CHRONIC GASTRITIS

Gastritis is an inflammation of the lining of the stomach. There are many possible
causes. Gastritis is caused by excessive alcohol consumption, prolonged use of
nonsteroidal anti-inflammatory drugs, also known as NSAIDs, such as aspirin or
ibuprofen, or infection with bacteria, such as Helicobacter pylori. Sometimes
gastritis develops after major surgery, traumatic injury, burns, or severe infections.
Certain diseases, such as pernicious anemia and chronic bile reflux, or autoimmune
disorders, can cause gastritis as well. Gastritis may also occur in those who have
had weightloss surgery resulting in the banding or reconstruction of the digestive
track. The most common symptom is abdominal upset or pain. Other symptoms are
indigestion, abdominal bloating, nausea, and vomiting, or a feeling of fullness or
burning in the upper abdomen. Blood in your vomit or black stools may be a sign of
bleeding in the stomach, which may indicate a serious problem.

CAUSES :
• Bacterial infection. People infected with Helicobacter pylori (H. pylori) can
experience gastritis — most commonly chronic gastritis.

• Regular use of pain killers. Nonsteroidal anti-inflammatory drugs

(NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen
(Aleve), can cause both acute gastritis and chronic gastritis. Using these
drugs regularly or taking too much of these drugs may reduce a key
substance that helps preserve the protective lining of your stomach.

• Excessive alcohol intake. Alcohol can irritate and erode your stomach
lining, which makes your stomach more vulnerable to digestive juices.

• Stress. Severe stress due to major surgery, traumatic injury, burns or

severe infections can cause gastritis.

• Bile reflux disease. Bile — a fluid that helps you digest fats — is produced
in your liver and stored in your gallbladder. When it's released from the
gallbladder, bile travels to your small intestine through a series of thin tubes.
Normally, a ring-like sphincter muscle (pyloric valve) prevents bile from flowing
into your stomach from your small intestine. But if this valve doesn't work
properly, or if it has been removed because of surgery, bile can flow into your
stomach, leading to inflammation and chronic gastritis.

• Autoimmune disease. Called autoimmune gastritis, this rare condition

occurs when your body attacks the cells that make up your stomach lining.
This produces a reaction by your immune system that can wear away at your
stomach's protective barrier. Autoimmune gastritis is more common in
people with autoimmune disorders.

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• Other diseases and conditions. Gastritis may be associated with other
medical conditions, including HIV/AIDS, Crohn's disease, parasitic infections, some
connective tissue disorders, and liver or kidney failure.

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SIGN & SYMPTOMS
• A gnawing or burning ache or pain (indigestion) in your upper
abdomen that may become either worse or better when you eat
• Nausea
• Vomiting
• Loss of appetite
• Belching or bloating
• A feeling of fullness in your upper abdomen after eating
• Weight loss

RISK FACTOR
Factors that may increase your risk of gastritis include:

• H. pylori infection. The most significant risk factor for gastritis is

infection with H. pylori bacteria.

• Regular use of aspirin or other NSAIDs. If you regularly take

aspirin to prevent a heart attack or stroke, you're at risk of developing
gastritis. The same is true if you take anti-inflammatory pain relievers for
arthritis or another chronic condition. That's because long-term use of
aspirin and other NSAIDs can cause stomach irritation and bleeding.

• 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.

TESTS & DIAGNOSES

• Blood test

• Breath test

• Upper gastrointestinal endoscopy

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 • Upper gastrointestinal X-Ray

• Stool test

COMPLICATION

• Stomach ulcer

• Stomach bleeding

• Increased risk of stomach cancer

• Thinning of the stomach lining and changes in the lining cells.

PREVENTION
• Eat smart. If you experience frequent indigestion, eat smaller, more
frequent meals to help ease the effects of stomach acid. In addition, avoid
any foods you find irritating, especially those that are spicy, acidic, fried or
fatty.

• Limit or avoid alcohol. Excessive use of alcohol can irritate and erode the
mucous lining of your stomach, causing inflammation and bleeding.

• Don't smoke. Smoking interferes with the protective lining of the stomach,
making your stomach more susceptible to gastritis as well as ulcers. Smoking
also increases stomach acid, delays stomach healing and is a leading risk
factor for stomach cancer.

• Switch pain killers. If possible, avoid taking NSAIDs — aspirin, ibuprofen

and naproxen. These over-the-counter medications can cause stomach
inflammation or make existing irritation worse.

