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Example research essay topic: Problems And Treatment Of Peptic Ulcer Disease - 1,551 words

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... on, and heartburn. Emergency Symptoms Gastrointestinal bleeding is the most serious complication of peptic ulcers. The bleeding is a result of an ulcer eroding into a blood vessel of the stomach or small intestine. The signs of bleeding are vomiting bright red blood, or a bowel movement consisting of bloody, or tarry, black stool. If the hemorrhage is very severe, weakness, shock, and loss of consciousness may occur.

Obstruction of the digestive tract is another emergency complication of peptic ulcers. The obstruction usually occurs where the stomach meets the duodenum. It is caused by the accumulation of old ulcer scars, which narrow the passage in this area. This causes food and liquids from the stomach to the duodenum to become constrained or blocked.

This process causes a distended stomach, pain, and incessant vomiting. A third and very serious complication of peptic ulcers is perforation. This occurs when stomach acid corrodes through the wall of the intestines and spills into the abdominal cavity. The very first sign of perforation is very intense and sudden pain in the abdomen.

There may even be shoulder pain if the stomach acid causes irritation to the phrenic nerve (Lewis, 1113). When perforation occurs, bowel sounds are usually absent, and the patients respirations become very rapid and shallow (Lewis, 1113). Diagnosis and Lab Test Diagnosis of a peptic ulcer is done by doing an upper gastrointestinal endoscopy. This allows the doctor to see the lining of the stomach and duodenum and also take biopsies. The biopsies allow them to rule out other conditions as well as detecting the presence of H. pylori (Medinfo, 1).

This test is invasive, but the most accurate for detecting H. pylori. Carbon isotope-urea breath test (UBT) is a simple breath test used to test for H. pylori. The patient must not eat or drink for six hours prior to the test. The patient is the asked to swallow a capsule that contains urea that is treated with carbon atoms.

If H. pylori is present, the bacterium converts the urea into carbon dioxide, which is then exhaled by the patient. Blood tests are also done in order to measure the antibodies to H. pylori.

Blood tests are not useful for treatment follow up, since after therapy antibodies are lowered, but still remain in the blood. Blood tests also reveal anemia in those patients with a bleeding ulcer. Also, in cases of Zollinger-Ellison syndrome, blood tests can show elevations of gastrin levels. Therapeutic Interventions In order to treat ulcers, the patient should avoid factors that predispose them to ulceration, such as, alcohol, NSAIDs, and tobacco (Zoler, 14).

When H. pylori is at cause for the ulcer, a two week, a three-drug regimen is the standard therapy for treatment. The three-drug regimen includes a proton pump inhibitor (PPI) and two antibiotics. The antibiotics are usually clarithromycin, amoxicillin, or metronidazole. PPI therapy is usually continued on for long-term periods in patients that have high risks for recurrence. Proton Pump Inhibitors Ppi's are prescription drugs that decrease acid secretion by inhibiting the gastric acid pump.

They should be taken thirty minutes before breakfast and if a second dose is necessary, it should be taken ten to twelve hours after the morning initial does and thirty minutes before the next meal or snack. These drugs have few side effects. The side effects may include allergic reaction, headache, stomach pain, and diarrhea. Pregnant women or nursing mothers should not use Ppi's because Ppi's are excreted in the breast milk (Zoler, 15). The most common Ppi's include, Omeprazole (Prilosec) and Iansoprazole (Prevacid). Prilosec Prilosec is the oldest and most commonly used PPI.

Usual dosage is 20 - 40 mg / day . It suppresses gastric acid secretion by specific inhibition of the hydrogen / potassium ATPase enzyme system at the secretory surface of the gastric parietal cells which blocks the final step of acid production (Lippincott, 879). Prilosec affects the action of warfarin, benzodiazepines and many other drugs. It reaches the maximum effect in five to seven days. Common side effects of Prilosec include, dizziness, headache, nausea, vomiting, diarrhea, and abdominal pain (Lippincott, 879). Prevacid Prevacid works in the same manner as Prilosec.

It blocks the final step in acid production by inhibiting the hydrogen / potassium ATPase enzyme system at the secretory surface of the gastric parietal cell (Lippincott, 670). Usual dose of Prevacid is 15 - 30 mg / day . It reaches the maximum effect in five days. The common side effects of Prevacid are dizziness, headache, nausea, vomiting, diarrhea, symptoms of upper respiratory tract infection, and cough (Lippincott, 671).

Antibiotics Antibiotics are used to treat peptic ulcers when H. pylori is the causing factor. The doctor prescribes antibiotics to reduce the potential for drug resistance. The most commonly used antibiotics are clarithromycin (Biaxin), amoxicillin, and metronidazole. Since H. pylori is a bacteria, the effectiveness of antibiotics is very high.

