Review of Peptic Ulcer Disease (Nursing)

00:00 Hi. Welcome to our video on peptic ulcer disease.

00:04 Now, I wanna make sure you're very focused because this next question is incredibly complex.

00:11 So I may need you to pay intense attention, okay? So are you ready for this? I'm gonna come up with a question, I need you to be very quiet in your environment and really pay attention to the wording.

00:24 What does frosting a hot cupcake and your stomach lining have in common? You're up! Okay, I know that was a weird question but let me tell you.

00:36 I promise we really have a meaning here.

00:39 Now even if you didn't come up with anything, frankly I'd be kinda amazed if you did.

00:44 But here's what I want you to think about.

00:46 If you haven't tried to frost a hot cupcake, I wanna explain to you what happens.

00:51 If you've ever been like late for something and you make a cake or cupcake and you need to get the frosting on it and you take it and the cake is still hot.

00:59 As you spread the frosting, big chunks of the cake lining keep coming up in the frosting.

01:05 So it's kind of like your stomach lining.

01:08 See, the purpose of frosting is to cover the cake and to protect it, to keep it from getting stale.

01:14 Same thing works on your stomach lining.

01:17 The lining of your stomach is very sensitive and fragile, much like that cupcake that's still too warm.

01:24 So we need to frost or coat the inside of your stomach.

01:28 Now what the inside of your stomach is frosted or coated with is this really thick mucus.

01:34 So I want you to keep this in mind.

01:36 So draw your version of what a stomach would look like.

01:40 Okay.

01:41 So use one color to draw a version of your stomach then I want you to draw what looks like to you mucus, all the way around in that stomach - a coating.

01:50 Okay.

01:50 So you got that coating, now part of what keeps that mucus really effective, it's kind of that thick gel mucus in your stomach but it also has things called bicarbonate.

02:02 Cool part about bicarbonate is it neutralizes and it protects your stomach lining - that really fragile lining, from the gastric acid.

02:11 So take a look at your drawing.

02:13 If you're thinking about this, you should have a drawing of a stomach, you have some mucus coating all the way around the inside of your stomach and I then I want you to put just some little dots to remind you that that mucus is full of bicarbonate which neutralizes gastric acid.

02:28 Now, don't forget to draw some gastric acid in there so you can remember that we obviously have gastric acid in our stomach that helps to break down food.

02:36 Now, why would we take the time to draw this? Because here's what I want you to start thinking about before we get in to the rest of the video.

02:43 Peptic ulcer disease means that you have like a small erosion on your stomach.

02:48 It's an open sores that develop on the stomach lining because that stomach lining somehow gets exposed to that gastric acid.

02:57 So it can happen either on your stomach lining or your small intestine.

03:00 Now again, debbie downer here, the worst case scenario that can happen is that, that can lead to a perforation and a GI bleed.

03:09 That means that that open sore can become worse and worse and worse, work its way all the way through the stomach lining 'til we call that a perforation.

03:18 Once you have that perforation, now your'e risking GI bleeding.

03:21 Meaning there's gonna be lots of blood leaving from that wound and ding to your gut cavity and now we've got a really big problem with your patient.

03:28 GI bleeds could be severe and lead to shock and even bigger problems.

03:33 So, we wanna make sure that we stop peptic ulcer disease earlier.

03:38 Now, back to your drawing.

03:40 Take a look at that and I want you to see this picture up here on the screen.

03:43 See how we have that sore? that's what peptic ulcer disease is.

03:47 Now hopefully you can remember that you have it in a couple of places.

03:50 It can be in your stomach or the small intestine in the duodenum.

03:54 So those are the places when we say peptic ulcer disease that you're most likely to see these wounds.

03:59 Now see how being kind of deep into the different layers of your stomach lining.

04:04 Now before we talk about the drugs together, I want you to think like an engineer.

04:09 You know, they're amazing problem solvers.

04:12 So, we say that we have this problem, right? We have these sores.

04:16 What are some things that we could do to help kind of prevent or to treat peptic ulcer disease? Well, the problem is, we have this gastric acid stuff.

04:28 So, a simple over the counter medication that might help us with acid is that we could use an antacid, right? So you know those by their trade names like Tums, or something like that.

04:40 We use those as antacids that'll actually neutralize that acid.

04:43 That's one way to treat it but it's really not the most effective.

04:48 Maybe we could use something that would slow down the amount of gastric acid in the stomach.

04:53 Ah, now that sounds better.

04:56 So we've got a couple of choices when it comes to medications that will make less gastric acid available in our bodies.

05:03 They're called H2-antagonist or proton pump inhibitors.

05:08 Okay, so we can either neutralize the acid that we have or make less acid available.

05:15 There's some couple of ways we can do it.

05:17 We can also put like a liquid bandage or a little band-aid on that booboo, on that sore that you have in your stomach lining.

05:24 They can use the medications that are like sucralfate, that are super sticky.

05:28 Your patient swallows them by mouth, they go down to the GI tract and they... they will stick right to that sore just like a band-aid.

05:37 So before we start talking about the drugs, I want you just to kinda have in mind what are we treating.

05:44 We're treating these wounds, these sores in the stomach.

05:47 We wanna deal with that gastric acid because that's what started the wound or that sore in peptic ulcer disease.

05:54 And so we wanna help it heal.

05:56 We've got to protect it from more of the gastric acid.

05:59 We wanna neutralize the acid and just have less acid available.

06:03 Okay, that's your introduction.

06:06 Now, let's start taking a look at as we walk through each of these concepts.

06:10 This next slide is gonna layout those things that you want to keep in mind when we're thinking about peptic ulcer disease.

06:16 So you guess.

06:18 Yeah, that's kind of a fun word to say but it's the cells in the mucosa and it coats the lining of the stomach.

06:25 So that's really good.

06:26 This is how the body normally keeps my stomach protected.

06:29 First thing, I need to have plenty of mucus available to coat the entire lining of my stomach.

06:36 Next we talk about that bicarbonate.

06:38 Now that's secreted by the epithelial cells of your GI tract and that's what neutralizes the gastric acid.

06:45 So mucus has to be there but it needs to have lots of bicarbonate in it so it will neutralize gastric acid.

06:53 So the first two ways, we're talking about how the body naturally protects that stomach lining is plenty of mucus and then bicarbonate that will help neutralize the acid.

07:05 Now just like anything else, you have to have really good blood flow.

07:09 Otherwise, you won't have adequate levels of mucus to completely coat the inside of the stomach and adequate levels of bicarbonate to neutralize the acid.

07:19 And finally, prostaglandins are what stimulate the mucus and the bicarbonate secretions.

07:25 So, all four of these things work together.

07:29 So if my patient is having a problem, it might be a blood flow issue but more often than not, we've got some challenges with the amount of bicarbonate or mucus that are available or maybe the initial problem is starting from prostaglandins being supressed.

07:44 There's some of the medications that suppress the prostaglandins like NSAIDs (Non Steroidal Anti-Inflammatories).

07:53 So the most important point here, I'd like you to number those: 1, 2, 3 and 4 because I want you to get your brain to recognize that all four of these things need to be healthy.

08:06 I'm almost, in healthy amounts because I want you to almost think of it as a scale.

08:10 If I have... if I'm under attack then we'll talk about what attacks your body in just a minute.

08:15 But if I'm under attack by a thing we call H-pylori - that's a bug, if I'm under attack by H-pylori, if I have adequate amounts of mucus, bicarbonate, good blood flow and lots of prostaglandins, hopefully I can fight that off.

08:31 But if I don't, if the bug gets stronger, then the ability I have to defend my stomach lining then I'm gonna end up with peptic ulcer disease.