Peptic Ulcer Disease

Peptic ulcer disease is a break in the protective lining of the stomach or duodenum. It develops when acid and pepsin overwhelm mucosal defences, including mucus, bicarbonate, epithelial repair, and mucosal blood flow. The two major causes are *Helicobacter pylori* infection and chronic nonsteroidal anti-inflammatory drug (NSAID) use. *H. pylori* impairs mucosal protection and sustains inflammation; NSAIDs reduce prostaglandin-mediated mucus, bicarbonate, and blood-flow support. The ulcer itself may cause gnawing or burning epigastric discomfort, nausea, early satiety, or pain associated with meals, but symptoms are not reliable enough to confirm the diagnosis. A patient may present instead with a complication: gastrointestinal bleeding, perforation, or gastric outlet obstruction. Blood loss may be occult and first appear as fatigue or anemia, or overt as hematemesis or black, tarry stool. The practical nurse watches for the change from localized discomfort to systemic deterioration. Tachycardia, dizziness, pallor, hypotension, reduced urine output, or altered mentation suggest impaired circulating volume rather than uncomplicated dyspepsia. Sudden severe abdominal pain with guarding, rebound tenderness, or a rigid abdomen raises concern for perforation and peritonitis. That is an emergency,...