NTA Level 4 • Semester 1 • PST04102

Identification of Patients with Peptic Ulcers

Disease Control and Prevention • Source Session/Topic 37

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Session 37: Identification of Patients with Peptic Ulcers

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Peptic Ulcers

• Describe Types of Peptic Ulcers

• Describe Major Signs and Symptoms of Peptic Ulcers

• Explain Treatment of Common Peptic Ulcers

• Explain Prevention and Control of Peptic Ulcers

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Related Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Causes of Peptic Ulcers (5 minutes)

• Definition : An ulcers is a break in the mucosal surface >5 mm in size,

with depth to the submucosa

• Common causes include;

o The bacteria, helicobacter pylori

o non-steroidal anti-inflammatory drugs

o tobacco smoking

o Alcohol

o Psychological stress

o Diet: certain foods can cause dyspepsia, but no convincing studies

indicate an association between ulcer formation and a specific diet.

STEP 3: Types of Peptic Ulcers (15 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What are the types of peptic ulcers? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• PUD encompasses:

o Gastric ulcers (GU) which is an ulcer in the stomach

o Duodenal ulcers (DU) which is an ulcer in the first part of the small

intestines (duodenum)

• Duodenal and gastric ulcers share common features in terms of

pathogenesis, diagnosis, and treatment, but several factors distinguish

them from one another.

STEP 4: Signs and Symptoms of Peptic Ulcers (30 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are signs and symptoms of peptic ulcers? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Signs and symptoms of peptic ulcer can include one or more of the

following:

• Epigastric pains associated with mealtimes

o pain appears about three hours after taking a meal in duodenal ulcers

• Bloating and abdominal fullness

• Hematemesis (vomiting of blood); this can occur due to bleeding directly

from a gastric ulcer, or from damage to the esophagus from

severe/continuing vomiting.

• Melena (tarry, foul-smelling feces due to presence of oxidized iron

from hemoglobin);

• Nausea, and copious vomiting;

• Loss of appetite

• Weight loss

• Dyspepsia that becomes constant not relieved by food or antacids,

radiating to the back may indicate a penetrating ulcer

STEP 5: Treatment of Peptic Ulcers (20 minutes)

• Treatment is initiated at the hospital

• The clinician's goal in treating PUD is to:

o Provide relief of symptoms (pain or dyspepsia)

o Promote ulcer healing

o Prevent ulcer recurrence and complications

• Therapy for H. Pylori Eradication

o H. pylori should be eradicated in patients with documented PUD

o The agents used with the greatest frequency include:

▪ Amoxicillin

▪ Metronidazole

▪ Tetracycline

▪ Clarithromycin

▪ Bismuth compounds

o Triple Therapy Regimes include:

▪ Amoxicillin, Metronidazole and omeprazole

▪ Lansoprazole, clarithromycin, and amoxicillin

▪ Bismuth subsalicylate, tetracycline, and metronidazole etc.

• Antacids e.g. Magnesium Trisilicate – offer symptomatic relief by

neutralizing stomach acidity

• Acid inhibitory agents – decrease the amount of acid in the stomach

helping with healing of ulcers.

o Histamine 2 receptors blockers (H2 blockers) e.g. Ranitidine,

fomatidine

o Proton Pump Inhibitors (PPIs)e.g. Omeprazole, Lansoprazole

• Prostaglandin analogue (misoprostol) for prevention of NSAID-induced

ulceration

STEP 6: Prevention and Control of Peptic Ulcers (30 minutes)

|Activity: Group discussion (20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are preventive and control measures of peptic ulcers? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Personal hygiene – It's not clear how H. pylori spread, but there's some

evidence that it could be transmitted from person to person or through food

and water.

o Wash hands with soap and water before handling

o Eat foods properly cooked

• Use NSAIDs with caution.

o Avoid taking aspirin, ibuprofen, and other non-steroidal anti-

inflammatory drugs

o Take medication with meals

• Avoid drinking or drink alcohol in small amounts

o Avoid drinking alcohol when taking medication

• Don't smoke. Smokers are much more likely to get ulcers

STEP 7: Key Points (5 minutes)

• Peptic ulcer is caused by bacterial infection, drugs, alcohol and

stress

• Types of peptic ulcer includes duodenal and gastric ulcers

• Signs and symptoms are epigastric pains, abdominal fullness, loss of

weight, nausea and vomiting

• Treatment is mainly with antacids and antibiotics may be required

• Prevention strategies includes avoid alcohol, smoking and stress

STEP 8: Evaluation (5 minutes)

• What causes peptic ulcer?

• What are the types of peptic ulcers

• What are signs and symptoms of peptic ulcers?

• What is the treatment of peptic ulcers?

• What are preventive measures of peptic ulcers?

STEP 9: Assignment (5 minutes)

|Activity: Take Home Assignment (5 minutes) |

| |

|DIVIDE individual assignment |

| |

|ASK the students to work individually on the following Assignment |

|Explain preventive measures that you will take to control peptic ulcers|

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal

Medicine (15thed.). Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.).

Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine. Churchill:

Livingstone

MOHSW (2005).National Formulary. Dar es Salaam: Ministry of Health and

Social Welfare.

Swash, M. & Glynn, M. (2007). Hutchison’s Clinical Methods (22nded.).

London: Harcourt Publishers Ltd.

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