Question

The nurse is admitting a client with a suspected duodenal ulcer. The client will most likely report that his abdominal discomfort lessens when he: A. Skips a meal B. Rests in recumbent position C. Eats a meal D. Sits upright after eating

Short answer

A. Skipping a meal B. Resting in a recumbent position C. Eating a meal D. Sitting upright after eating Answer: C. Eating a meal

Step-by-step solution

Introduction to Duodenal Ulcers

A duodenal ulcer is a sore that forms on the lining of the duodenum, which is the first part of the small intestine where food enters from the stomach. The most common cause of duodenal ulcers is Helicobacter pylori bacterial infection or the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Symptoms may include gnawing or burning pain in the upper abdomen, nausea, vomiting, and loss of appetite.

Option A: Skipping a Meal

Skipping a meal is not likely to help someone with a duodenal ulcer, as an empty stomach may actually worsen the discomfort. When the stomach is empty, acid production is not buffered by food, so the discomfort caused by the ulcer can be increased.

Option B: Resting in a Recumbent Position

Resting in a recumbent position means lying down, and this may not help alleviate abdominal discomfort caused by a duodenal ulcer. The reason is that this position can cause gastric juices to flow back into the esophagus, which may worsen the pain.

Option C: Eating a Meal

Eating a meal can indeed help to alleviate abdominal discomfort caused by a duodenal ulcer. When food is consumed, it can help to buffer the stomach acid and promote healing of the ulcer. Additionally, eating a meal may stimulate the release of bicarbonate from the pancreas, which helps to neutralize stomach acids and can relieve pain temporarily.

Option D: Sitting Upright after Eating

Although sitting upright after eating may help prevent acid reflux by keeping the acid contained in the stomach, it is less likely to provide relief for someone with a duodenal ulcer, as it doesn't necessarily affect the ulcer directly.

Conclusion

Based on the analysis of each option, the client will most likely report that his abdominal discomfort lessens when he eats a meal (Option C). This is due to the buffering effect of food on stomach acids and the possible release of bicarbonate ions, which can help neutralize the acids and provide temporary pain relief.

Key concepts

Symptoms of Duodenal Ulcer

Understanding the symptoms of a duodenal ulcer can help in recognizing the condition early and seeking prompt treatment. The hallmark symptom of a duodenal ulcer is a gnawing or burning pain in the upper abdomen. This pain often occurs between meals or at night. It might be relieved temporarily by eating, drinking milk, or taking antacids.
Other symptoms might include:

• Nausea: a feeling of needing to vomit.
• Vomiting: expelling contents of the stomach through the mouth.
• Bloated feeling: feeling of fullness or swelling.
• Loss of appetite: lack of desire to eat.
• Weight loss: losing weight without trying.

The pain from a duodenal ulcer can sometimes be confused with other conditions, so it’s important to consult a healthcare provider for a correct diagnosis.

Treatment Options for Ulcers

Duodenal ulcers can be effectively treated with a range of options aimed at reducing stomach acid and helping the lining of the duodenum heal. One common approach is the use of medications like proton pump inhibitors (PPIs) or H2-receptor antagonists, which reduce acid production.
Antacids may also be used to neutralize existing stomach acid and provide quick relief.
For ulcers caused by Helicobacter pylori infection, a combination of antibiotics and acid-reducing medications is often necessary to eradicate the bacteria.

• Proton Pump Inhibitors (PPIs): Reduce the production of stomach acid.
• H2-Receptor Antagonists: Decrease the amount of acid the stomach makes.
• Antacids: Provide temporary relief by neutralizing stomach acid.
• Antibiotics: Used when testing positive for Helicobacter pylori to kill the bacteria.

It's crucial for patients to follow their healthcare provider's instructions and complete the full course of treatment to prevent recurrence.

Helicobacter Pylori Infection

The bacterium Helicobacter pylori is a major contributor to the development of duodenal ulcers. This microorganism thrives in the acidic environment of the stomach by burrowing into the mucous lining, where it can cause inflammation and lead to ulcer formation.
Detection and treatment are essential steps in managing the infection and preventing complications like ulcers.
Standard treatment involves a combination of:

• Two different antibiotics: To ensure that the bacteria do not become resistant.
• A proton pump inhibitor: To lower stomach acid levels and enhance antibiotic effectiveness.

Successful eradication of the bacteria can lead to the healing of the ulcer and prevent future occurrences. A breath, blood, or stool test can confirm the presence of the infection.

Role of Diet in Ulcer Management

While medication plays a key role in ulcer management, diet can also significantly impact symptom relief and healing of the ulcer. Certain foods and beverages might irritate the ulcer or increase acid production, so avoiding these can aid recovery.
For effective ulcer management:

• Avoid spicy and acidic foods: Items like citrus fruits, tomatoes, and hot spices can irritate the ulcer.
• Limit caffeine and alcohol: These can increase acid production and worsen symptoms.
• Focus on a balanced diet: Include fruits, vegetables, whole grains, and lean proteins to support healing.
• Eat smaller, more frequent meals: This can help buffer stomach acid more consistently throughout the day.

Each individual's tolerance can vary, so it may be helpful to track symptoms in relation to diet to identify personal triggers.