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Clinical Manifestation and Symptoms

- The most common symptom of peptic ulcer disease is burning stomach pain that occurs between meals or at night. The pain may last from minutes to hours and may be relieved by eating food or taking antacids. The pain may vary in intensity, frequency, and location depending on the type and location of the ulcer.

  • Gastric ulcers tend to cause pain shortly after eating, while duodenal ulcers tend to cause pain 2 to 5 hours after eating.
  • Gastric ulcers may also cause loss of appetite, weight loss, and vomiting, while duodenal ulcers may cause increased appetite, weight gain, and bloating.

- Some people with peptic ulcers may have no symptoms or only mild discomfort. This is more common in older adults, who may have fewer pain receptors or more tolerance to pain. However, asymptomatic ulcers can still lead to complications such as bleeding or perforation.

- Other symptoms of peptic ulcer disease may include:

  • Nausea and vomiting: Nausea and vomiting may occur due to irritation of the stomach or duodenum by acid or ulcer. Vomiting may also indicate a complication such as bleeding or obstruction. Vomiting blood or material that looks like coffee grounds may indicate a bleeding ulcer, while vomiting undigested food hours after eating may indicate an obstructed ulcer.
  • Bleeding: Bleeding is the most common complication of peptic ulcer disease, occurring in about 15% of cases. Bleeding can be mild or severe, acute or chronic. Bleeding can cause hematemesis (vomiting blood), melena (black, tarry stools), or hematochezia (bright red blood in stools). Bleeding can also cause anemia, which can manifest as weakness, fatigue, dizziness, shortness of breath, and pale skin.
  • Perforation: Perforation is a life-threatening complication of peptic ulcer disease, occurring in about 5% of cases. Perforation occurs when the ulcer erodes through the entire wall of the stomach or duodenum, creating a hole that allows the contents of the digestive tract to spill into the abdominal cavity. Perforation can cause sudden and severe abdominal pain that radiates to the back or shoulder, fever, nausea, vomiting, shock, and peritonitis (inflammation of the lining of the abdominal cavity).
  • Obstruction: Obstruction is a rare complication of peptic ulcer disease, occurring in less than 1% of cases. Obstruction occurs when the ulcer narrows or blocks the passage of food through the stomach or duodenum. Obstruction can cause persistent vomiting, abdominal distension, dehydration, weight loss, and malnutrition.

Questions on Clinical Manifestation and Symptoms

Correct Answer is C

Explanation

While stress and emotional factors may exacerbate peptic ulcer symptoms, they are not the primary cause of the condition. The primary causes are H. pylori infection and the use of NSAIDs.

Correct Answer is A

Explanation

The frequency of consuming high-fiber foods is not specifically related to peptic ulcer disease. However, diet history is essential for overall health assessment.

Correct Answer is B

Explanation

Taking the PPI before bedtime may not provide the best acid suppression throughout the day. Taking it on an empty stomach before a meal is a more appropriate approach.

Correct Answer is D

Explanation

This statement is correct. An endoscopy involves inserting a flexible tube (endoscope) with a camera on the end through the mouth to examine the stomach and duodenum. It is a commonly used procedure to assess and diagnose peptic ulcer disease.

Correct Answer is B

Explanation

Citrus fruits and juices are acidic and can aggravate the stomach lining in a client with peptic ulcer disease. It is best to avoid or limit their consumption. QUESTIONS

Correct Answer is A

Explanation

While stress and emotional factors may exacerbate peptic ulcer symptoms, they are not the primary cause of the condition. The primary causes are Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Correct Answer is D

Explanation

This statement is correct. Long-term use of NSAIDs is a well-established risk factor for peptic ulcer disease. NSAIDs can irritate the stomach lining and increase the risk of ulcer formation.

Correct Answer is C

Explanation

Helicobacter pylori infection is not caused by excessive consumption of spicy foods. The infection is typically acquired through person-to-person transmission, such as through contaminated water or food, and is unrelated to diet choices.

Correct Answer is C

Explanation

While a high-fiber diet is generally beneficial for digestive health, it does not specifically counteract the effects of NSAIDs on the stomach lining.

Correct Answer is A

Explanation

Regular physical exercise is important for overall health, but it is not a direct risk factor for peptic ulcer disease. The nurse should focus on risk factors related to diet, medication use, and other medical conditions. QUESTIONS

Correct Answer is A

Explanation

Diffuse abdominal pain with a low-grade fever may be seen in various conditions, but it does not specifically point to cholecystitis.

