Peptic Ulcer Disease: Causes and Medications (Nursing)

00:00 Okay, so here's our friend, H. Pylori, it's a gram-negative bacillus.

00:07 Now, you guys have been with us for the antibiotic videos and if you haven't seen them, you wanna check those out.

00:13 But we all know that gram-negative is harder to treat, bacillus just means the shape of the bug.

00:19 You will see that on the reports when you're looking at those.

00:22 Now, the H. Pylori hides in between the mucus and epithelial cells.

00:27 So here's the deal.

00:29 Here's why it can survive longer, living in there, because it's in between the mucus and the epithelial.

00:36 So that's why the gastric acid doesn't kill H. Pylori, because sadly, it's protected by that layer of mucus and the bicarbonate, okay.

00:47 So keep in mind, why do H.Pylori survive gastric acid? Because my own body protects them with the mucus and the prostaglandin and the bicarbonate.

00:59 This is actually the most common cause of peptic ulcer disease.

01:03 I know you may have been taught, in your life, people may have told you, "Oh, stress is what does it!", but really? H.Pylori is really the most common cause of peptic ulcer disease.

01:15 So, we talked about H. Pylori, that nasty bug that hides in between our mucus and it's protected from gastric acid.

01:24 Now, let's talk again about NSAIDS.

01:26 We briefly discussed those but they inhibit prostaglandins.

01:30 So now that it's been a minute since we talked about NSAIDS, can you remember what is the end result of less prostaglandin? Pause the video, take a minute and write yourself answer to that question in the margin of your notes.

01:45 Why is the inhibition of prostaglandins a cause of peptic ulcer disease? Well remember, prostaglandins are what help keep us healthy levels of mucus and bicarbonate.

02:00 And if you take a drug like NSAIDS, Non-Streroidal Anti-Inflammatory Drugs that inhibit prostaglandins, that means we have less of them available, you have less healthy levels of mucus, that has bicarbonate that will neutralize gastric acid.

02:16 That's why people who have to take lots of NSAIDS, people usually with joint pain and arthritis are taking high doses of these medications for their anti-inflammatory effects.

02:26 They're taking high doeses of these medications over long periods of time.

02:30 And sometimes, we even need to take some real steps to help protect that stomach lining for them.

02:36 Now, let's talk about gastric acid, a healthy stomach lining protects that very sensitive stomach lining.

02:43 Remember that cupcake? If you're in too much of a hurry and you're trying to frost it too quickly, you just end up with a mess of cake stuff in your frosting.

02:51 Doesn't looks very pretty, still taste pretty good but doesn't look very pretty.

02:56 Same thing, if we have those cells that are really fragile, beautiful lining of our stomach is exposed directly to gastric acid, it's not protected well enough by the bicarbonate and the mucus, then that's how the gastric acid is going to injure those mucosal cells.

03:13 It activates the pepsin - that's the enzyme in our stomach that (snarls), just chews things up.

03:19 Which is great if I just had a burger, not good if it's digesting my own stomach lining.

03:25 Now the last to our, the lifestyle thing, if someone already has peptic ulcer disease, well we don't recommend smoking for anyone but smoking and alcohol are also problematic for someone with peptic ulcer disease.

03:38 So we would want to encourage the patient to really limit and if they could eliminate and if they could eliminate, that would be fantastic but remember, these are very difficult habits to give up and so it's not enough to just tell your patients, "You have to stop." You wanna work with your patients, help them identify how it will help them and just encourage them, educate them in a kind and non-judgemental way.

04:02 "That Hey, I understand that you smoke and you drink a fair amount of alcohol, this is what it's doing to your stomach lining." So, you don't want to be judgmental, we all have things that are challenging for us but help the patient decide that that's a better choice for them to stop smoking, to limit their alcohol.

04:18 Because these things increase their gastric acid, they make less bicarbonate being produced in your stomach so then we've got less ability to neutralize that gastric acid and so their peptic ulcer disease takes longer to heal and we can possibly develop even additional sores.

04:35 So, when we're looking at, back as we look back at these, I want you to think about what are the causes of peptic ulcer disease.

04:42 Well we talked about four major causes of peptic ulcer disease.

04:46 Without looking at the actual notes, see if you can number those at the margin of your notes: 1, 2, 3 and 4.

05:01 Okay, good work.

05:02 So you listed the four most common causes of peptic ulcer disease.

05:06 So for H. Pylori, we're gonna use antibiotics.

05:09 For NSAIDS, we're gonna try to encourage the patient to limit those as much as possible.

05:14 While they're still good pain relief but we're also gonna consider drug called Misoprostol.

05:18 Now wait a minute, it sounds like I'm really going quickly through this. But I'm just giving you an overview and then we'll go back to these medications much more slowly.

05:28 so we're gonna hit those four main areas, kind of give you a quick snapshot of what we'll use and then we'll go over them in much more detail, so for H. Pylori - antibiotics.

05:37 For NSAIDS, we're gonna try to get you to limit them as much as possible and consider using Misoprostol.

05:42 For the gastric acid, we're gonna consider histamine receptor antagonist and write a little H2 next to that.

05:50 Because that's the name of the receptors in the stomach that we're blocking or antagonizing.

05:55 Proton pump inhibitors, next to that just write PPI 'cause that's what we'll call them moving forward.

06:03 Mucosal protectants, that's what's gonna protect that stomach lining.

06:08 and then antacids, remember those are over the counter meaning I can buy them at CVS or any drugstore.

06:15 They're not the most effective but they work pretty quickly.

06:18 And smoking, while we don't recommend it for anyone, we're gonna encourage patients to stop smoking and also limit their alcohol use.

06:26 Okay, so that is your quick snapshot view.

06:30 So I kinda mark those as summary slides, as if I just want to remember, hey what are the big overarching concepts that we're going to talk about next.

06:37 That's the key for those slides.

06:39 So let's talk about H. Pylori.

06:41 There's some testing options for H. Pylori.

06:43 I told you lots of us are walking around with it.

06:46 In fact, you could have it hiding in your body right now but it doesn't mean you're gonna develop peptic ulcer disease.

06:54 Now the test we can do, we can do a serum antibody test, that's a blood test.

06:59 We can do a urea breath test which that doesn't involve sticking you so most people prefer that.

07:05 Or we can do a stomach biopsy. Woah, that is really invasive.

07:10 So, we're thinking about H. Pylori testing, we definitely need to test people who have peptic ulcer disease to see if they have H. Pylori.

07:19 Because if they do, remember, that's a bacteria.

07:23 So we want to use a minimum of two antibiotics to treat it.

07:28 Now just as a little side bar, tuberculosis is another disease process that we always want to treat with multiple medications.

07:35 Okay, when it comes to treating that nasty bug, H. Pylori, remember it hides behind my own personal defenses in my stomach lining, protected from that gastric acid by my own bicarbonate and mucus, I have to give it the one true punch, alright? So take a look at those antibiotics listed at the bottom of your screen.

07:55 I want you to read through each one.

07:59 Now take a minute and what do you remember or what do you recognize about those drugs? Which one of them is a penicillin? Remember, clue is, it will end in -cillin And I also want you to put a giant 2 by that note.

08:16 Because you need to remember that you have to use at least a minimum of two antibiotics to get rid of that nasty little critter.