(DISORDER OF DIGESTIVE SYSTEM)
TOPIC – GASTRITIS
INTRODUTION
Gastritis is a general term for a group of conditions with one thing in
common: inflammation of the lining of the stomach. The inflammation of
gastritis is most often the result of infection with the same bacterium that
causes most stomach ulcers. Regular use of certain pain relievers and
drinking too much alcohol also can contribute to gastritis.
Gastritis may occur suddenly (acute gastritis), or appear slowly over time
(chronic gastritis). In some cases, gastritis can lead to ulcers and an increased
risk of stomach cancer. For most people, however, gastritis isn't serious and
improves quickly with treatment.
DEFINITION
Gastritis is an inflammation of the gastric mucosa, is classified as either acute
or chronic.
ETIOLOGY AND RISK FACTOR
CAUSES
A number of diseases and conditions can increase your risk of gastritis,
including Crohn's disease and sarcoidosis, a condition in which collections of
inflammatory cells grow in the body.
RISK FACTORS
Factors that increase your risk of gastritis include:
Bacterial infection. Although infection with Helicobacter pylori is among
the most common worldwide human infections, only some people with the
infection develop gastritis or other upper gastrointestinal disorders.
Doctors believe vulnerability to the bacterium could be inherited or could
be caused by lifestyle choices, such as smoking and diet.
Regular use of pain relievers. Common pain relievers — such as aspirin,
ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, Anaprox) —
can cause both acute gastritis and chronic gastritis. Using these pain
relievers regularly or taking too much of these drugs may reduce a key
substance that helps preserve the protective lining of your stomach.
Older age. Older adults have an increased risk of gastritis because the
stomach lining tends to thin with age and because older adults are more
likely to have H. pylori infection or autoimmune disorders than younger
people are.
Excessive alcohol use. Alcohol can irritate and erode your stomach lining,
which makes your stomach more vulnerable to digestive juices. Excessive
alcohol use is more likely to cause acute gastritis.
Stress. Severe stress due to major surgery, injury, burns or severe
infections can cause acute gastritis.
Your own body attacking cells in your stomach. Called autoimmune
gastritis, this type of gastritis occurs when your body attacks the cells that
make up your stomach lining. This reaction can wear away at your
stomach's protective barrier.
Autoimmune gastritis is more common in people with other autoimmune
disorders, including Hashimoto's disease and type 1 diabetes.
Autoimmune gastritis can also be associated with vitamin B-12 deficiency.
Other diseases and conditions. Gastritis may be associated with other
medical conditions, including HIV/AIDS, Crohn's disease and parasitic
infections.
CAUSES OF CHRONIC GASTRITIS
Peptic Ulcer Disease (PUD), infection with Helicobacter pylori
bacteria or gastric surgery may lead to chronic gastritis.
After gastric resection with a gastro- jejunostomy, bile and bile
acids may reflux into the remaining stomach, causing gastritis.
H.Pylori infection can lead to chronic atrophic gastritis.
Age is also a risk factor; chronic gastritis is more common in older
adults.
Chronic gastritis occurs in 3 different forms
1) Superficial gastritis, which causes a reddened, edematous mucosa with
small erosions and hemorrhages.
2) Atrophic gastritis, which occurs in all layers of the stomach, develops
frequently in association with gastric ulcer and gastric cancer, and is
invariably present in pernicious anemia; it is characterized by a
decreased number of parietal and chief cells.
3) Hypertrophic gastritis, which produces a dull and nodular mucosa
with irregular, thickened, or nodular rugae; hemorrhages occur
frequently.
CLNICAL MANIFESTATION
Nausea or recurrent upset stomach
Vomiting
Indigestion
Hiccups
Loss of appetite
Burning or gnawing feeling in the stomach between meals or at night
Gnawing or burning ache or pain (indigestion) in your upper abdomen
Feeling of fullness in your upper abdomen after eating
IN CHRONIC: Manifestations are vague and may be absent because the
problem does not cause an increase in hydrochloric acid.
Assessment may reveal
Anorexia
Feeling of fullness
Dyspepsia
Belching
Vague epigastriac pain
Nausea
Vomiting
Intolerance of spicy and fatty foods
PATHOPHYSIOLOGY OF ACUTE GASTRITIS
The mucosal lining of the stomach normally protects it from the action of
gastric acid. This mucosal barrier is composed of prostaglandins
Due to any cause
This barrier is penetrated
Hydrochloric acid comes into contact with the mucosa
Injury to small vessels
Edema, hemorrhage, and possible ulcer formation
PATHOHYSIOLOGY OF CHRONIC GASTRITIS
The stomach lining first becomes thickened and erythematous and then
becomes thin and atrophic.
