Gastritis

Gastritis Gastritis ▪ Inflammation of the stomach mucosa. ▪ Gastritis may be acute, or chronic Acute Erosive gastritis: Acute Nonerrosive gastritis The most Common causes are: Common cause is : H. pylori • long term use of NSAIDs, • alcohol consumption , • gastric exposure to radiation 3/16/2021 2 Acute Gastritis Severe acute gastritis – Caused by ingestion of strong acid or alkali, • the mucosa become gangrenous or perforate • due to scarring pyloric stenosis or obstruction Stress-related acute gastritis – Caused by acute illnesses ( e.g., major trauma; burns; hepatic, kidney, or respiratory failure; major surgery). 3/16/2021 3 Pathophysiology In acute gastritis: Gastric mucosa inflammation In chronic gastritis Chronic inflammation of gastric mucosa Mucosal edema & hyperemia superficial erosion & ulcer may develop (bleeding may occur) 3/16/2021 Atrophy (or thinning) of the gastric tissue 4 Gastritis/Pathophysiology Gastritis/ pathophysiology 3/16/2021 5 Acute Gastritis Causes: Irritating food, Alcohol, Bile reflux, Overuse of NSAIDs Radiation therapy Ingestion of strong acid or alkali Acute illness or major surgery 3/16/2021 6 Acute Gastritis Clinical manifestations • Epigastria pain, Dyspepsia , Anorexia, Hiccups, or N &V • Erosive gastritis may cause bleeding – hematemesis (Vomiting blood ) – melena (black, tarry stools) – hematochezia (bright red, bloody stools) 3/16/2021 7 Chronic Gastritis Causes ▪ H. pylori infection (most common) ▪ Prolong term use of aspirin and other NSAIDs, alcohol, smoking, bile reflux • May be associated with • pernicious anemia, (malabsorption of B12 due to deficiency of intrinsic factor ) • Autoimmune disorders: Hashimoto thyroiditis, Addison disease, and Graves’ disease 3/16/2021 8 Chronic Gastritis Clinical Manifestations ▪ Fatigue, Anorexia, early satiety, belching, heartburn (pyrosis), sour taste, N &V ▪ Slight epigastric pain relieved by eating ▪ S& S of pernicious anemia. 3/16/2021 9 Gastritis Diagnostic tests ▪ Hydrochloric acid level: ▪ May be associated with achlorhydria or hypochlorhydria or high levels of HCL ▪ Upper GI endoscopy and tissue biopsy ▪ Antibodies to H. pylori antigen and Urea breath test ▪ Stool for occult blood ▪ Blood test (hemoglobin) 3/16/2021 10 Acute Gastritis Management ▪ No alcohol nor eating until symptoms subside. ▪ Supportive therapy: IV fluids, NGT, analgesic, antacids. ▪ Histamine 2 receptor antagonists e.g., zantac ▪ Proton pump inhibitors (omeprazole) ▪ Emergency surgery ▪ Gastrojejunostomy to treat pyloric obstruction. 3/16/2021 11 Acute Gastritis Continued…management ▪ Neutralize the ingested acid with antacids (eg, aluminum hydroxide), ▪ Neutralize the ingested alkali with diluted lemon juice or diluted vinegar. ▪ Avoid emetics and lavage because of danger of perforation 3/16/2021 12 Chronic Gastritis Medical Management ▪ Diet modification ▪ Rest & stress reduction ▪ Avoidance of alcohol and NSAIDs ▪ H. pylori infection is treated with selected drug combinations. 