Peptic Ulcer Disease


(+) Pain (abdominal)
(+) Epigastric Tenderness
"Pointing Sign" - Patient can show site of pain with one finger
 
w/Food w/Food Not related w/Food
Gastric Ulcer
Weight loss
? mesenteric Ischemia
Duodenal Ulcer
Weight Gain
H. Pylori
Nasty Burps

Background

Pathophysiology

Diagnostics

Treatment

  1. Initial
  2. Medical/Pharmaceutical
  3. Surgical/Procedural

Disposition

  1. Admit if
  2. Avoid foods that aggravate Sx
  3. 95% ulcers heal after 3 Mo of Tx; 70% recur
  4. Follow-up if complications occurs
  5. Surgical consult if bleeding ulcers

 

Admit Orders: Peptic Ulcer Disease

1. Admit to:

2. Diagnosis: Peptic ulcer disease.

3. Condition:

4. Vital Signs: q4h. Call physician if BP >160/90, <90/60; P >120, <50; T >38.5°C.

5. Activity: Up ad lib

6. Nursing: Guaiac stools.

7. Diet: NPO 48h, then regular diet, no caffeine.

8. IV Fluids: D5 ½ NS with 20 mEq KCL at 125 cc/h.

9. Special Medications:

-Ranitidine (Zantac) 50 mg IV bolus, then continuous infusion at 12.5 mg/h (300 mg in 250 mL D5W at 11 mL/h over 24h) or 50 mg IV q8h OR

-Cimetidine (Tagamet) 300 mg IV bolus, then continuous infusion at 50 mg/h (1200 mg in 250 mL D5W over 24h) or 300 mg IV q6-8h OR

-Famotidine (Pepcid) 20 mg IV q12h.

-Pantoprazole (Protonix) 40 mg PO/IV q24h OR

-Nizatidine (Axid) 300 mg PO qhs OR

-Omeprazole (Prilosec) 20 mg PO bid (30 minutes prior to meals) OR

-Lansoprazole (Prevacid) 15-30 mg PO qd prior to breakfast [15, 30 mg caps].

Eradication of Helicobacter pylori

Amoxicillin, Omeprazole,Clarithromycin Triple Therapy

1. 10 days of therapy.

2. Amoxicillin 1 gm PO bid.

3. Omeprazole (Prilosec) 20 mg PO bid.

4. Clarithromycin (Biaxin) 500 mg PO bid.
 

10. Symptomatic Medications:

-Mylanta Plus or Maalox Plus 30 mg PO q2h prn.

-Trimethobenzamide (Tigan) 100-250 mg PO or 100-200 mg IM/PR q6h prn nausea OR

-Prochlorperazine (Compazine) 5-10 mg IM/IV/PO/PR q4-6h or 25 mg PR q4-6h prn nausea.
 

11. Extras: Upright abdomen, KUB, CXR, ECG, endoscopy. GI consult, surgery consult.

12. Labs: CBC, chem 7&12, amylase, lipase. UA, Helicobacter pylori serology. Urea breath test for H pylori