Correct Answer is C

Explanation

Elevated serum amylase is more associated with pancreatitis rather than cholecystitis. It is not directly related to the clinical manifestations described.

Correct Answer is D

Explanation

This statement is correct. High fever and chills may indicate the presence of infection and sepsis, which can be severe complications of acute cholecystitis.

Correct Answer is A

Explanation

Decreased production of pancreatic enzymes may lead to malabsorption issues and cause symptoms like diarrhea and steatorrhea. However, it is not the primary cause of indigestion and bloating after meals in chronic cholecystitis.

Correct Answer is C

Explanation

Auscultation of the left upper quadrant is not relevant to assessing for Boas' sign, which involves the right upper quadrant.

Correct Answer is C

Explanation

ERCP is an invasive procedure used to visualize the biliary and pancreatic ducts, but it is not typically used as a first-line diagnostic test for cholecystitis.

Correct Answer is C

Explanation

Avoiding pain medications is not necessary before an abdominal ultrasound. The client can continue taking prescribed medications as usual.

Correct Answer is C

Explanation

Low serum bilirubin levels are not consistent with cholecystitis, which can cause obstructive jaundice and elevated bilirubin levels due to bile duct obstruction.

Correct Answer is B

Explanation

Providing detailed images of the pancreas is not the primary purpose of a HIDA scan, although it can sometimes provide some information about the pancreas if the tracer reaches the duodenum and enters the common bile duct.

Correct Answer is B

Explanation

CT scans use X-rays, not sound waves. Sound waves are used in ultrasound imaging, not in CT scans.

This statement is incorrect and indicates a need for further teaching. Alcohol can irritate the stomach lining and exacerbate peptic ulcer disease. Clients with peptic ulcers should avoid or minimize alcohol consumption.

Administering antacids at bedtime may help with overnight acid reduction, but it may not adequately address pain during meals when acid production is higher.

Antibiotics do not relax stomach muscles or alleviate abdominal pain. Pain relief is typically achieved through acid-reducing medications and other pain management strategies.

Recovering fully in 6 months may be an extended recovery period. While some clients may experience a longer recovery, it is not a standard time frame for everyone.

High-fiber foods can be beneficial for overall digestive health, but they are not specifically recommended for promoting ulcer healing. In some cases, high-fiber foods may need to be avoided if they cause discomfort.

Feeling fatigued and sleepy after meals is not typically associated with peptic ulcer disease or its complications.

This statement is correct. A perforated peptic ulcer can cause increased abdominal rigidity due to the inflammation and irritation of the peritoneal lining. The abdomen may feel tense and rigid upon palpation.

Avoiding alcohol is advisable while on NSAIDs as alcohol can increase the risk of gastrointestinal bleeding and worsen peptic ulcer disease.

Checking for drug interactions with other medications is essential for safe medication administration, but it is not the priority when administering PPIs intravenously to this client.

Diagnosing conditions in the lower digestive tract is not the purpose of an upper gastrointestinal endoscopy. Lower digestive tract evaluations are typically done using colonoscopy or sigmoidoscopy.

It is essential to avoid taking sucralfate with other medications, especially those that require an acidic environment for absorption. This is because sucralfate can decrease the absorption of certain drugs.

Providing the client with spicy foods is not advisable, as they can irritate the stomach lining and worsen symptoms for the client with peptic ulcer disease.

H2 receptor blockers are not known to affect the CBC, so monitoring the complete blood count is not the priority for this client.

Hyperactive bowel sounds are not early signs of gastrointestinal bleeding. Bowel sounds may be hyperactive or hypoactive depending on the severity of the bleeding and associated factors.

Misoprostol is not used to reduce stomach acid production. Instead, it helps protect the stomach lining by increasing mucus production and promoting bicarbonate secretion.

Regular use of NSAIDs can increase the risk of developing peptic ulcers and is not a preventive strategy for clients with a history of peptic ulcer disease.

This statement is correct. Antacids can interfere with the action of PPIs, and clients should avoid taking them together. If needed, antacids should be taken at least 1 hour before or after the PPI.

Caffeine-containing beverages should be limited or avoided, as caffeine can stimulate gastric acid secretion and may worsen symptoms for clients with peptic ulcers.

Taking over-the-counter antacids regularly is not a preventive strategy for H. pylori reinfection. Antacids do not target the bacterium and are not effective in eradicating H. pylori.

Sucralfate does not typically cause drowsiness, so taking it before bedtime is not necessary for this medication. It should be taken at regular intervals during the day as prescribed.
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