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CASE STUDY

NAME : TIANG LAM PHU

MRN : 585151
BED NO : 229 B
GENDER : MALE
AGE : 27 YEARS OLD 10 MONTH
DOA : 10 NOVEMBER 2008
DICIPLINE : MEDICAL
SPECIALIST : DR. DATO’ SELVA

VITAL SIGNS
BLOOD PRESSURE : 130/87
HEART RATE : 82 bpm
TEMPERATURE : 37’C
SPO2 : 99% ON AIR

DIAGNOSES
• CHRONIC GASTRITIS

# came to hospital by car with relatives

# non-trauma / alert and conscious

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ADMISSION HISTORY
Mr. Tiang first came to A&E TAMAN DESA MEDICAL CENTRE at 10 NOVEMBER 2008
complaining to have an abdominal pain since at home. He came to A&E Taman
Desa Medical Centre by car with relatives. He is been resting on bed at home and
immobilize due to gastrointestinal tract disorder and chronic abdominal pain for
about 2 month. He also having a sleeping pattern disturbance due to his abdominal
pain. Because immobility, he is having a superficial pressure sore on his sacrum. On
admission to GENERAL WARD, he is totally dependent to wheel chair due to
abdominal discomfort. Mr. Tiang got allergies to Paracetamol and able to take his
medication well except PCM. He looks like stress and sometimes request for
discharge frequently. At PCU, his head of bed was elevated to 70’ to ensure airway
clearance, & stomach reflux. His relatives visited every day to ensure Mr. Tiang is
psychologically comfortable. He also have done his OGDS. On admission, Mr. Tiang
receive a soft and normal diet due to his disease condition.

PAST SURGICAL HISTORY

• APPENDICECTOMY

PAST MEDICAL HISTORY

• DENGUE FEVER

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PROGRESS NOTES
New admission in A&E at 1400 by car with his relatives and family member who live
nearby. And then transferred to GENERAL WARD at TAMAN DESA MEDICAL CENTRE.
The patient is complaining to have a chronic abdominal pain on the abdomen.

DAY BY DAY PROGRESS NOTE

10 NOVEMBER 2008 – 1330H

- Wheel chair admission via A&E.

- Accompanied by staff.

- h/o abdominal pain on / off for 2/hours.

- At A&E IV line set up, blood taken, IV N/S in progress order from Dr. Bornia.

- To keep patient NBM.

- DMH – admitted at Ipoh Hospital for dengue fever last Sunday

- PSH – Appendicectomy done 11 years ago.

- Allergic – PCM

- On admission, vital signs taken.

- BP : 112/86

-P : 71

- temp : 36.8’c

1430H

- Seen by Dato’ Selva, patient’s examined noted patient still c/o abdominal
pain for ultrasound whole abdomen today.

- FBC, H, pyloric test

- Stool GS, FEME required.

- KIV OGDS for tomorrow. (morning)

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11 NOVEMBER 2008

- Total intake 550mls.

- Total output PUx2, BNO

- For maintain NBM.

- OGDS today. 0915 done.

ULTRASOUND ABDOMEN

- The liver is not yet enlarged. Not local lesion Sun. the parenchyma chew are
normal.

- The gallbladder, bile duct, pancreas and spleen are normal.

- Both kidney and urinary bladder are normal.

- The abdominal assess seen.

- The prostate is not enlarged.

- Vital signs taken.

BP PULSE TEMP.
1330 112/81 74 36.8’C
1600 128/76 68 37’C

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NURSING DIAGNOSIS
IMBALANCE NUTRITION LESS THAN BODY REQUIREMENT r/t POOR
APPETITE

INTERVENTION RATIONALE

Ensure the patient environment is Clean and clear environment makes

clean. patient gain his appetite.

Ask the relative to bring his favorite Bringing the patient’s favorite food
food but must maintain diet increases the patient appetite.
disciplinary.

Ask the relative to feed the patient This will make the patient feel like
instead of eating by himself. being at home.

Frequently change the patient’s daily To prevent the patient from being
meal. bored of having the same meal
everyday.

Giving the patient a multi vitamin. To gain more appetite.

RISK FOR INFECTION r/t PRESSURE SORE

INTERVENTION RATIONALE

Always ask the patient to turn and To prevent pressure on the site of
reposition himself on bed. commonly occurs bedsore.

Apply pillows under the pressured part To make patients feels more
of the body. comfortable while on his bed.

Using automatic air pump bed. To prevent the skin from superficially
bruising.

Maintain good hygiene on patient. Keep the patient clean and tidy to
prevent infection.

Apply cream or lotion on patient’s skin. To keep moisture skin.

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SELF CARE DEFICIT r/t IMMOBILITY

INTERVENTION RATIONALE

Do sponging to the patient everyday. To clean patient body from odor,

secretion and microorganism.

