Ch 42 Gastritis

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


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


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


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


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


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


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


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


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


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))


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


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



• Radiologic studies not helpfulRadiologic studies not helpful

• CBCCBC Confirm presence of anemiaConfirm presence of anemia

• Occult blood testOccult blood test



• 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



• Tissue biopsy with cytologic Tissue biopsy with cytologic examinationexamination Rule out gastric carcinomaRule out gastric carcinoma


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


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



• Drug therapyDrug therapy Focused on reducing irritation of Focused on reducing irritation of

mucosamucosa Providing symptomatic reliefProviding symptomatic relief



• 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


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


Chronic Gastritis Chronic Gastritis Collaborative CareCollaborative Care

• Lifestyle changesLifestyle changes• DietDiet• AlcoholAlcohol• SmokingSmoking

• Close medical follow-upClose medical follow-up


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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Ch 42 Gastritis