ch 42 gastritis
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Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
GastritisGastritis
• Inflammation of gastric mucosaInflammation of gastric mucosa
• One of most common problems One of most common problems affecting the stomachaffecting the stomach
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Gastritis Gastritis
• Result of a breakdown in gastric Result of a breakdown in gastric mucosal barriermucosal barrier
• Stomach tissue unprotected Stomach tissue unprotected from autodigestion by HCl acid from autodigestion by HCl acid and pepsinand pepsin
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Gastritis Gastritis
• Tissue edema resultsTissue edema results
• Disruption of capillary walls Disruption of capillary walls With loss of plasma into gastric With loss of plasma into gastric
lumen lumen Possible hemorrhagePossible hemorrhage
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Gastritis Gastritis Etiology and PathophysiologyEtiology and Pathophysiology
• Risk factorsRisk factors DrugsDrugs• Direct irritating effect on gastric Direct irritating effect on gastric
mucosamucosa• Aspirin, NSAIDs, and Aspirin, NSAIDs, and
corticosteroidscorticosteroids
DietDiet• Alcohol, spicy foodAlcohol, spicy food
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GastritisGastritisEtiology and PathophysiologyEtiology and Pathophysiology
• Risk factors (cont’d)Risk factors (cont’d) MicroorganismsMicroorganisms• HelicobacterHelicobacter pylori pylori – Important cause of chronic gastritisImportant cause of chronic gastritis
– Promotes breakdown of gastric Promotes breakdown of gastric mucosal barriermucosal barrier
• Staphylococcus organismsStaphylococcus organisms
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GastritisGastritisEtiology and PathophysiologyEtiology and Pathophysiology
• Risk factors (cont’d)Risk factors (cont’d) Environmental factorsEnvironmental factors• Radiation, smokingRadiation, smoking
Pathophysiologic conditionsPathophysiologic conditions• Burns, renal failure, sepsisBurns, renal failure, sepsis
Other factorsOther factors• Psychologic stress, NG tubePsychologic stress, NG tube
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Gastritis Gastritis Etiology and PathophysiologyEtiology and Pathophysiology
• Risk factors (cont’d)Risk factors (cont’d) Autoimmune atrophic gastritisAutoimmune atrophic gastritis• Affects fundus and body of stomachAffects fundus and body of stomach• Associated with Associated with increased risk of increased risk of
gastric cancergastric cancer• May be link to presence of May be link to presence of H. pyloriH. pylori
and development of autoimmune and development of autoimmune chronic gastritischronic gastritis
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Acute Gastritis Acute Gastritis Clinical ManifestationsClinical Manifestations
• Self-limitingSelf-limiting Lasts few hours to a few daysLasts few hours to a few days Complete healing of mucosa Complete healing of mucosa
expected expected
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Acute GastritisAcute GastritisClinical ManifestationsClinical Manifestations
AnorexiaAnorexia NauseaNausea VomitingVomiting Epigastric tendernessEpigastric tenderness Feeling of fullnessFeeling of fullness HemorrhageHemorrhage• Common with alcohol abuseCommon with alcohol abuse• May be only symptomMay be only symptom
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Chronic GastritisChronic GastritisClinical ManifestationsClinical Manifestations
Symptoms are similar to acute Symptoms are similar to acute gastritisgastritis
Loss of intrinsic factor can occur Loss of intrinsic factor can occur when acid-secreting cells are lost when acid-secreting cells are lost or are nonfunctioningor are nonfunctioning• Essential for absorption of Essential for absorption of
cobalamin (vitamin Bcobalamin (vitamin B1212))
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Gastritis Gastritis Diagnostic StudiesDiagnostic Studies
• Acute gastritisAcute gastritis Diagnosis most often based on Diagnosis most often based on
history of drug and alcohol abusehistory of drug and alcohol abuse
• Chronic gastritisChronic gastritis Diagnosis may be delayed or Diagnosis may be delayed or
missed due to nonspecific missed due to nonspecific symptomssymptoms