Do hairwashing 3 times a week. To ensure patient comfort.

Keep his nails clean and tidy. To prevent microorganism under the
nails.

Do oral care every morning. To ensure the patient’s breathe smells

good and prevent stomatitis.

Do perineum care to the patient To prevent infection on the patient’s

everyday. perineum and lower body extremities.

ALTERED BODY FLUID (LESS THAN BODY REQUIREMENT) R/T VOMITTING

INTERVENTION RATIONALE

Assess the skin turgor and condition. Dry skin shows that the patient is
dehydrated.
Encourage patient to drink a lot of To maintain body fluid and hydration
water. status.
Administer total parenteral nutrition To provide continuous fluid
and IV infusion. replacement.

Always prepare mineral water on the To make patient easier to reach and
cardiac table or near the patient. drink the water.

Give the patient a meal that contain To keep patient always hydrated.
large amount of water. Example soup.

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TREATMENT
PAIN MANAGEMENT – MEDICATION

- CONTROLOC

- MORTILIUM

- ENZYPLEX

- BUSCOPAN (BEFORE OGDS)

HEALTH EDUCATION
- Avoid dairy products, caffeine, alcohol, and sugar. Coffee, even
decaffeinated, should be eliminated because it contains potentially irritating
oils.

- Include sulfur-containing foods such as garlic, onions, broccoli, cabbage,

Brussels sprouts, and cauliflower in the diet. Sulfur is the basis for forming
glutathione, which provides antioxidant protection to the stomach lining. N-
acetyl cysteine (200 mg twice a day between meals) is also the basis for
forming glutathione.

- Vitamin C (1,000 mg three times per day) decreases nitrosamines,

substances that have been linked to stomach cancer.

- Zinc (30 to 50 mg per day) helps patient’s healing.

- Eliminate any known food allergens from your diet.

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CONCLUTION – SUMMARY

 Nearly everyone has experienced a bout of indigestion and stomach irritation.

Most cases of indigestion are short-lived and don't require medical care. But
if you experience signs and symptoms of gastritis consistently for a week or
longer, see your doctor. And be sure to tell your doctor if you experience
stomach problems after taking any prescription or over-the-counter drug,
especially aspirin or other pain relievers.

 If you are vomiting blood or have blood in your stools, see your doctor right
away to determine the cause.

GENERAL RECOMMENDATION :

• Do not smoke, and avoid secondhand smoke.

• As much as possible avoid stress, and learn ways to manage the stress you
can not avoid.

From these case, I would like to give a conclusion that I get so many information
about the case of chronic gastritis from my patient. How to give care plan and the
expected outcome for my nursing intervention. I also found out that the chronic
gastritis disease can be prevented by avoid taking the alcohol and certain drugs, and
medications used to control inflammation. Also learn how to manage stress well and having a healthy
diet as well.

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MEDICATION
CONTROLOC – PANTOPRAZOLE NA

DOSAGE :

- Tab adult and adolescent >12yr symptomatic treatment of mild reflux

oesophagitis 20mg daily for 4-8 weeks. Long term management of relapse of
reflux oesophagitis 20mg daily. May increase 40mg/day.

ACTION :

- Take 1hr before meals. Swallow whole. Do not chew or crush.

CONTRAINDICATION :

- Hypersensitivity.

SPECIAL PRECAUTION :

- Pregnancy and lactation.

ADVERSE REACTION :

- Nausea, upper abdominal pain, rash, pruritus, dizziness.

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MOTILIUM – DOMPERIDONE

INDICATION :

- Nausea, vomiting of functional.

DOSAGE :

- Adult – 10mg tds

- Children – 2.5mls

ACTION :

- Take 15-30min before meals.

CONTRAINDICATION :

- GI hemorrhage.

SPECIAL PRECAUTION :

- Babies <1yr

- Pregnancy, lactation.

ADVERSE REACTION :

- Rarely.

- Mild abdominal cramps.

- Rash.

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ENZYPLEX

USE :

- Digestive disorder, manifested by bloating, belching, flatulence, abdominal

discomfort.

DOSAGE :

- 1-2 tab w/ or after meals.

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 REFERENCES

BOOK :

• TEXTBOOK OF MEDICAL SURGICAL NURSING – ELEVENTH EDITION – BRUNNER

& SUDDATH (GASTROINTESTINAL TRACT DISORDER AND DISEASE
CONDITION)

INTERNET :

• HTTP://EN.WIKI.FREE.NET/CHRONIC-GASTRITIS/info.php

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