消化性溃疡英文专家讲座.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Peptic Ulcer disease(PUD),by,Kelly,minyi xu,from Guangzhou Medical University,L,earning,O,bjectives,To master the cause of peptic ulcer clinical manifestations and complications;,Be f,amiliar with the key points of the pathogenesis and treatment of peptic ulcer;,To m,aster the peptic ulcer nursing intervention and health education;,Definition,A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection.,(Uphold&Graham,2023),Peptic Ulcers:Gastric&Dudodenal,Peptic Ulcers:Gastric&Duodenal,gastric ulcer:the ulcer that occurs in the stomach lining,some of them may be malignant.,duodenal ulcer:most often seen in first portion of duodenum.,GU,DU,PUD Demographics（流行病学）,Lifetime prevalence is 10%.,The incidence of,duodenal,is,4,times,as common as gastric,ulcer,most common in middle age,peak 30-50 years,Male to female ratio4:1,Etiology（病因学）,Helicobacter pylori,（HP）,nonsteriodal anti-inflammatory drugs(NSAID）,Acid and pepsin,Others,disease,characteristics,Chronic,process,periodical,attack,Rhythmic,abdominal pain,main symptom,(1),abdominal pain,：,the classic symptom of PUD.,Pain”gnawing”,“aching”,o,r,“burning”“hungerlike”,（钝痛、胀痛、灼痛,或,饥饿痛）,(2)rhythmicity:,GU Eating-pain-relief,DU pain-eating-relief,(3)cyclicity：,Attack m,ore,in,autumn or winter,gastric ulcer,duodenal ulcer,time,position,nature,rule,occurs 0.51 hour,after a meal and relief until next meal,may not awaken patient from sleep.,median or left of Subxiphoid,burning,pain or crampy pain,Eating-pain-relief,occurs 3-4 hours after a meal and may,a,waken patient from sleep.,Midline or right of epigastric,hungerlike,pain or,burning,pain,pain-eating-relief,Pain characteristics of peptic ulcer,Clinical manifestation,Other symptoms of digestive system,：,Nausea,vomiting,belching,dyspepsia,bloating,chest discomfort,anorexia may also occur.,Clinical manifestation,sign,Epigastric tenderness,Complications,hemorrhage,Perforation,obstruction,pyloric stenosis,Gastric carcinoma,.(not duodenal carcinoma),Hemorrhage:,hematemesis,black or tarry stools,Gastric carinoma,GU 1%can become cancerous,A chronic,GU history,45 years of age or older,The more symptoms stubbornly,Continuous and occult blood(+),Endoscopy,Barium meal contrast x-ray,Biopsy bacteria&malignancy,Stool for fecal occult blood,H.Pylori:,(13)C-urea,B,reath,T,est.,PUD-Diagnosis,Endoscopy,Barium meal contrast x-ray,Treatment Plan,Medicationstreat with Proton Pump Inhibitors or H2 receptor antagonists to assist ulcer healing,H2:Tagament,Pepcid,Axid,or Zantac for up to 8 weeks,PPI:Prilosec,Prevacid,Nexium,Protonix,or Aciphex for 4-8 weeks.,DU：PPI 46w,GU:PPI 68w,Surgery,People who do not respond to medication,or who develop complications,Nursing diagnosis,Pain,related to gastric and duodenal injury,Altered Nutrition:less than body requirements,related to anorexia,nausea,nursing intervention,Relieve pain,Medication and care,Diet,Rest,Monitor,P,sychotherapy,and h,eath education,Relieve pain,DU:Eat alkalescent food in pain or before pain(such as soda biscuit,etc.);,The local hot compress,Medication and care,抗酸剂,：应在饭后或睡前1h，乳液要震动，应咀嚼片。

不与衣服旳酸,性饮料，防止与牛奶同服；,氢氧化铝凝胶,：引起,磷缺乏症,体现食欲不振、无力长久服,用引起便秘，可与氢氧化镁交替H,2,RA,：应在,餐中或餐后服，,也可把一日旳剂量在睡前服用,静脉给药应控制速度（过快低血压和心律失常）,PPI类,：可引起头晕,硫糖铝,：在酸性环境下有效，餐前1小时服用不能与多酶片同服，,铋剂：,因在酸性下起作用，故,餐前服,可使粪便呈黑色Diet,Eating little but often and,regularly,.,Avoid eating raw,cold,hard and strong irritant food,.,Select easily digestible,and,nutritious food.,Eating,pasta,adequate skim milk,during a,ctive period.,After,the,symptoms,is,alleviate,d,you,should return to normal meal diet timely.,Nutrition monitoring,(such as:,body weight,hemoglobin,),Rest,The light symptom:appropriate activities to distraction the attention,The heavy symtom:stay in bed for a few days to 1 2 weeks,relieve pain symptoms,Monitor,Vital sign,Measuring weight on a regular basis,monitoring nutritional indexes such as serum albumin and hemoglobin,P,sychotherapy,and h,eath education,Information about the relationship between peptic ulcer and factors such as Hp,NSAIDs,smoking,alcohol intake,stress.,Education about both therapeutic and preventive strategies.,Lifestyle management,Avoid the use of steroid,caffeine,aspirin and other NSAIDs.,Instruction about the medication regimen prescribed and how to take the drugs.,Teach the client the symptoms that may indicate a complication,such as increased abdominal pain or distention,vomiting,black or tarry stools,or fainting.,Question,Which type of PUD will have abdominal pain at night?,How can we,diagnosis,the infection of Hp?,thank you!,。