Nursing Field Notes / GI · Pathophysiology Course

Peptic Ulcer Disease 🕳️

PUD — when acid finally wins and eats a hole through the wall

NG-295 GI ADHD-friendly visual edition

Gastric acid erodes the GI lining and creates an open sore — a hole — in the stomach or duodenum (rarely the esophagus). Same acid-vs-mucus fight as Gastritis (NG-296), just deeper — see NG-293 Key Terms for dyspepsia, hematemesis & melena.

🕳️ Mucus loses the fightPUD = acid eats all the way through the protective mucus + wall.

🍽️ Gastric hurts WITH foodDuodenal hurts 2–3 hrs AFTER food & at night — opposite timing.

🦠 H. pylori + NSAIDsThe two biggest causes — both strip away the protective barrier.

🚨 Board-like abdomenPerforation → peritonitis/sepsis = PRIORITY, report to HCP.

🧨

CAUSE

STEP 1 · MUCUS LOSES

Normally the stomach protects itself from its own acid — PUD is what happens when that protection fails.

🧫 The mucosa fight — protection vs. attack

EXAM TIP Every risk factor either strips the mucus/bicarbonate layer or increases the acid attacking it.

🧠 "No mucus, no protection." This exact crater picture is the same mental model used on the Gastritis page — Gastritis is the mucosa getting irritated, PUD is the acid finishing the job and punching all the way through.

⚠️ Causes & risks — top 3

🦠 1. H. pylori bacteria — burrows into the mucus layer
💊 2. NSAIDs — naproxen · indomethacin · ibuprofen — block protective prostaglandins
😰 3. Stress — prolongs the ulcer, delays healing

🧠 "Bug, drug, and a bad mood." H. pylori (bug), NSAIDs (drug), stress (mood) — the three-way cause of nearly every PUD case tested.

🚑 Stress ulcers — the fast-onset kind

Occur within hours of a traumatic event — linked to low blood flow/perfusion to the GI tract, called mucosal ischemia.

🔥 Curling's ulcer — after severe burns
🧠 Cushing's ulcer — after head injury / increased ICP

🧠 "Curling = Cooked skin, Cushing = Cranium." Curling's follows burns; Cushing's follows a brain injury. Both are ICU emergencies — patients often get prophylactic acid reducers for exactly this reason.

🔎

CLUES

STEP 2 · TIME THE PAIN

Gastric and duodenal ulcers hurt on opposite schedules — that timing is the highest-yield fact on this whole page.

🍽️ Gastric vs. Duodenal — opposite pain timing

Gastric ulcer (stomach)	Duodenal ulcer (duodenum)
Pain increases WITH food — 30–60 min after meals	Pain decreases WITH food, returns 2–3 hrs later — worse at night
Weight LOSS — patients avoid eating	Weight GAIN — patients eat to relieve pain
More likely to vomit blood — hematemesis	More likely melena — dark tarry stool

🧠 "Gastric = Grief with food, Duodenal = Delight then Delayed pain." If eating makes it worse, blame the stomach. If eating helps but the pain sneaks back a couple hours later (especially at night), blame the duodenum.

🩸 Hemorrhage — recognize it fast

🤮 Hematemesis — vomiting blood
💩 Melena — black, tarry stool
📉 Dropping H&H, tachycardia, hypotension

🧠 Report black tarry stools to the HCP — every time, no exceptions.

🚨 Perforation → Peritonitis & Sepsis — PRIORITY

🌡️ Fever over 100.3°F
🤲 Rebound tenderness
🪵 "Rigid" / "board-like" abdomen
📈 Increasing pain · 😰 restless · 💓 tachycardia/tachypnea

🧠 "BOARD" — same word set from NG-293/GERD. A board belly = report to the HCP now.

🚧 Gastric outlet obstruction

Chronic scarring/swelling near the pylorus blocks emptying → early satiety, bloating, nonbilious vomiting of undigested food.

🧠 Think of it as the ulcer's scar tissue becoming a speed bump the stomach can no longer empty over.

🔬 Diagnostics: scope & swallow

Test	Client education
EGD — Esophagogastroduodenoscopy	NPO 8 hrs before · no smoking beforehand
Upper GI series with barium contrast	During: abdominal cramping expected. After: chalky white stool — increase fluids to flush the contrast; may need a mild laxative.

🧠 EGD = "Every Gut Door" — Esophagus → Gastro → Duodenum, same scope taught on the GERD page.

