Gastritis

Gastritis

1. Pathophysiology

   • Breakdown of normal gastric mucosal barrier resulting in HCl and pepsin causing irritation of the normal stomach tissue.
     • Drugs that contribute to gastritis include NSAIDS, asprin, corticosteroids by inhibiting the synthesis of prostaglandins that protect the gastric mucosa.
     • Dietary contributions include alcohol and spicy foods in large quantities.
     • Other Risk factors include H. pylori, bacterial infections, fungal infections and viral infections

2. Clinical Manifestations

   • Acute Gastritis: anorexia, nausea, vomiting, epigastric tenderness, feelings of fullness
     • Hemorrhage is common with alcohol abuse
     • Complete healing of mucosa is expected
     • Duration: a few hours to a few days
   • Chronic Gastritis: anorexia, nausea, vomiting, epigastric tenderness, feelings of fullness. Patient may be symptomatic. Pernicious anemia and neurologic complications might occur as a result of cobalamin depletion
     • Parietal cells are lost because of atrophy

3. Diagnostic Studies

   • Diagnosed based on detailed history and physical, patient's symptoms, history of drug and alcohol use.
   • Endoscopy with biopsy for a definitive diagnosis.
   • Testing for H. plylori that contributes to acute gastritis is necessary. Testing is done by breath, urine, serum, stool and gastric tissue biopsies.
   • CBC might show anemia from blood loss or depletion of intrinsic factor
   • Stool is tested for occult blood.
   • Serum test for antibiodies to parietal cells that will show intrisic factor levels
   • Tissue biopsy might be done to rule out gastric cancer

4. Nursing and Interprofessional Care

   • Eliminating the source
   • In the case of nausea and vomiting, NPO status, rest, IV fluids to combat dehydration, administer prescibed antiemetics
   • Severe cases might require an NG tube to monitor bleeding, lavage precipitating agents from stomach, keep stomach empty and free of noxious stimuli
     • Clear fluids slowly resumed after symptoms reside. Reintroduce solids slowly.
   • If hemorrhage is a concern, frequently check vital signs and test vomitus for blood
   • Drug therapy focuses on reducing irritation to gastric mucosa. HIstamine receptor blockers and PPI's are the drugs of choice.

5. Nursing Diagnosis

   • Diarrhea
   • Deficient knowledge
   • Risk for fluid volume deficit
   • Imbalanced nutrition: Less than body requirements

6. Nursing Interventions

   • Evaluate bowel patterns
   • Assess for abdominal pain, abdominal cramping, hyperactive bowel sounds, frequency, urgency, and loose stools
   • Submit client’s stool for culture
   • Assess client’s knowledge of gastroenteritis, its mode of transmission, and its treatment
   • Assess the volume and frequency of vomiting
   • Instruct the client to monitor weight daily and consistently with the same scale, preferably at the same time of the day, and wearing the same amount of clothing
   • Encourage increase fluid intake of 1.5 to 2.5 liters/24 hour plus 200 ml for each loose stool in adults unless contraindicated
   • Monitor the client’s food intake
   • Refer to a dietitian if indicated