WHAT IS A PEPTIC ULCER AND WHERE DOES IT OCCUR?
Peptic ulcers are craters or open sores in the lining of the upper gastrointestinal tract. They include duodenal ulcers (those that are located in the top of the small intestine or duodenum) and gastric ulcers (those found in the stomach).
Peptic ulcers are common and usually occur singly. But it is possible to have two or more, or even both duodenal and gastric ulcers at thesame time. Duodenal ulcers are more common than gastric ulcers.
¨ WHAT CAUSES PEPTIC ULCERS?
¨ Peptic ulcers are caused by acid and pepsin (an enzyme) produced in the stomach. Patients who develop ulcers often produce greater amounts of acid than people without ulcers. Also, the ulcer patient
may not have strong enough natural defenses in the stomach or intestinal wall to resist the effect of acid and pepsin. ¨ Doctors do not yet know all the reasons too much acid is produced,
but many believe the key to healing an ulcer is to control the amount of acid produced.
¨ WHAT ARE THE SYMPTOMS OF PEPTIC ULCER DISEASE?
¨ Duodenal Ulcer symptoms:
1. Pain that awakens patients from sleep
2. Burning or gnawing sensation in the upper abdomen
3. Pain in the back, lower abdomen or chest area may
occasionally occur
4. Pain that occurs when the stomach is empty (about two hours
after a mean or during the night). Relief frequently occurs
after eating
¨ Gastric Ulcer symptoms:
1. Gastric ulcer pain may be less severe than duodenal ulcer pain and is noticeably higher in the abdomen
2. Eating may increase pain rather than relieve pain
3. Pain is described as aching, nagging, cramping or dull
4. Other symptoms may include nausea, vomiting and weight loss
Some ulcers may produce no symptoms at all. However, occasional painless bleeding, anemia (low blood count), or the passage of black,tarry stool may be the first sign of peptic ulcer disease.
HOW ARE PEPTIC ULCER DIAGNOSED?
Diagnosis can often be made from the patient’s symptoms. X-ray – your doctor may have you drink barium, a chalky liquid that shows up on an x-ray and outlines your stomach and duodenum. The ulcer can be diagnosed by an indentation in the stomach or duodenal wall. You may still have an ulcer even though the x-ray fails to showit.
¨ Endoscopy – this is a more accurate method of diagnosing ulcer disease. This exam allows the doctor to look into your stomach and duodenum with a lighted flexible tube. Gastric ulcers, unlike duodenal ulcers, can occasionally be cancerous. Therefore,endoscopy and biopsy of the gastric ulcer are commonly used for the
diagnosis and follow-up of ulcers.
¨ WHAT ARE THE COMPLICATIONS?
¨ If ulcers remain untreated they may lead to:
¨ Bleeding
¨ Perforation (an actual puncture through the stomach)
¨ Obstruction (repeated attacks may cause scar tissue that can
block the digestive tract)
¨ IMMEDIATELY REPORT TO YOUR DOCTOR…¨ Any signs of bloody or black, tarry stools (digested blood)
¨ Vomiting of blood or “coffee ground” material
¨ Pain
¨ Fever
¨ HOW CAN YOU TREAT PEPTIC ULCER DISEASE?
¨ Medications – medications that decrease the amount of acid produced
by the stomach are used to provide quick pain relief and promote
rapid healing.
¨ Other equally effective medications, such as coating agents called
carafate, antacids, and one called omeprazole, are available
¨ Most peptic ulcers heal within 4 to 6 weeks of treatment. Take your
medications regularly as directed, otherwise your ulcer may not heal
completely and your symptoms could return. Symptoms may disappear in a few days, but DO NOT STOP taking your medication.
¨ Nighttime is the most important time to heal ulcers, since many people produce large amounts of stomach acid while they sleep.
Take antacids as needed between meals and at bedtime to neutralize stomach acid and reduce pain.
¨ Aspirin and anti-inflammatory products should be avoided. Let your doctor know if you have been taking these, so alternate medications may be prescribed.