Continued deterioration and atrophy
Loss of function of the parietal cells
Acid secretion decreases
Inability to absorb vitamin B12
Development of pernicious anemia
COMPLICATIONS
Left untreated, gastritis may lead to stomach ulcers and stomach bleeding.
Rarely, some forms of chronic gastritis may increase your risk of stomach
cancer, especially if you have extensive thinning of the stomach lining and
changes in the lining's cells.
Tell your doctor if your signs and symptoms aren't improving despite
treatment for gastritis.
DIAGNOSTIC EVALUATION
Tests for H. pylori. Your doctor may recommend tests to determine
whether you have the bacterium H. pylori. Which type of test you
undergo depends on your situation. H. pylori may be detected in a blood
test, in a stool test or by a breath test.
For the breath test, you drink a small glass of clear, tasteless liquid that
contains radioactive carbon. H. pylori bacteria break down the test liquid
in your stomach. Later, you blow into a bag, which is then sealed. If
you're infected with H. pylori, your breath sample will contain the
radioactive carbon.
Using a scope to examine your upper digestive system (endoscopy). During
endoscopy, your doctor passes a flexible tube equipped with a lens
(endoscope) down your throat and into your esophagus, stomach and
small intestine. Using the endoscope, your doctor looks for signs of
inflammation.
If a suspicious area is found, your doctor may remove small tissue
samples (biopsy) for laboratory examination. A biopsy can also identify
the presence of H. pylori in your stomach lining.
X-ray of your upper digestive system. Sometimes called a barium swallow
or upper gastrointestinal series, this series of X-rays creates images of
your esophagus, stomach and small intestine to look for abnormalities. To
make the ulcer more visible, you may swallow a white, metallic liquid
(containing barium) that coats your digestive tract.
TREATMENT
Treatment of gastritis depends on the specific cause. Acute gastritis caused by
no steroidal anti-inflammatory drugs or alcohol may be relieved by stopping
use of those substances.
Medications used to treat gastritis include:
Antibiotic medications to kill H. pylori. For H. pylori in your digestive
tract, your doctor may recommend a combination of antibiotics, such as
clarithromycin (Biaxin) and amoxicillin (Amoxil, Augmentin, others) or
metronidazole (Flagyl), to kill the bacterium. Be sure to take the full
antibiotic prescription, usually for seven to 14 days.
Medications that block acid production and promote healing. Proton
pump inhibitors reduce acid by blocking the action of the parts of cells
that produce acid. These drugs include the prescription and over-the-
counter medications omeprazole (Prilosec), lansoprazole (Prevacid),
rabeprazole (Aciphex), esomeprazole (Nexium), dexlansoprazole
(Dexilant) and pantoprazole (Protonix).
Long-term use of proton pump inhibitors, particularly at high doses, may
increase your risk of hip, wrist and spine fractures. Ask your doctor
whether a calcium supplement may reduce this risk.
Medications to reduce acid production. Acid blockers — also called
histamine (H-2) blockers — reduce the amount of acid released into your
digestive tract, which relieves gastritis pain and encourages healing.
Available by prescription or over-the-counter, acid blockers include
famotidine (Pepcid), cimetidine (Tagamet HB) and nizatidine (Axid AR).
Antacids that neutralize stomach acid. Your doctor may include an
antacid in your drug regimen. Antacids neutralize existing stomach acid
and can provide rapid pain relief. Side effects can include constipation or
diarrhea, depending on the main ingredients.
NURSING MANAGEMENT
If the patient is vomiting, give antiemetic
Administer IV fluids as ordered
Provide a bland diet that takes into account his/her food preference
Offer smaller or more frequent servings
Help patient identify specific foods that cause gastric upset
Administer antacids
Administer pain medications
Monitor patients fluid intake and output
Assess the patient for presence of bowel sounds
Teach the patient about the disorder
HEALTH EDUCATION
Take medicines as directed
Avoid NSAIDs
Stop smoking
Drink fluids and get plenty of rest
Take soft foods
Drink clear liquids
LIFESTYLE AND HOME REMEDIES
You may find some relief from signs and symptoms if you:
Eat smaller, more-frequent meals. If you experience frequent indigestion,
eat smaller meals more often to help ease the effects of stomach acid.
Avoid irritating foods. Avoid foods that irritate your stomach, especially
those that are spicy, acidic, fried or fatty.
Avoid alcohol. Alcohol can irritate the mucous lining of your stomach.
Consider switching pain relievers. If you use pain relievers that increase
your risk of gastritis, ask your doctor whether acetaminophen (Tylenol,
others) may be an option for you. This medication is less likely to
aggravate your stomach problem.
