A Client Care Study of Patient with Perforated Duodenal Ulcer (Peptic Ulcer)

1.1 Introduction

Peptic ulcer refers to an inflammation in the stomach, duodenum, or, in rare instances, the lower oesophagus's mucosal lining. A duodenal ulcer is an ulcer in the first part of the intestines, whereas a stomach ulcer is known as a gastric ulcer. The most common symptoms of a duodenal ulcer include pain that usually gets better after eating and that gets worse at night (Wadie, 2011). Peptic ulcers (PUs) are caused by ambient gastric acid discharge and are characterized by a significant tissue loss that injures the mucosa of the stomach and/or duodenum. This injury frequently reaches the muscle layer through the muscularis mucosa.

This chapter will address the background information that motivated this study, the challenges that prompted it, its aim, and its objectives as a preface to subsequent sections of the study. Additional factors include the study's significance, scope, limitations, research questions and hypotheses, and the definition of technical terms.

1.2 Background of Study

Unbalanced acid production and mucosal defences that thwart acid digestion lead to peptic ulcer disease (PUD). Furthermore, research has shown a clear link between H pylori infection of the stomach antral cavity and peptic ulcers. Over 90% of individuals suffering from peptic ulcer disease have H pylori infection; eliminating this infection not only cures the majority of simple ulcers but also considerably reduces the risk of future ulcers ^1,2

Magnitude of the problem

The disease continues to have a substantial impact on our society’s health care system. It occurs slightly more frequent in men. Although 70% of ulcer patients are between the ages of 25 and 64, the peak prevalence of complicated ulcer disease requiring hospitalization is in the age group 65 to 74 years^{3, 4}

Although morbidity from PUD is decreasing in the west, the incidence of perforated ulcer remains relatively constant. Perforated ulcers are decreasing in incidence in younger age patients and are increasingly being observed in the elderly and in women. Perforation is typically a significant clinical event marked by abdominal pain, rigidity, the absence of bowel sounds and a sense of impending doom. Most duodenal ulcers perforate anteriorly, while gastric ulcers generally perforate along the anterior wall of the lesser curvature of the stomach. Elective surgery leads to 5 – 10% of mortality while in emergency situation it goes to 20 – 30% and may be as high as 30% to 50% particularly in elderly ^1-3

Current situation on the matter in World literature

Following developments in the medical treatment of PUD in the last two decades, surgical intervention is currently confined to the treatment of complicated disease, namely, ulcer hemorrhage, perforation, penetration and obstruction. Simple closure or omental patch repair is the mainstay of treatment of perforated peptic ulcer (PPU), definitive surgery being rarely practiced, and dependence now being on medical therapy to complete the healing process and prevent recurrence of the disease^{1, 2}

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to carry out a Client Care Study of Patient with Perforated Duodenal Ulcer (Peptic Ulcer).

1.3 Statement of Problems

In Nigeria, studies on the experiences of individuals living with perforated peptic ulcer seem to be limited. A few studies on perforated peptic ulcer in Nigeria centered on the cost of treatment and knowledge and practice of foot care among people diagnosed with the disease. It has been realized that, research is needed to investigate the experiences of individuals with perforated peptic ulcer at Korle-Bu Teaching Hospital. Reading through the available literature it was noted that patients living with perforated peptic ulcer sometimes have inadequate knowledge about the disease, fear of recurrence of the ulcers, pain, immobility and financial constraints (Gilpin and Lagan, 2008; Price, 2004).

In addition it has also been observed through clinical practices that patients with duodenal are at risk of slow and non-healing ulcers and once an ulcer is diagnosed, the possibility of amputation becomes unavoidable. Given the enormous challenges of perforated peptic ulcer and the number of people who report yearly to the University of Jos Teaching Hospital for treatment, it can be deduced that many people go through challenges while managing the disease. There is therefore the need for this study to be conducted purposely to assess the experiences of diabetic patients managing perforated peptic ulcer at the University of Jos Teaching Hospital.

1.4 Aim and Objectives of Study

The aim of the study is to assess individuals’ experiences of living with perforated peptic ulcer at the University of Jos Teaching Hospital.

Specific Objectives

In achieving the above stated aim, the following objectives were laid out as follows:

1. Assess coping strategies of individuals managing perforated peptic ulcer;
2. Identify challenges of diabetic patients managing perforated peptic ulcer;
3. Assess patients’ knowledge regarding perforated peptic ulcers (PPUs); and
4. Describe the support systems available for diabetic patients living with perforated peptic ulcer.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• What is a person diagnosed with type 1 or 2 duodenal understanding of a peptic ulcer?
• What are the challenges of diabetic patients with perforated peptic ulcer?
• What are the coping strategies of patients with perforated peptic ulcer?
• What support systems are available for diabetic patients with perforated peptic ulcer?