CHAPTER 7 Gastrointestinal System^319
- Monitor intake and output.
- NPO to avoid irritation of intestinal tract, further stress on abdominal organs.
- Position for comfort, head of bed elevated.
- Assess for return of bowel sounds postoperatively.
- Teach patient about home care:
- Pain management.
- Wound care, drains, etc.
- Monitor for signs of infection.
Peptic Ulcer Disease (PUD)
WHAT WENT WRONG?
An ulcer develops when there is erosion of a portion of the mucosal layer of either
the stomach or duodenum. The ulcer may occur within the stomach (gastric
ulcer), or the duodenum (duodenal ulcer). A break in the protective mucosal lin-
ing allows the acid within the stomach to make contact with the epithelial tissues.
Gastric ulcers favor the lesser curvature of the stomach. Duodenal ulcers tend to
be deeper, penetrating through the mucosa to the muscular layer. Helicobacter
pyloriinfection has been associated with duodenal ulcers. Stress ulcers are asso-
ciated with another acute medical condition or traumatic injury. As the body
attempts to heal from the other physical condition (for example, major surgery),
small areas of ischemia develop within the stomach or duodenum. The ischemic
areas then ulcerate.
PROGNOSIS
The ulcerated areas may develop bleeding or may perforate. Depending on the
location of the ulceration, a vessel may become exposed to the effects of the stom-
ach acids. Damage to these vessels may result in significant bleeding. Perforation
of the ulcer can occur as the ulcer continues to erode more deeply into the tissue.
Perforation permits the contents of the stomach or duodenum to enter the peri-
toneum, leading to peritonitis, paralytic ileus, septicemia, and shock. This patient
will need emergency surgery due to a life-threatening condition.
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