3/16/2021 13 Gastritis/ Nursing Management 1) Reducing Anxiety 2) Promoting fluid balance ▪ minimal intake of 1.5 L/day and urine output of 30 mL/h ▪ Assess electrolyte every 24 hours for fluid imbalance. ▪ Be alert for indicators of hemorrhagic gastritis (hematemesis, tachycardia, hypotension) 3) Relieving Pain ▪ Avoid irritating foods and beverages ▪ Assess pain & Correct use of medications 3/16/2021 14 Gastritis/ Nursing Management 4) Promoting Optimal Nutrition ▪ NPO until acute symptoms subside. ▪ Discourage caffeinated beverages , alcohol, smoking ▪ caffeine increases gastric activity and pepsin secretion ▪ nicotine inhibits neutralization of gastric acid in the duodenum. ▪ Refer patient for alcohol counseling and smoking cessation 3/16/2021 15 Gastritis/ Nursing Management 5) Teaching Patients Self-Care ▪ Assess knowledge about gastritis (eating pattern, daily caloric needs, and food preferences). ▪ Provide a list of substances to avoid caffeine, nicotine, spicy foods, irritating foods, alcohol) ▪ Educate about medication prescribed. ▪ Reinforce the importance of completing the medication to eradicate H. pylori infection. 3/16/2021 16 Peptic Ulcer (PU) ▪ PU: referred to as gastric, duodenal, or esophageal ulcer, depending on its location. ▪ The Erosion of a circumscribed area of mucous membrane ▪ Most common in the duodenum ▪ Chronic ulcers usually occur in the lesser curvature of the stomach 3/16/2021 17 Peptic Ulcer Helicobacter pylori acquired through ingestion of food and water . Pre disposing factors Family history of PU Use of NSAIDs Blood type O High stress. Alcohol & smoking Esophageal ulcers result from the back flow of HCL from the stomach into the esophagus. 3/16/2021 18 Peptic Ulcer Zollinger–Ellison syndrome (ZES) ▪ZES is caused by a gastrinoma ▪ Gastrinoma (a tumor arise in the duodenum, pancreas or stomach(, that secretes a GASTRIN hormone Elevated gastrin causes overproduction of gastric acid, resulting in peptic ulcers ▪ Symptoms: epigastric pain , diarrhea and steatorrhea (fat in the stool) ▪ Suspected when a patient has several peptic ulcers or an ulcer resistant to medical therapy. 3/16/2021 19 Peptic Ulcer Stress ulcer: ▪ Cushing’s ulcers: ▪ occurs after acute serious brain injury associated of increased ICP Curling’s ulcers: ▪ occurs after sever burn injury, shock, sepsis 3/16/2021 20 PU/Clinical Manifestations PAIN BLEEDING PYROSIS S&S CONSTPATION OR VOMITING DIARRHEA 3/16/2021 21 ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ DUODENAL ULCERS 80% are duodenal ulcer Hyper secretion of HCl Weight gain Pain occurs 2–3 hours after a meal; awakened 1–2AM Ingestion of food relieves pain Vomiting uncommon Melena more common More likely to perforate Malignancy Rare Risk factors: H. pylori,alcohol, smoking, cirrhosis, stress 3/16/2021 GASTRIC ULCER ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ 15% gastric ulcer Normal OR hypo secretion of HCL Weight loss Pain occurs 1⁄2 to 1 hour after a meal; rarely occurs at night; pain increases with food, may be relieved by vomiting; Vomiting common Hematemesis more common Lesslikely to perforate Malignancy: Occasionally Risk factors: Gastritis, alcohol, smoking, NSAIDs, stress 22 Diagnostic Methods ▪ ▪ ▪ ▪ ▪ Endoscopy (preferred) Barium study may be done. Stool for occult blood Gastric secretory studies to detect H. pylori: ▪ Biopsy and send for histology & culture ▪ serologic testing, stool antigen tests, or a breath test to detect H. pylori). 