¨ Side effects from the medication used to treat peptic ulcer disease are very infrequent (less than 5 percent), but many include mild diarrhea,dizziness, nausea, drowsiness, rash or headache.
¨ Remember, people are different and no single medicine is best for everyone. If your symptoms worsen, notify your doctor immediately.
¨ DIET
¨ The best diet to follow is a balanced nutritious one. Frequent meals and milk diets actually stimulate acid and can be less helpful. Avoid eating at least two hours before bedtime. Avoid whatever foods might cause discomfort, such as alcohol, caffeine beverages (coffee and pop), fatty foods, and highly seasoned foods.
¨ LIFE-STYLE CHANGES
¨ It is important to try to stop smoking, since smoking has been linked to ulcer formation, reduced healing, and ulcer recurrences.
¨ Also try to minimize stress in your life. Stress may worsen ulcer symptoms.
¨ Patients with a history of peptic ulcer disease may have frequent recurrences during their lifetime. Follow your doctor’s advice to minimize the frequency and severity of recurrences. Promptly report
any return of symptoms.
¨ If you have repeated occurrences of peptic ulcer disease, your doctor may use maintenance therapy and prescribe a low dose medication to minimize the risks and prevent painful symptoms.
A burn is an injury to the tissues of the body. Burns are classified according to the amount of tissue they affect and how deep they are. A third-degree burn is the most serious because it destroys all the layers of the skin.
Anyone can get a third-degree burn. Children and the elderly are more likely to experience complications from burns.
Causes of Burns Third Degree
People are more likely to suffer third-degree burns from contact with corrosive chemicals, flames, electricity, or extremely hot objects; immersion of the body in extremely hot water, or clothing that catches fire.
Symptoms of Burns Third Degree
Skin with a third-degree burn may appear white or black and leathery on the surface. Because the nerve endings in the skin are destroyed, the burned area may not be painful, but the area around the burn may be extremely painful. Pain causes the breathing rate and pulse to increase. Some areas of the burn may appear bright red, or may blister. Third-degree burns can also damage fat, muscle, and bone. Electrical burns damage the deep tissues. Often only the area of the skin where the electricity entered the body looks black and charred. Electrical shocks can make a person stop breathing and interrupt the rhythm of the heart. Third-degree burns can cause the victim to go into shock. Shock occurs when loss of fluids causes the blood pressure to become so low that not enough blood reaches the brain and other major organs. The symptoms of shock include fainting, general weakness, nausea and vomiting, rapid pulse and breathing, a blue tinge to the lips and finger nails, and pale, cold, moist skin. If the victim has been burned in a fire and has been exposed to large amounts of smoke, he or she may also have chest pain, red and burning eyes, and a cough. All third-degree burns require emergency medical treatment.Diagnosed of Third Degree Burns
Your doctor will examine the burned area and classify it according to the amount of tissue affected and the depth of the burn. He or she will ask how the burn occurred. The doctor will check for other conditions related to burn injuries, such as smoke inhalation, carbon monoxide poisoning, or other injuries. If the patient is a child, the doctor will ask further questions to ensure the patient is not a victim of child abuse. Doctors assess the severity of a burn by determining what percentage of the total body surface area (BSA) is affected. In patients older than nine years, they apply what’s called the “rule of nines” to determine the percentage of BSA. For example, the genital area is considered 1% of BSA. The head and neck are 9%. Burns on each arm, including the hand, is also 9% of BSA. Each leg, including the foot, is 18%. The front of the torso is 18%, as is the back of the torso, including the buttocks. In children younger than nine, the palm of the child’s hand is used as a measure of 1% of BSA. Third-degree burns that cover less than 2% of BSA are considered minor. Third-degree burns that cover 2 to 10% of BSA are considered moderate burns. Those that cover more than 10% of BSA, as well as those on the face, hands, feet, or genitals, are critical.
