Prepared by: Tayyeba Instructor RNC 14/11/2012

Definition: Inflammation of stomach lining from irritation of gastric mucosa (normally protected from gastric acid and enzymes by mucosal barrier)
Types: Acute Chronic

a.

Acute Gastritis: Lasts several hours to few days 1.Disruption of mucosal barrier allowing hydrochloric acid and pepsin to have contact with gastric tissue: leads to irritation, inflammation, superficial erosions 2.Gastric mucosa rapidly regenerates; selflimiting disorder

b. Chronic Gastritis: few days to onwards resulting from repeated exposure to irritating agents or recurring episodes of acute gastritis. Progressive disorder beginning with superficial inflammation and leads to atrophy of gastric tissues (prolong Gastritis

Causes of acute gastritis Irritants include aspirin and other NSAIDS, corticosteroids, alcohol, caffeine Ingestion of corrosive substances: alkali or acid food contamination (microorganisms) Alcoholic Beverages Immune response to other diseases Smoking Extreme stress(hypersecretion of acid, increased reflux of bile)

Causes of chronic gastritis: benign or malignant ulcers of the stomach by the bacteria Helicobacter pylori autoimmune diseases such as pernicious anemia; dietary factors such as caffeine; the use of medications, especially NSAIDs(PG decreased) ;alcohol; smoking; or reflux of intestinal contents/bile into the stomach because of an operative stoma, an incompetent pyloric sphincter, or abnormal duodenal motility

In gastritis, there is epithelial damage, erosions, and ulcers that are followed by regenerative hyperplasia. The gastric mucous membrane becomes edematous and hyperemic (congested with fluid and blood) and undergoes superficial erosion. It secretes a scanty amount of gastric juice, containing very little acid but much mucus. Superficial ulceration may occur and can lead to hemorrhage.

ACUTE GASTRITIS

CHRONIC GASTRITIS

Abdominal discomfort, headache, lassitude, Indigestion Loss of appetite/anorexia Nausea Vomiting blood or material that looks like coffee grounds Dark stools

Headache, mild epigastric discomfort, Belching, heart burn after eating sour taste in mouth If perforation occurs, signs of peritonitis loss of appetite

Complete blood count (CBC, shows anemia ) Gastroscopy/endoscopy Stool test for bleeding Upper GI and small bowel x-ray series Histological examination ( a tissue specimen obtained by biopsy) serologic testing for antibodies against the H. pylori antigen 1-minute ultrarapid Urease test

Mangement of acute gastritis As a rule the patient recover in a day or two NPO status to rest GI tract for 6 12 hours, reintroduce clear liquids gradually and progress. After the patient can take nourishment by mouth, a nonirritating diet is recommended. If the symptoms persist, fluids may need to be administered parenterally. If gastritis is caused by ingestion of strong acids or alkalis, treatment consists of diluting and neutralizing the offending agent. By gastric lavage (washing out stomach contents via nasogastrictube)

To neutralize acids, common antacids (eg, aluminum hydroxide) are used; to neutralize an alkali, diluted lemon juice or diluted vinegar is used. If corrosion is extensive or severe, emetics and lavage are avoided because of the danger of perforation and damage to the esophagus. Therapy is supportive and may include nasogastric (NG) intubation, analgesic agents and sedatives, antacids, and intravenous (IV) fluids. Stop taking any medications that cause gastritis If extreme condition Gastrojejunostomy or gastric resection

Chronic gastritis management Chronic gastritis is managed by modifying the patients diet, promoting rest, reducing stress, and initiating pharmacotherapy. H. pylori may be treated with antibiotics (eg, tetracycline or amoxicillin, combined with clarithromycin) and a proton pump inhibitor (eg, lansoprazole ), and possibly bismuth salts

Nursing Management Reducing anxiety. Gastritis due to stress is best treated by prevention. Medications to decrease gastric acid production, such as proton pump inhibitors, should be considered for stressed hospital patient

Keep pt. NPO or on restricted food and fluids as ordered, and advance as tolerated Monitor electrolyte imbalance Maintain IV Record I&O

The effect of stress on the mucosal lining of the stomach How salicylates, NSAIDs, and particular foods may be irritating How lifestyles that include alcohol and tobacco my be harmful. Stop taking any medications that cause gastritis Calling your health care provider if symptoms of gastritis persist longer than 2 or 3 days. Call your health care provider if you vomit blood or have bloody stools.

Because of the many classifications and causes, prognosis is variable Generally prognosis is good if pt is willing to change their lifestyles and follow a medical regimen.

A potential complication is a severe loss of blood

Nsg. consideration: Restrict food and fluid for at least 6 hours before test. If test is performed in emergency tell the pt. that all of his stomach contents will be suctioned to permit better visualization. Test is performed using IV sedation for pt. comfort Before insertion of tube, pts throat will be sprayed with a local anesthetic. the spray tastes unpleasant and will make his mouth feel swollen, numb, causing difficulty in swallowing.

He will have a mouth guard to protect his teeth from the tube Before the test tell the pt to remove dentures and bridges. As the tube is inserted and advanced, he can expect pressure in the abdomen and some fullness or bloating as air is introduced to inflate the stomach for a better view. Pt can eat when his gag reflux returns usualy in an hour.