GASTRITIS
Gastritis is defined as the inflammation of the stomach. Acute Gastritis is most often due to dietary indiscretion.
Causes
Food that is highly seasoned, Alcohol, aspirin, uremia, or radiation therapy
Pathophysiology
Etiological Factors
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Edematous and hyperemic gastrio-mucous membrane.
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Mucous-membrane undergoes superficial erosion.
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It secretes scanty amount of gastric juice, containing very little acid but much mucus.
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Superficial ulceration
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Haemorrhage
Clinical Manifestation
Uncomfortable feelings in the abdomen, headache, lassitude, nausea and anorexia, accompanied by vomiting and hiccuping.
Chronic gastritis it is the inflammation of the stomach that exists for a prolonged period of time.
Causes: Benign or malignant ulcers of the stomach, cirrhosis of the liver complicated by portal hypertension and by uraemia (the breakdown in the gastric mucosa is believed to be caused by excess urea in the blood).
Pathophysiology
Parietal cell changes.
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Atrophy and cellular infiltration
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Lining and walls become thinned and secretion lessens in quantity and quality.
Types
Type A: The Antrum of the stomach is not affected.
Type B: Only the antrum is affected.
Clinical Manifestations
1. Iron deficiency anemia - seen in Type A and Type B..
2. Pernicious anemia associated with only type A.
3. Anorexia or Bulimia, heart burn after eating and there are eructations of gas, taste in the mouth is unpleasant; nausea and vomiting may occur early in the morning.
Diagnostic Evaluation
1. Levels of Serum Gastrin may vary - in type A its elevated. Type-B its normal.
2. Gastroscopy
3. Upper Gastro Intestinal X-ray
4. Histological Examination
Corrosive Gastritis - More severe form of acute gastritis caused by ingestion of strong acids or alkalis. Mucosa may become gangrenous and perforate, scarring can occur, Pyloric obstruction.
Management of Gastritis
Acute Gastritis
1. Nil per oral until symptoms subside.
2. Bland diet is advised.
3. If symptoms persists, parenteral administration of fluids.
4. If bleeding is present, iced saline lavage.
Chronic Gastritis
1. Diet Modification
2. Rest
3. Stress reduction.
4. Pharmacotherapy.
Corrosive Gastritis
1. Immediate treatment consists of diluting and neutralizing the offending substance.
2. To neutralize acids, common antacids (e.g. aluminium hydroxide) are used. To neutralize an alkali diluted lemon juice or diluted-Vinegar is used. If corrosion is severe, emetics and lavage are avoided because of the danger of perforation. Thereafter therapy is supportive nasogastric intubation, analgesics and sedatives, antacids, intravenous fluids and electrolytes.
3. Evaluate the situation by fibreoptic endoscopy. Emergency surgery may be required to remove gangrenous or perforated tissue.
4. Gastro jejunostomy or gastric resection may be necessary to treat pyloric obstruction.
Nursing Management
I. Nutritional Measures
Acute Gastritis
- Provide physical and emotional support
- Do not allow the patient to ingest anything by mouth for hours or days until the acute symptoms subside.
- Monitor intravenous fluids and serum electrolytes daily.
- When symptoms (nausea, vomiting, heart burn and fatigue) subside, ice chips are followed by clear fluids.
- Provide small, frequent bland meals (provides oral nutrition, decrease the need for I.V fluids and minimizes irritation to the gastric mucosa).
- Discourage the intake of caffeinated beverages.
- Discourage cigarette smoking.
- Notify the physician for signs of haemorrhagic gastritis (hematemesis, tachycardia, hypotension). If evident, vital signs are monitored every 5 to 15 minutes and manage as upper GIT bleeding.
Chronic Gastritis
- Identify irritating foods and treat symptoms.
Corrosive Gastritis
- Supportive therapy - neutralize or dilute the acid or alkali
- Prepare the patient for additional diagnostic studies or surgery. Explain all procedures and treatment to the patient.
-Provide psychologital support to alleviate anxiety.
II. Fluid Balance
- Monitor daily intake and output.
- Detect early signs of dehydration, Administer IV fluids as prescribed, if food and fluids are withheld.
- Assess electrolyte values (sodium, potassium, chloride) every 24 hours to detect early indicators of fluid imbalance.
III. Dietary Management
- Evaluate the patient's knowledge about gastritis. Construct a bland diet taking into consideration the daily caloric needs, food preferences and desired frequency of eating Recommend smaller, more frequent meals-helps control gastric secretions.
- Advise the patient to avoid irritating substances (caffeine, nicotine, spicy food, highly seasoned foods). - Administer antacids, sedatives and/or anticholinergics as prescribed.