Treatment of Third Degree Burns
All third-degree burns require medical treatment. Minor third-degree burns can be treated in a doctor’s office, but all others should be considered a medical emergency that requires hospital treatment, or get the person to an emergency room as soon as possible. If the person is on fire, do not let him or her run. Smother any flames with a blanket, jacket, or water, if available, or have the victim use the “stop, drop, and roll” method. Remove any clothing or jewelry from the injured area, but DO NOT remove clothing if it is stuck to the burn. Very briefly immerse the burned area in cold water or use a clean towel or wash cloth moistened with cold water to stop the burning process. Don’t hold the burned area in cold water for too long or you will cool down the body too much. Also don’t use ice or ice water because they will further damage the tissue. Do not break open any blisters, or there will be a greater risk of infection. If the blisters are open, don’t remove any clothing that might be stuck to the burn, and don’t run water over the burn. This will increase the risk of shock. Whether the blisters are broken or not, you can place a dry, sterile gauze pad over the burn, but do not use any bandages with adhesive. If the burned area is larger, lightly drape a clean sheet over it to protect it until you get medical treatment. It is important for the bandage to be loose so the burn gets air.
Never apply butter, oils, or burn ointments. They make it more difficult for the burn to heal and can actually make the burn worse because the heat can’t escape. Arms or legs that are burned should be kept raised to reduce the amount of swelling. If the face or neck are burned, raise the person’s head slightly. This will also help if he or she is having trouble breathing. If the person appears to be going into shock, lay him or her flat on the ground, raise the feet around 12 inches (30 cm), and call for medical help. You can cover the patient with a blanket to keep him or her warm.
Do not give a person who is in shock anything to drink. Otherwise, you can provide the patient with small sips of clear liquid, such as water or juice.
Chemical burns are treated a little differently. For liquid chemicals, first remove any clothing or other items that the chemicals have spilled on. Then, thoroughly wash any chemicals off the skin under running water for 15 to 30 minutes. For dry chemicals, use large amounts of water to flush the chemicals from the skin. Never use small amounts of water because they may actually activate the chemicals. If no water is available, use a clean cloth to brush any dry chemicals off the skin. Loosely cover the burn with a dry, sterile bandage, and see a doctor for further treatment. Different chemicals have different effects, so you should always check the chemical label, if possible, for additional directions. Always see a doctor if the chemicals have gotten into the eyes or mouth. If a person has had contact with electricity, call 911 and make sure the source of the electrical current is disconnected before touching the victim. Administer emergency cardiopulmonary resuscitation (CPR) if the victim’s heart has stopped beating or he or she is having trouble breathing. Lightly cover the burned area with a dry, sterile bandage until medical help arrives.
Moderate and critical third-degree burns require hospitalization. The body loses a great deal of fluid through the burned area, so replacement fluids are given through an intravenous (IV) line, which is a tube placed into a vein. If the lungs are damaged, or breathing is difficult, a tube is inserted into the throat to help with breathing. The patient will need to take antibiotics to protect the burned area from infection, as well as a prescription pain medication. If the patient’s immunizations aren’t up to date, he or she may also need a tetanus booster. Sometime severe burns are treated by putting the patient into a special room that is filled with pure oxygen under high pressure. This is called a hyperbaric chamber, and the patient must receive this treatment within 24 hours of being burned for the treatment to be effective. The burned areas are cleaned and covered with an antibiotic cream, then covered in sterile bandages. These bandages are changed frequently and the burned area is carefully monitored for signs of infection. The dead tissue around the burn is surgically removed, called debridement.
As burned skin heals, it develops a thick, scabbed surface, called eschar, that makes it difficult for blood to flow to the injured area. Doctors often have to use a procedure called an escharotomy to cut through the eschar so the healthy tissue underneath can receive the blood flow it needs. Severe third-degree burns leave extensive scars because the burns are so deep. For this reason, the burned area may need to be covered with a skin graft, where a piece of healthy skin is taken from an unburned area of the body and transplanted permanently to the burned area. This is called an autograft. If the patient’s skin can’t be used, the plastic surgeon may use the skin of another human donor (called an allograft), or the skin of an animal, such as a pig (called a xenograft). Allografts and xenografts are temporary, but protect the skin as it heals. Critical third-degree burns may take weeks to months of hospital treatment and require physical therapy to help restore movement to the burned areas and to minimize scarring.