3/16/2021 23 Medical Management Goals: to eradicate H. pylori and manage acidity ▪ Proton pump inhibitor: Suppress acid production (omeprazole) ▪ H2-receptor antogonist Block histamine-stimulated gastric secretions to decrease stomach acid secretion (Zantac) • Antiacid Neutralizes acid & prevents formation of pepsin, (eg., Maalox), Given 2 hrs after meal 3/16/2021 ▪ Prostaglandin Analogs • Reduce gastric acid and increase mucosal resistance to injury (Cytotec ) ▪ Mucosal barrier • Forms a protective coat • Carafate/sucralfate • Antibiotics 24 Peptic ulcers (treatment of H.pylori) A combination of antibiotics, PPI, for 10 to 14 days • Triple therapy: (2 antibiotics and 1 PPI) 1. Antibiotic: metronidazole (Flagyl) OR amoxicillin (Amoxil) 2. Antibiotic: (Clarithromycin) 3. PPI (eg, lansoprazole, or omeprazole) to be swallowed whole and taken before meal • Quadruple therapy – Two antibiotics: Metronidazole & Tetracycline – 1 PPI: (lansoprazole, or omeprazole) – 1 bismuth salts 3/16/2021 25 Complications of peptic ulcer disease 1. Hemorrhage ▪ Assess for bleeding, hematemesis, melena, shock, anemia. 2. Perforation or penetration: ▪ Signs: severe upper abdominal pain, vomiting , tender board-like abdomen, and shock. ▪ RX: immediate surgery 3. Pyloric obstruction: ▪ Symptoms: nausea, vomiting, constipation, epigastric fullness, anorexia, and (later) weight loss. ▪ insert an NG tube to decompress the stomach. 3/16/2021 26 Management Lifestyle Changes ▪ Stress reduction and rest • Avoid stressful situations & Stop Smoking ▪ Dietary modification • small, frequent meals • avoid: • extremes of food temperature • alcohol and caffeinated beverages • diets rich in milk and cream 3/16/2021 27 Surgical Management ▪ Vagotomy – Cuts vagus nerve – Eliminates acid secretion stimulus ▪ Pyloroplasty • Widens the pylorus to guarantee stomach emptying 3/16/2021 28 Surgical Management • Billroth 1 3/16/2021 Billroth II 29 Nursing Assessment/ Peptic Ulcer Assess for: ▪ ▪ ▪ ▪ Pain, food intake history Color of emesis Food habits, alcohol, smoking, medication use ▪ How patient expresses anger. ▪ Family history of ulcer disease. ▪ Assess V/S for indicators of anemia ▪ Assess for blood in the stools with an occult blood 3/16/2021 30 Nursing Diagnoses ▪ Acute pain R/T effect of gastric acid secretion on damaged tissue ▪ Anxiety related to coping with an acute disease ▪ Imbalanced nutrition related to changes in diet ▪ Deficient knowledge about preventing symptoms and managing the condition 3/16/2021 31 Nursing Interventions Relieving Pain and Improving Nutrition ▪ Administer pain, and other medication as ordered ▪ Relaxation technique ▪ Avoid aspirin and beverages contain caffeine ▪ Encourage frequent meals ▪ Encourage dietary modifications. 3/16/2021 32 Nursing Interventions Reducing Anxiety ▪ Assess level of anxiety; encourage patient to express fears ▪ Explain diagnostic tests and prescribed medications . ▪ Identify stressors, and explain effective coping techniques and relaxation methods. ▪ Encourage family to participate in care, and give emotional support. 3/16/2021 33 Nursing Interventions • Managing Complications (hemorrhage) ▪ ▪ ▪ ▪ ▪ Assess for dizziness, Monitor vital signs frequently Test stool for occult or gross blood Insert urinary catheter and monitor I &O ; maintain an IV Monitor laboratory values (hemoglobin and hematocrit). Insert and maintain NGT and monitor drainage; provide lavage as ordered. ▪ Monitor oxygen saturation and administering oxygen therapy. ▪ Place the patient in the recumbent position with the legs elevated ; left side to prevent aspiration from vomiting. 3/16/2021 34 Nursing Interventions ▪ Managing Complications (perforation and penetration) ▪ report symptoms of penetration ▪ back and epigastric pain not relieved by medications. ▪ report symptoms of perforation ▪ sudden abdominal pain, referred pain to shoulders, vomiting, rigid abdomen, hypotension, tachycardia. 3/16/2021 35