🩺

CARE

STEP 3 · KILL THE BUG, CALM THE ACID

Treat the cause (H. pylori), reduce the acid, protect the mucosa — and teach what to never take again.

💊 Antibiotics — eradicate H. pylori

Standard therapy combines 2 antibiotics + a PPI (triple therapy) or adds bismuth (quadruple therapy):

💊Amoxicillin

💊Clarithromycin

💊Tetracycline

💊Metronidazole

🩷Bismuth(Pepto-Bismol)

🧠 NCLEX trap: a PPI alone will calm symptoms but will NOT cure PUD if H. pylori is present — the antibiotics are what actually eradicate the cause.

💊 Acid reducers — 3 tiers

Class	Example	Name clue
Antacids 🧴	—	"ANT-acid" = against acid
H2 blockers 🚫	Ranitidine	-tidine
PPIs ⛽	Omeprazole	-prazole

🧠 Same "TIDY the acid, PRAZOLE the pump" mnemonic from GERD (NG-036) — this ladder repeats across every acid-related GI page.

🛡️ Mucosal protectants

💊 Sucralfate — coats & sticks to the ulcer crater; give on an empty stomach, separate from antacids by ~30 min
💊 Misoprostol — prostaglandin analog; protects mucosa + reduces acid
⚠️ Misoprostol is contraindicated in pregnancy — it can induce uterine contractions/abortion

🧠 "Sucralfate = a bandage. Misoprostol = a baby's biggest NO." Always confirm pregnancy status before starting misoprostol.

❌ AVOID — the ulcer-friendly triggers

💊NSAIDsnaproxen, ibuprofen, indomethacin

☕Caffeinecoffee, soda, tea

🍺Alcohol

🚬Cigarettestobacco

🌶️Spicy foods

🥓Fatty / fried foods

🍋Acidic foods

😰Unmanaged stressprolongs the ulcer

🧠 "NCAAS" — NSAIDs · Caffeine · Alcohol · Acidic/spicy/fried foods · Stress. Cut all five and the mucosa finally gets a chance to heal.

🎯 Common NCLEX question — Select All That Apply

"The nurse is educating the client on peptic ulcer prevention. Which statements show correct understanding?"

✅ "I will not drink beer at the party this weekend."
✅ "I will avoid using naproxen."
✅ "I should avoid drinking excess coffee or soda."
✅ "I will start smoking cessation."
❌ "I will avoid spicy foods, but fried chicken is okay." — fried food is also a trigger; this statement is INCORRECT.

🧠 Watch for the half-right answer choice — it avoids one trigger but keeps another. SATA questions punish partial understanding.

⚡

QUICK RECALL

SAY IT OUT LOUD

🕳️ PUD= acid erodes ALL THE WAY through the mucosa

🍽️ Gastric hurts WITH foodDuodenal hurts 2-3 hrs later & at night

🦠 H. pylorineeds antibiotics — a PPI alone won't cure it

🪵 Board-like belly= perforation/peritonitis → report to HCP

🎯 Cover & check — 4 rapid-fire questions

Q1: A patient's pain worsens 30-60 minutes after eating and they've lost weight. Gastric or duodenal ulcer?

Gastric ulcer — pain increases with food, patients often lose weight from avoiding meals.

Q2: Why won't a PPI alone cure PUD caused by H. pylori?

A PPI only reduces acid — it doesn't kill the bacteria. Eradication requires antibiotics (e.g., amoxicillin + clarithromycin) combined with a PPI, or a bismuth-based quadruple regimen.

Q3: Which drug used for PUD is contraindicated in pregnancy, and why?

Misoprostol — a prostaglandin analog that can trigger uterine contractions and abortion.

Q4: What's the difference between Curling's and Cushing's stress ulcers?

Curling's ulcer follows severe burns; Cushing's ulcer follows head injury/increased ICP. Both develop within hours due to mucosal ischemia.

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STUDY SHEETS

FROM YOUR SAVED SET

Duodenal versus gastric ulcer, the four risk factors, how it is diagnosed, and the triple-therapy treatment with its complications. — swipe it sideways if it is cut off, or tap to open it full size.

The timing trick: duodenal ulcer hurts about two hours after eating and food helps; gastric ulcer hurts within thirty minutes and food makes it worse. — swipe it sideways if it is cut off, or tap to open it full size.

Saved study graphics from your own collection. Each one is someone else’s work — check anything clinical against your course materials before you rely on it.