Prevented Mangment
Many burns occur at home and could have been prevented. You can avoid first-degree burns by handling hot liquids and objects carefully. Make sure electrical cords are in good condition, household chemicals are safely stored and labeled, and hot beverages and objects are out of reach of small children. When handling chemicals, wear protective gloves and eyewear, and follow label directions for safe handling. Never wear clothing with long, loose sleeves while cooking or around any type of open fire. Never put a child into a tub unless you have first tested the water temperature. You can guard against burns from hot water by keeping your hot water heater set lower than 120 degrees Fahrenheit (49 degrees Celsius). Children should also sleep in flame-resistant pajamas or nightgowns. Do not smoke, or make sure discarded cigarettes are completely extinguished. Teach your children fire safety and make sure they do not have access to matches or lighters. You can also protect you and your family from burns by making sure you have operating smoke detectors on every floor of your house. Also check the temperature of a child’s car seat or seat belt before buckling the child in. Even these objects can cause burns after a period of time in direct sunlight. Never allow children to handle fireworks without adult supervision. Fireworks are a leading cause of burns and other injuries. You can avoid sunburns by using a sunscreen of at least a 15 SPF rating. Apply sunscreen liberally at least 20 minutes before sun exposure and reapply after swimming or sweating. Avoid spending time in the sun from 10 a.m. to 3 p.m., when the rays are strongest. Always take shelter during severe storms to avoid being struck by lightning.
A burn is an injury to the tissues of the body. Burns are classified according to the amount of tissue they affect and how deep they are. A second-degree burn injures the top layers of skin, called the epidermis, and extends down to the deeper layers of skin, called the dermis.
Anyone can get a second-degree burn. Children and the elderly are more likely to experience complications from burns.
Causes of Second Degree Burns
Most second-degree burns are caused by contact with flames, hot liquids, or chemicals, or by severe sunburns. Burns caused by heat are called thermal burns. Burns caused by hot liquids or steam are called scalds.
Symptoms Second Degree Burns
Skin with a second-degree burn is extremely red and blistered, and may look wet because of fluid loss. Second degree burns are very painful, and the victim’s pulse rate usually increases in response to the pain. Small second-degree burns usually heal without scarring. Larger second-degree burns can cause the victim to go into shock. Shock occurs when loss of fluids causes the blood pressure to become so low that not enough blood reaches the brain and other major organs. The symptoms of shock include fainting, general weakness, rapid pulse and breathing, nausea and vomiting, a blue tinge to the lips and finger nails, and pale, cold, moist skin. See a doctor immediately if a second-degree burn is on the face, hands, feet, or genitals; is caused by an electrical source; or covers an area larger than two to three inches.
Diagnosed Second Degree Burns
Treatment Second Degree Burns
Minor burns are treated at home, while moderate and critical burns require hospital treatment. The goal of treatment for second-degree burns is to reduce pain and prevent infection. If the burn was caused by fire, and the victim’s clothing is on fire, smother any flames with a blanket or water, if available, or have the victim use the “stop, drop, and roll” method. If the burn has blisters that are not open, first remove any clothing or jewelry from the injured area. Then, hold the burned area under cool running water for around 10 minutes to stop the burning process. You can also use a clean towel or wash cloth moistened with cold water. However, don’t use ice or ice water because they will further damage the tissue. Do not break open the blisters, or there will be a greater risk of infection. If the blisters are open, don’t remove any clothing that might be stuck to the burn, and don’t run water over the burn. This will increase the risk of shock. Whether the blisters are broken or not, you can place a dry, sterile gauze pad over the burn, but do not use any bandages with adhesive. If the burned area is larger, lightly drape a clean sheet over it to protect it until you get medical treatment. It is important for the bandage to be loose so the burn gets air.
Never apply butter, oils, or burn ointments. They make it more difficult for the burn to heal and can actually make the burn worse because the heat can’t escape. Arms or legs that are burned should be kept raised to reduce the amount of swelling. If the face or neck are burned, raise the person’s head slightly. This will also help if he or she is having trouble breathing. If the person appears to be going into shock, lay him or her flat on the ground, raise the feet around 12 inches (30 cm), and call for medical help. You can cover the patient with a blanket to keep him or her warm.