Biaxin Biaxin inhibits protein synthesis in H. pylori, which causes cell death. The dosage is usually 500 mg / bid . Common side effects of Biaxin are diarrhea, abdominal pain, nausea, and super infections (Lippincott, 316). Biaxin is usually combined with amoxicillin 1, 000 mg / day to treat peptic ulcers. Amoxicillin Amoxicillin is a bactericidal; it inhibits the synthesis of cell wall of sensitive organisms, such as H.

pylori. This causes cell death. In treatment of peptic ulcers, the dose of amoxicillin is usually 1, 000 mg / day . Common side effects of this drug are glossitis, stomatitis, gastritis, sore mouth, nausea, vomiting, diarrhea, abdominal pain, rash, fever, wheezing, and super infections (Lippincott, 126). This should not be used if the patient is allergic to any form of penicillin. Metronidazole This antibiotic is used when the patient is allergic to amoxicillin or if they are infected with an amoxicillin-resistant strain of H.

pylori. This drug is a bactericidal. It inhibits DNA synthesis in specific obligate anaerobes (H. pylori), which in turn causes cell death. Usual dosage for peptic ulcers is 500 mg / bid . The common side effects of metronidazole are headache, dizziness, ataxia, metallic taste in mouth, anorexia, nausea, vomiting, diarrhea, and, darkening of the urine (Lippincott, 786).

H 2 Blockers H 2 blockers antagonize the actions of histamine, which encourages acid secretion in the stomach. H 2 blockers were the standard treatment for peptic ulcers until the development of antibiotic regimens. H 2 blockers cannot cure or prevent ulcers caused by H. pylori (Meurer, 622). These drugs are available over the counter and include: famotidine (Pepcid AC), cimetidine (Tagamet), ranitidine (Zantac), and nizatidie (And). Pepcid AC is the most potent H 2 blocker and is the most effective for treating NSAID-induced ulcers.

The most common side effect is headache and is free of drug interactions. Although Pepcid AC appears to prevent and even heal ulcers, the use of acid-blocking drugs might actually increase the risk for serious complications such as perforation, internal bleeding, and maybe even stomach cancer (Web MD, 18). Nursing and Medical Interventions Determine pain characteristics from verbal description and physical assessment data so that appropriate interventions can be planned. Administer antacids, H 2 antagonists, Ppi's to reduce pain.

Teach patient to avoid smoking, drinking alcohol, eating hot and spicy foods, drinking coffee, teas and cola in order to prevent excessive acid production. Assess for evidence of hemorrhage. Take vitals every 15 to 30 minutes to determine patients health status and for evidence of shock. Monitor hematocrit and hemoglobin, which are indicators of hemorrhage. Provide a quiet, relaxed environment and limit visitors to decrease stress and other factors that increase acid production (Lewis, 1120). With the proper care and patient compliance, peptic ulcers can be cured and even prevented.

If the patient is willing to change their lifestyle and stick to their drug therapy, the chances of reoccurrence is low. In the past, having a peptic ulcer meant living with a chronic condition. But today a better understanding of the cause of peptic ulcers and how to treat them means that most people can be cured of this disease. Bibliography Helicobacter pylori in Peptic Ulcer Disease, National Institutes of Health Consensus Development Panel on Helicobacter pylori in Peptic Ulcer Disease, Journal of the American Medical Association. Volume 272, no. 1. July 6, 1994, pp 65 - 69.

Lewis S. , Heitkemper M. , and Dirksen S. (2000) Medical-Surgical Nursing (5 th ed. ) St. Louis, Missouri: Mosby Inc. , pp 1109 - 1121. Lippincott's Nursing Drug Guide (2000) Philadelphia, Pa: Lippincott Williams & Wilkins. , pp 126, 316, 670, 671, 786, & 879. Medinfo medinfo. co. uk Meurer L.

Treatment of Peptic Ulcer Disease and Non ulcer Dyspepsia, Journal of Family Practice. Volume 50, July 2001, pp 614 - 623. Munnangi S. and Sonnenberg A.

Time Trends of Physician Visits and Treatment Patterns of Peptic Ulcer Disease in the United States. Arch Intern Med. vol. 175, July 14, 1997. pp 1489 - 94. Peptic Ulcers web Sonnenberg A.

Peptic Ulcer Digestive diseases in the United States: epidemiology and impact. Washington DC: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1994, pp 359 - 408. Web MD. Peptic Ulcers web Zoler M. and Bank D. Drug Update: Peptic Ulcer Disease, Family Practice New.

Volume 31, number 19, October 1, 2001, pp 14 - 17.


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