitalPepticUlcerdisease

(PUD)byLearningObjectives

Tomasterthecauseofpepticulcerclinicalmanifestationsandcomplications;Tomasterthepepticulcernursinginterventionandhealtheducation;Befamiliarwiththekeypointsofthepathogenesisandtreatmentofpepticulcer;LearningObjectivesTomaDefinition

AcircumscribedulcerationofthegastrointestinalmucosaoccurringinareasexposedtoacidandpepsinandmostoftencausedbyHelicobacterpyloriinfection.(Uphold&Graham,2003)DefinitionAcircumscribeduPepticUlcers:

Gastric&DudodenalPepticUlcers:

Gastric&DudoPepticUlcers:

Gastric&Duodenalgastriculcer:theulcerthatoccursinthestomachlining,someofthemmaybemalignant.duodenalulcer:mostoftenseeninfirstportionofduodenum.PepticUlcers:

Gastric&DuodGUGUDUDU消化性溃疡(英文)ppt课件PUDDemographics（流行病学）Lifetimeprevalenceis~10%.Theincidenceofduodenalis4timesascommonasgastriculcermostcommoninmiddleagepeak30-50yearsMaletofemaleratio—4:1PUDDemographics（流行病学）Etiology（病因学）Helicobacterpylori（HP）Etiology（病因学）HelicobacterpyloEtiology（病因学）nonsteriodalanti-inflammatorydrugs(NSAID）AcidandpepsinOthersEtiology（病因学）nonsteriodalantidiseasecharacteristicsChronicprocessperiodicalattackRhythmicabdominalpaindiseaseChronicperiodicalRhymainsymptom(1)abdominalpain：theclassic

symptomofPUD.

Pain—”gnawing”,“aching”,or“burning”“hungerlike”

（钝痛、胀痛、灼痛或饥饿痛）(2)rhythmicity:GUEating-pain-relief

DUpain-eating-relief(3)cyclicity：Attackmoreinautumnorwinter

mainsymptomgastriculcerduodenalulcertimepositionnatureruleoccurs0.5~1hour

afteramealandreliefuntilnextmeal,maynotawakenpatientfromsleep.medianorleftofSubxiphoidburningpainorcrampypainEating-pain-reliefoccurs3-4hoursafteramealandmayawakenpatientfromsleep.Midlineorrightofepigastrichungerlikepainorburningpainpain-eating-reliefPaincharacteristicsofpepticulcergastriculcerduodenalulceroccClinicalmanifestationOthersymptomsofdigestivesystem：Nausea,vomiting,belching,bloating,chestdiscomfortmayalsooccur.

ClinicalmanifestationOthersyClinicalmanifestation

sign

EpigastrictendernessClinicalmanifestation

signComplicationshemorrhage

ComplicationshemorrhageComplications

PerforationComplicationsPerforationComplicationsobstruction–pyloricstenosisComplicationsobstruction–pyComplicationsGastriccarcinoma.(notduodenalcarcinoma)ComplicationsGastriccarcinomHemorrhage:

hematemesis,blackortarrystools

Hemorrhage:

hematemesis,blacGastriccarinomaGU1%canbecomecancerousAchronic,GUhistory45yearsofageorolderThemoresymptomsstubbornlyContinuousandoccultblood(+)GastriccarinomaEndoscopyBariummeal–contrastx-rayBiopsy–bacteria&malignancyStoolforfecaloccultbloodH.Pylori:(13)C-ureaBreathTest.PUD-DiagnosisEndoscopyPUD-DiagnosisEndoscopyEndoscopy

Bariummeal–contrastx-ray

Bariummeal–contrastx-rayTreatmentPlanMedications—treatwithProtonPumpInhibitorsorH2receptorantagoniststoassistulcerhealingH2:Tagament,Pepcid,Axid,orZantacforupto8weeksPPI:Prilosec,Prevacid,Nexium,Protonix,orAciphexfor4-8weeks.DU：PPI4~6wGU:PPI6~8wTreatmentPlanMedications—treaSurgeryPeoplewhodonotrespondtomedication,orwhodevelopcomplicationsSurgeryPeoplewhodonotrespoNursingdiagnosisPain

relatedtogastricandduodenalinjuryAlteredNutrition:lessthanbodyrequirements

relatedtonauseaNursingdiagnosisPainrelatnursinginterventionRelievepainMedicationandcareDietRestMonitorPsychotherapyandheatheducationnursinginterventionRelievepaRelievepain

DU:Eatalkalescentfoodinpainorbeforepain(suchassodabiscuit,etc.);ThelocalhotcompressRelievepainDU:EatalkalescenMedicationandcareAntacids:shouldbe1hafterthemealorbeforebed.AluminiumHydroxideGel:causephosphorusdeficiency,lossofappetite,weaknessMedicationandcareAntacids:MedicationandcareH2RA:Itshouldbetakenatmealsoraftermeals,oratbedtime.PPI:Effectiveinacidicenvironment,take1hourbeforemeal.Bismuthagent:Becauseitworksinacidity,itistakenbeforemeal.Itcanmakethefecesblack.MedicationandcareH2RA:ItsDiet

Eatinglittlebutoftenandregularly.Avoideatingraw,cold,hardandstrongirritantfood.Selecteasilydigestibleandnutritiousfood.Eatingpasta,adequateskimmilkduringactiveperiod.Afterthesymptomsisalleviated,youshouldreturntonormalmealdiettimely.Nutritionmonitoring(suchas:bodyweight,hemoglobin)Diet

EatinglittlebutoftenRestThelightsymptom:appropriateactivitiestodistractiontheattentionTheheavysymtom:stayinbedforafewdaysto1~2weeks,relievepainsymptomsRestThelightsymptom:approprMonitorVitalsignMeasuringweightonaregularbasis,monitoringnutritionalindexessuchasserumalbuminandhemoglobinMonitorVitalsign

Psychotherapyandheatheducation

InformationabouttherelationshipbetweenpepticulcerandfactorssuchasHp,NSAIDs,smoking,alcoholintake,stress.

Psychotherapyandheathe

Psychotherapyandheatheducation

Educationaboutb