A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the purpose of this procedure. The nurse tells the client that the procedure:
A. Decreases food absorption in the stomach.
B. Heals the gastric mucosa.
C. Halts stress reactions.
D. Reduces the stimulus to acid secretions.
Correct Answer: D. Reduces the stimulus to acid secretions.
A vagotomy, or cutting the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion. A vagotomy is a type of surgery that removes all or part of the vagus nerve. This nerve runs from the bottom of the brain, through the neck, and along the esophagus, stomach, and intestines in the gastrointestinal (GI) tract.
Option A: The indications for vagotomy are few with the advancements of medical therapy. Generally, acid-reducing operations are reserved for complicated ulcer disease in a stable patient who has failed maximum medical therapy. The type of surgery performed depends on the type of ulcer (duodenal versus gastric), the complication of PUD (bleeding, perforation, obstruction, intractability), and the location of the ulcer (types I to V gastric ulcers as described by the Modified Johnson Classification system).
Option B: The relevant physiology revolves around the mechanisms relating to stomach acid secretion. Intraluminal gastric acid is released by the parietal cells, mainly located in the body of the stomach. Parietal cells are stimulated via 3 mechanisms: gastrin, acetylcholine, and histamine. All 3 mechanisms activate the hydrogen-potassium ATPase-releasing hydrogen ion into the stomach lumen.
Option C: Vagotomy was once commonly performed to treat and prevent PUD; however, with the availability of excellent acid secretion control with H2-receptor antagonists, proton pump inhibitors, and anti–Helicobacter pylori medications, the need for surgical management of this condition has greatly decreased.
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