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GastritisGastritisDiagnostic StudiesDiagnostic Studies
• Endoscopic examination with Endoscopic examination with biopsybiopsy Necessary for definitive diagnosisNecessary for definitive diagnosis
• Breath, urine, serum, stool, and Breath, urine, serum, stool, and gastric tissue to determine gastric tissue to determine H. pyloriH. pylori
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GastritisGastritisDiagnostic StudiesDiagnostic Studies
• Radiologic studies not helpfulRadiologic studies not helpful
• CBCCBC Confirm presence of anemiaConfirm presence of anemia
• Occult blood testOccult blood test
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GastritisGastritisDiagnostic StudiesDiagnostic Studies
• Gastric analysisGastric analysis Determines achlorhydria (lack of acid Determines achlorhydria (lack of acid
secretion)secretion) Associated with severe atrophic Associated with severe atrophic
gastritisgastritis
• Serum antibody tests to parietal Serum antibody tests to parietal cells and intrinsic factorcells and intrinsic factor
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GastritisGastritisDiagnostic StudiesDiagnostic Studies
• Tissue biopsy with cytologic Tissue biopsy with cytologic examinationexamination Rule out gastric carcinomaRule out gastric carcinoma
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Acute Gastritis Acute Gastritis Collaborative CareCollaborative Care
Supportive care similar to N/VSupportive care similar to N/V If vomitingIf vomiting• NPONPO
• FluidsFluids– Dehydration can occur rapidlyDehydration can occur rapidly
• RestRest
• AntiemeticsAntiemetics
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Acute Gastritis Acute Gastritis Collaborative CareCollaborative Care
• NG tube—if severe symptomsNG tube—if severe symptoms• Observe for bleedingObserve for bleeding• Lavage of precipitating agent from Lavage of precipitating agent from
stomachstomach• Keep stomach empty and free of Keep stomach empty and free of
noxious stimulinoxious stimuli
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Acute GastritisAcute GastritisCollaborative CareCollaborative Care
• If hemorrhage likelyIf hemorrhage likely• Frequent VS Frequent VS • Testing vomitus for bloodTesting vomitus for blood
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Acute GastritisAcute GastritisCollaborative CareCollaborative Care
• Drug therapyDrug therapy Focused on reducing irritation of Focused on reducing irritation of
mucosamucosa Providing symptomatic reliefProviding symptomatic relief
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Acute GastritisAcute GastritisCollaborative CareCollaborative Care
• Drug therapyDrug therapy Antacids, HAntacids, H22R blockers, PPIs, R blockers, PPIs,
combinationscombinations Nurse must teach patient about Nurse must teach patient about
medications and side effectsmedications and side effects
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Chronic Gastritis Chronic Gastritis Collaborative CareCollaborative Care
Focuses on evaluating and Focuses on evaluating and eliminating causeeliminating cause• H. pylori—H. pylori—antibioticsantibiotics• Pernicious anemia—cobalamin Pernicious anemia—cobalamin
supplementssupplements
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Chronic Gastritis Chronic Gastritis Collaborative CareCollaborative Care
• Lifestyle changesLifestyle changes• DietDiet• AlcoholAlcohol• SmokingSmoking
• Close medical follow-upClose medical follow-up
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Nursing Diagnosis
1. -Pain R/T irritation of gastric mucosa• -Planning: relief of discomfort by removing irritating
factor or agent• -Implementation:the nurse should focus on teaching the client
about causes of gastritis& food that may aggravate the disease*• -The nurse should helpthe client assess factor that increase
symptoms such as stress or fatique*• -Nutritional altered less than body requirement
R/Tdecrease appitite,nausia&vomitting&pian*• -Plnning : improve nutriton intake by eating abalanced diet as
evidanced by w,t gain*• -Implementation:N P O if nausia & vomiting is severe& give him
I-V fluid until the symptoms subsite*• -the nurse can help the client identify food that stimulate development of gastritis&
incourage the client to avoid these agent*
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