The Digestive System and Peptic Ulcers in Nursing

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Table of Contents

Introduction
Normal structure of the digestive system
Alterations in the Normal structure of the digestive system
Diagnosis (case study)
Treatment
Nursing interventions
References

Introduction

The normal structure of the digestive system can encounter alterations in various disease states. This article will focus on a case study where the patient had peptic ulcers, the diagnostic procedures and appropriate nursing interventions that could be carried out.

Normal structure of the digestive system

The digestive tract develops from the yolk sac. It is lined by a mucus membrane, has a muscle layer at the middle and is covered by serosa which is in contact mainly with the peritoneum. The muscular wall has an outer longitudinal layer and an inner circular layer. The mucus membrane has three layers; the epithelial layer is closest to the surface. Lamina propria is the underlying layer made up of connective tissue and the outermost is the muscularis mucosa.

The mouth and the esophagus and are mainly covered by squamous non-keratinizing epithelium. The cardia lies between the esophagus and the stomach which is the most dilated part of the digestive tract. The epithelium from the stomach to the anal tract is columnar. The stomach has many secretory cells among which are gastric pits which have mucus secreting cells, peptic cells which secrete pepsin and parietal cells which secrete hydrochloric acid and intrinsic factor.

The small intestine has crypts of Lieberkuhn which are glands, villi and microvilli. It has many neuroendocrine cells, villi and microvilli. It is divided into the duodenum, jejunum and ileum. The ileocecal junction is where the small intestine meets the large intestine which has some crypts with many Goblet cells. There is a change from columnar cells to squamous cells at the upper part of the anal canal (Sinnatamby, 2006, p. 257).

Alterations in the Normal structure of the digestive system

Alterations may be present due to congenital anomalies, neoplasia, infections, mechanical trauma or endocrinological malfunctions. The esophagus may have congenital anomalies like esophageal atresia and tracheoesophageal fistula. Like most other part of the digestive system, it can get diverticula. Mallory Weiss tears can occur during severe vomiting. Hiatal hernia is protrusion of the stomach through the diaphragm. Barrett’s esophagus can occur in the setting of gastroesophageal reflux disease (GERD) (Porth & Maftin, 2009. p. 921).

Inflammation of the stomach is called gastritis. Acute gastritis is associated with local irritants. Helicobacter pylori gastritis, multifocal atrophic gastritis and autoimmune gastritis are the three types of chronic gastritis. Peptic ulcers are aberrations in the walls of the stomach or duodenum, due to prolonged exposure to hydrochloric acid which is enhanced by factors like use of aspirin or other NSAIDS and the presence of H. pylori infection. Zollinger-Ellison is a condition where there is a gastrin-secreting tumor. Curling ulcers develop from physical stresses. Gastric lymphomas are common types of neoplasms in the stomach (Porth & Maftin, 2009. p. 927).

The small and large intestine can get irritable bowel syndrome which is idiopathic. Inflammatory bowel diseases are of two types; Crohn’s disease can affect any part of the digestive tract and ulcerative colitis which is a disease of the large gut. Enterocolitis can be due to infection by viruses and microbes. Diverticulitis is inflammation of a diverticulosis, which is an extension of the lumen through the mucosa. Many factors cause abnormal alterations in intestinal motility and subsequently cause diarrhea or constipation. Malabsorption is lack of or decreased absorption of individual nutrients or more due to disease of the small intestine, disorders in digestion or impaired lymph flow. Colorectal cancer, which has a very high morbidity, is among other cancers of the intestines (Porth & Maftin, 2009, p. 946).

Diagnosis (case study)

The risk factors and the signs and symptoms of this patient indicate that he has peptic ulcer disease. Full Blood Count could indicate hypochromic microcytic anemia due to blood loss from the ulcers. Examination of the stool will show blood cells due to occult blood loss from the stomach. Visualization of the ulcers can be done using endoscopic methods like gastroscopy and duodenoscopy. Biopsies can also be collected using these methods to test for the presence of H. pylori. Other basic tests like urease breath test can also be used to detect their presence. Ulcer craters are important markers in differentiating gastric ulcers from neoplasia when using x-rays and a contrast media (Porth & Maftin, 2009, p. 925).

Treatment

Proton Pump Inhibitors are the drugs of choice for the treatment of peptic ulcer disease. Examples are omeprazolle, lansoprazole and rabeprazole. They irreversibly bind to the proton pump making them very effective in reducing hydrochloric acid secretion which is followed by healing of the ulcers. H₂ (histamine) receptor antagonists like cimetidine, ranitidine and famotidine also reduce acid secretions and thus reduce ulceration (Katzung, 2007, p.1011).

Mucosal protective agents used include sucralfate and colloidal bismuth compounds like bismuth subsalicylate and these form vicious compounds which stick to the ulcers and reduce their exposure to the acid. Others are prostaglandin analogs like misoprostol which are mucosal protective (Katzung, 2007, p. 1018).

Nursing interventions

Nurses should give the medication as prescribed by the doctors. They should take note of nausea and vomiting and report any cases of hematemesis to the doctor. Actual patient care like providing an emesis basin should be provided. Foods should be provided to the patient at regular intervals.

Nurses should aim at reducing the risk factors like teaching the patient about the risk of smoking. Nurses should encourage the patient to reduce the stress that he has. Nurses should control the amount of antacids and aspirin taken by the patient (Longstretch, 2009, p. 1).

References

Katzung, B. (2007). Basic and Clinical Pharmacology. New York, NY: McGraw-Hill Education.

Longstretch, G. (2009). Peptic Ulcer. Web.

Porth, C. & Matfin, G. (2009). Pathophysiology, Concepts of Altered Health States. Walters Kluwer Health.

Sinnatamby, C. (2006). Last’s Anatomy Regional and Applied. New York, NY: Churchill Livingstone Elsevier.

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