Gastritis

(Itis) – Inflammation of gastric or gastric mucosa (common GI problem). Gastritis can be acute,
chronic, lasting several hours to a few days. RECURRENT or REPEATED.

Types
ACUTE CHRONIC
1. Irritants (Spicy, > highly seasoned, 1. H. pylori
microorganisms. 2. Autoimmune Disease
2. OVERUSE of Aspirin and NSAIDS 3. Caffeine
3. Alcohol 4. NSAIDS
4. Bile Reflux 4. Alcohol and Smoking
5. Radiation Therapy 5. CHRONIC reflux or pancreatic secretions and
6. Ingestion of strong ACID or ALKALI bile into the stomach.

Clinical Manifestations
ACUTE CHRONIC
REMEMBER HAVANA Anorexia, Heartburn after eating, Belching or
Burping, sour taste, nausea and vomiting, mild
Hiccupping epigastric discomfort, or intolerance of spicy and
Abdominal Pain fatty foods or slight pain that is relieved by
Vomiting eating. Vitamin B12 def (malabsorption of
B12 caused by antibodies that interfere
Anorexia with the binding of vitamin to intrinsic
Nausea factor)

TESTS
Upper GI X-RAY and ENDOSCOPY
Biopsy
Serology (H. pylori0

MEDICAL MANAGEMENT
1. NO Alcohol or food until symptom is subside.
2. Nonirritating diet is recommended.
3. INCREASED > Fluid INTAKE.
4. DILUTING AND NEUTRALIZING
 To Neutralize ACIDS, common ANTACIDS: ALUMINUM HYDROXIDE are used.
 To Neutralize ALKILI, Diluted Lemon Juice or Diluted Vinegar is used.
NOTE:
o If corrosion is extensive or severe, emetics and lavage are avoided because of the danger of
perforation and damage to esophagus.
5. THERAPY: NGT, Analgesic, Sedatives, Antacids, IV fluids.
6. SURGERY: Remove GANGRENOUS and PERFORATED TISSUE.
GASTROJEJUNOSTOMY – or GASTRIC RESECTION may be necessary to treat pyloric
obstruction, a narrowing pyloric orifice.
CHRONIC GASTRITIS
MODIFIES:
1. Px Diet
2. Rest
3. Reducing Stress
4. Pharmacotherapy.

H. PYLORI
- This can be treated with
ANTIBIOTICS: Tetracycline or Amoxicillin, combined with Clarithromycin.

PROTOM PUMP INHIBITORS: Lansoprazole [Prevacid]

NURSING MANAGEMENT
1. < Reduce Anxiety
2. Promote Optimal Nutrition
o NPO for few days
o IV therapy
o ICE CHIPS followed by clear liquids
o NO Caffeinated Beverages - Caffeine is a CNS stimulant that > gastric activity.
o NO ALCOHOL and CIGARRETE/SMOKING – Nicotine reduces the secretion of pancreatic
bicarbonate.
o ALCOHOL and SMOKING cessation program.
3. Promote Fluid Balance
o MONITOR daily fluid I&O to detect early s/sx of DEHYDRATION
Intake – 1.5 L/day
Output – 30 mL/hr
o Food and Oral Fluid is withheld
- Administer IV fluids (3L/day)
- Assess Electrolyte Values: Sodium/Na, Potassium/K, Chloride/Cl q24
- OBSERVE: hemorrhagic gastritis, hematemesis (vomiting of blood), tachycardia, and
hypotension NOTIFY THE PHYSICIAN!
4. Relieve Pain
a. Avoid Irritants foods and beverages that irritates MUCOSA
b. Correct use of medications
c. ASSESS level of PAIN
 Impaired Esophageal Motility
TYPES
ACHALASIA DIFFUSE ESOPHAGEAL SPASM
- IMPAIRED PERISTALSIS of smooth muscle of - NON-PERISTALTIC contraction of esophageal
esophagus and impaired relaxation of lower smooth muscle.
esophageal sphincter.

CAUSE: UNKNOWN/IDIOPATHIC
RISK FACTORS CLINICAL MANIFESTATIONS
Infection DYSphagia
Heredity Sensation of food sticking in the lower portion
Aged 40 of esophagus
Autoimmune Disease Regurgitation of food
Chest pain and Heart Burn (pyrosis)

COMPLICATION: PULMONART COMPLICATION from Aspiration of Gastric Contents.

