Gastritis
Gastritis: Excerpt from Professional Guide to Diseases (Eighth Edition)
Gastritis, an inflammation of the gastric mucosa, may be acute or chronic. Acute gastritis produces mucosal reddening, edema, hemorrhage, and erosion. Chronic gastritis is common among elderly people and people with pernicious anemia. It typically occurs as chronic atrophic gastritis, in which all stomach mucosal layers are inflamed, with reduced numbers of chief and parietal cells. Acute or chronic gastritis can occur at any age.
Causes and incidence
Acute gastritis has numerous causes, including:
❑ chronic ingestion of (or an allergic reaction to) irritating foods or beverages, such as hot peppers or alcohol
❑ drugs, such as aspirin and other nonsteroidal anti-inflammatory agents (in large doses), cytotoxic agents, corticosteroids, antimetabolites, phenylbutazone, and indomethacin
❑ ingestion of poisons, especially DDT, ammonia, mercury, carbon tetrachloride, and corrosive substances
❑ endotoxins released from infecting bacteria, such as staphylococci, Escherichia coli, or salmonella.
Acute gastritis leading to stress ulcers also may develop in acute illnesses, especially when the patient has had major traumatic injuries; burns; severe infection; hepatic, renal, or respiratory failure; or major surgery.
Chronic gastritis may be associated with peptic ulcer disease or gastrostomy, both of which cause chronic reflux of pancreatic secretions, bile, and bile acids from the duodenum into the stomach. Recurring exposure to irritating substances, such as drugs, alcohol, cigarette smoke, or environmental agents, may also lead to chronic gastritis. Chronic gastritis may occur with pernicious anemia, renal disease, or diabetes mellitus. Pernicious anemia is commonly associated with atrophic gastritis, a chronic inflammation of the stomach resulting from degeneration of the gastric mucosa. In pernicious anemia, the stomach can no longer secrete intrinsic factor, which is needed for vitamin B 12 absorption.
Bacterial infection with Helicobacter pylori is a common cause of nonerosive chronic gastritis. About 35% of adults are infected with H. pylori, but the prevalence of H. pylori infection in minority groups and in immigrants is much higher. Children ages 2 to 8 in developing nations acquire the infection at a rate of 10% per year; in the United States, the rate of yearly infection is less than 1%.
Signs and symptoms
After exposure to the offending substance, the patient with acute gastritis typically reports a rapid onset of symptoms, such as epigastric discomfort, indigestion, cramping, anorexia, nausea, vomiting, and hematemesis. The symptoms last from a few hours to a few days.
The patient with chronic gastritis may describe similar symptoms or may have only mild epigastric discomfort, or his complaints may be vague, such as an intolerance for spicy or fatty foods or slight pain relieved by eating. The patient with chronic atrophic gastritis may be asymptomatic.
Diagnosis
CONFIRMING DIAGNOSIS Esophagogastroduodenoscopy or gastroscopy (with biopsy) confirms gastritis when done before lesions heal (usually within 24 hours). This test is contraindicated after ingestion of a corrosive agent.
Laboratory analyses can detect occult blood in vomitus or stool (or both) if the patient has gastric bleeding. Hemoglobin level and hematocrit are decreased if the patient has developed anemia from bleeding.
Treatment
Treatment for gastritis focuses on eliminating the cause; for example, bacterial gastritis is treated with antibiotics, whereas gastritis caused by ingested poison is treated by neutralizing the poison with the appropriate antidote. Histamine-2 (H2) receptor antagonists may block gastric secretions. Many over-the-counter preparations are available. Antacids may be used as buffers.
For critically ill patients, antacids administered hourly, with or without H2-receptor antagonists, may reduce the frequency of gastritis attacks. Some patients also require analgesics. Until healing occurs, patients’oxygen needs, blood volume, and fluid and electrolyte balance must be monitored.
When gastritis causes massive bleeding, treatment includes blood replacement; iced saline lavage, possibly with norepinephrine; angiography with vasopressin infused in normal saline solution; and, sometimes, surgery.
Vagotomy and pyloroplasty achieve limited success when conservative treatments fail. Rarely, partial or total gastrectomy may be required.
Simply avoiding aspirin and spicy foods may prevent exacerbations of chronic gastritis. If symptoms develop or persist, antacids may be taken. If pernicious anemia is the cause, vitamin B12 may be administered parenterally. A combination of bismuth and an antibiotic, such as amoxicillin, may relieve H. pylori infection, but eradication is difficult.
Special considerations
Patient care includes education and attention to various aspects of nutritional status to control symptoms and prevent their recurrence.
❑ For vomiting, give antiemetics and I.V. fluids, as ordered. Monitor fluid intake and output and electrolyte levels.
❑ Monitor the patient for recurrent symptoms as food is reintroduced; provide a bland diet.
❑ Offer smaller, more frequent meals to reduce irritating gastric secretions. Eliminate foods that cause gastric upset.
❑ Administer antacids and other prescribed medications, as ordered.
❑ If pain or nausea interferes with the patient’s appetite, give analgesics or antiemetics 1 hour before meals.
❑ Tell the patient to avoid alcohol, caffeine, and irritating foods such as spicy or highly seasoned foods.
❑ If the patient smokes, refer him to a smoking-cessation program.
❑ Urge the patient to seek immediate attention for recurring symptoms, such as hematemesis, nausea, or vomiting.
❑ Urge the patient to take prophylactic medications, as ordered. To reduce gastric irritation, advise the patient to take steroids with milk, food, or antacids. Instruct him to take antacids between meals and at bedtime and to avoid aspirin-containing compounds.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
More About Gastritis
More Medical Textbooks Online about Gastritis
Review other book chapters online related to Gastritis:
Medical Books Excerpts
- Vomiting
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- Vomiting
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Gastritis
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Vomiting
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Nausea and Vomiting
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Vomiting
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Vomiting
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Vomiting
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Vomiting (Professional Guide to Signs & Symptoms (Fifth Edition))
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