Do not give a person who is in shock anything to drink. Otherwise, you can provide the patient with small sips of clear liquid, such as water or juice.
Chemical burns are treated a little differently. For liquid chemicals, first remove any clothing or other items that the chemicals have spilled on. Then, thoroughly wash any chemicals off the skin under running water for 15 to 30 minutes. For dry chemicals, use large amounts of water to flush the chemicals from the skin. Never use small amounts of water because they may actually activate the chemicals. If no water is available, use a clean cloth to brush any dry chemicals off the skin. Loosely cover the burn with a dry, sterile bandage, and see a doctor for further treatment. Different chemicals have different effects, so you should always check the chemical label, if possible, for additional directions. Always see a doctor if the chemicals have gotten into the eyes or mouth. If the area of the burn is larger than two to three inches, you should get immediate medical treatment. The body loses a great deal of fluid through the burned area, so replacement fluids are given through an intravenous (IV) line, which is a tube placed into a vein. If the lungs are damaged, or breathing is difficult, a tube is inserted into the throat to help with breathing. The patient will need to take antibiotics to protect the burned area from infection, as well as a prescription pain medication. If the patient’s immunizations aren’t up to date, he or she may also need a tetanus booster. If your doctor thinks there will be a great deal of scarring, he or she may recommend a skin graft, where a piece of healthy skin is taken from an unburned area of the body and transplanted to the burned area. This is called an autograft.
For smaller burns that can be treated at home, gently wash the area with an antiseptic cleanser, loosely bandage the burn, then leave it alone for at least 24 hours. You can apply an aloe-based cream to relieve pain before bandaging it. Pain relievers such as acetaminophen, ibuprofen, or aspirin can help with inflammation and pain, and should be used according to directions. Never give aspirin to a child under the age of 18 because of the risk of a serious illness called Reye’s syndrome. If you have seen a doctor, follow his or her instructions for changing the bandages. Make sure you wash your hands with soap and water. Be sure to remove the bandage slowly and carefully. You will need to soak it before removing if it is sticking to the burn. Gently wash the burn, check for signs of infection, apply a thin layer of antibiotic cream, then cover it with a clean bandage.
Signs of infection include increased swelling or redness, blisters filled with greenish or brownish fluid, oozing pus in the burned area, or red streaks spreading away from the burn, and are a reason to call your doctor. Also call your doctor if you have a fever, swollen lymph nodes, or notice numbness or a cold feeling in the arms or legs. A second-degree burn can take anywhere from 10 days to 3 weeks to heal. Call your doctor if it doesn’t heal within that time. Vitamins C and E, and zinc may help the burn to heal, but should be taken only in safe amounts.
Prevented Mangment
Many burns occur at home and could have been prevented. You can avoid first-degree burns by handling hot liquids and objects carefully. Make sure electrical cords are in good condition, household chemicals are safely stored and labeled, and hot beverages and objects are out of reach of small children. When handling chemicals, wear protective gloves and eyewear, and follow label directions for safe handling. Never wear clothing with long, loose sleeves while cooking or around any type of open fire. Never put a child into a tub unless you have first tested the water temperature. You can guard against burns from hot water by keeping your hot water heater set lower than 120 degrees Fahrenheit (49 degrees Celsius). Children should also sleep in flame-resistant pajamas or nightgowns. Do not smoke, or make sure discarded cigarettes are completely extinguished. Teach your children fire safety and make sure they do not have access to matches or lighters. You can also protect you and your family from burns by making sure you have operating smoke detectors on every floor of your house. Also check the temperature of a child’s car seat or seat belt before buckling the child in. Even these objects can cause burns after a period of time in direct sunlight. Never allow children to handle fireworks without adult supervision. Fireworks are a leading cause of burns and other injuries. You can avoid sunburns by using a sunscreen of at least a 15 SPF rating. Apply sunscreen liberally at least 20 minutes before sun exposure and reapply after swimming or sweating. Avoid spending time in the sun from 10 a.m. to 3 p.m., when the rays are strongest.