ASSESSMENT AND DIAGNOSTIC MEDICAL

FINDINGS
X-RAY – shows dilatation and narrowing
MANOMETRY – pressure is measured by
radiologist or gastro
BARIUM SWALLOW, CT SCAN – of the chest
and ENDOSCOPY for dx.
MANAGEMENT
1. Eat Slowly and Drink fluids w/ meals.
2. CALCIUM CHANNEL BLOCKERS and
NITRATES
3. Botulinum toxin (Botox) to inhibits
contraction of the smooth muscle
4. BALLOON DILATION to stretch narrow area
(Complications: Perforation)

Surgical Management
ESOPHAGOMYOTOMY
- Esophageal muscle fibers are separated to relieve the lower esophageal structure.
Usually performed LAPARASCOPICALLY a complete LOWER ESOPHAGEAL SPHINCTER
MYOTOMY and ANTIREFLUX procedure or w/out an ANTIREFLUX procedure.

CALCIUM CHANNEL BLOCKERS - pine

Botulinum toxin (Botox) to inhibits contraction of the smooth
muscle

Hiatal Hernia
- part of the stomach PROTUDES through the esophageal hiatus of the diaphragm into the
thoracic cavity.
- most cases are ASYMPTOMATIC

TYPES

SLIDING
- 90% of Px w/ esophageal hiatal hernia
- TYPE I occurs when the upper stomach and
the gastroesophageal junction are displaced
upward and slide in and out of the thorax
PARAESOPHAGEAL
- classified as types II, III, or IV, depending on
the extent of herniation.
- TYPE IV having the greatest herniation; it
occurs when all part of the stomach pushes.
- HERNIA can be STRANGULATED and Px may
develop gastritis w/ bleeding.

CAUSE: UNKNOWN/IDIOPATHIC

RISK FACTORS MANIFESTATIONS ASSESSMENT and DX

WOMAN than MAN SLIDING – reflux(heartburn),
Injury or damage may weaken regurgitation, & dysphagia
muscle
Obesity PARAESOPHAGEAL – fullness XRAY
Aging or chest pain, regurgitation of Barrium Swallow (ConTe)
Smoking undigested foods, halitosis, Fluoroscopy (ConTe)
Pressure (coughing, vomiting regurgitation of sour materials.
straining or lifting heavy
objects)

MANAGEMENT SURGERY
EATING PATTERN PARAESOPHAGEAL: emergency surgery to
Small, frequent feedings and NO aggravate correct torsion (TWISTING) of the stomach or
foods other body organ that leads to restriction of
UPRIGHT POSITION 1hr / avoid eating 3hrs blood flow to that area.
before bedtime
H2 ANTAGONISTS and ANTACIDS
 Gastroesophageal Reflux Disease (GERD)
- BACKFLOW of gastric of duodenal contents in the esophagus.

called REFLUX ESOPHAGITIS

CAUSES
- From transient RELAXATION or INCOMPETENCE of lower esophageal sphincter;
pyloric stenosis or motility disorder.

RISK FACTORS MANIFESTATIONS

Smoking Pyrosis
Hiatal Hernia Dyspepsia
Aging Regurgitation
Pregnancy Dysphagia
Excessive ingestion of fatty foods, cola, coffee, Hypersalivation
milk, spicy, citrus fruits. Esophagitis

Belching / Burping NOTE: The symptoms may mimic heart attack.

Incompetent lower esophageal sphincter The Px history aids in obtaining an accurate dx.
Obesity

ASSESSMENT and DX MANAGEMENT

Endoscopy AVOID decrease lower esophageal sphincter or
Barrium Swallow Irritation
12-36hrs Ambulatory esophageal pH < fat diet; AVOID caffeine, tobacco, beer, milk,
monitoring peppermint or spearmint, and carbonated drinks
Bilirubin Monitoring (Bilitec) AVOID SMOKING
Esophageal Manometry Normal Body Weight
AVOID bending or TIGHT CLOTHES
ELEVATE head of the bed on 6 to 8 inch (15 to
20 cm)

PHARMACOLOGIC

Antacids: Maalox, Mylanta, GAVISCON

Histamine2 Receptor Antagonist: <acid production (Cimetidine, Ranitidine)
Proton Pump Inhibitors: reduces gastric secretions promote healing (Omeprazole,
Lansoprazole)
Promotility Agent: gastric emptying (Domperidone, Metoclopramide)
 SURGICAL MANAGEMENT
NISSEN FUNDOPLICATION – wrapping of a
portion of the gastric fundus around the
sphincter area of the esophagus.
COMPLICATIONS
a. ESOPHAGEL STRICTURES = progress to
dysphagia
b. BARRETTS ESOPHAGUS = changes in cell
that lines in the esophagus
c. ESOPHAGEAL CANCER