Gastritis: Inflammation and Causes

Gastritis

• Gastritis is the inflammation of the gastric or stomach mucosa
• This inflammation results from either erosion or atrophy
• Erosive causes include physical illness and medications like nonsteroidal anti-inflammatory drugs (NSAIDs)
• Atrophic causes include prior surgery such as gastrectomy, pernicious anemia, alcohol use, or Helicobacter pylori infection
• The autoimmune form of gastritis has a strong genetic predisposition
• Genetic variations in immune factors leading to increased susceptibility to H. pylori also heightens the risk

Aetiology/Classification of Gastritis

• Gastritis can be categorized as acute or chronic
• Acute gastritis often stems from dietary indiscretion, such as consuming food contaminated with disease-causing microorganisms or food that is irritating
• Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy
• A severe form of acute gastritis arises from ingesting strong acid or alkali, leading to gangrenous or perforated mucosa
• Chronic gastritis results from prolonged inflammation, caused by benign or malignant stomach ulcers, or the bacteria Helicobacter pylori
• Chronic gastritis is sometimes associated with autoimmune diseases like pernicious anemia, dietary factors like caffeine, use of medications especially NSAIDs, alcohol, smoking, or reflux of intestinal contents into the stomach

Pathophysiology of Gastritis

• Inflammation may be localized or patchy
• Gastric structure and function are altered in either the epithelial or glandular components of the gastric mucosa
• Inflammation is usually limited to the mucosa, but deeper layers may be involved
• The gastric mucous membrane becomes edematous and hyperemic (congested with fluid and blood) and undergoes superficial erosion
• It leads to secretion of scanty gastric juice
• The gastric juice contains very little acid, but much mucus
• Superficial ulceration may occur and can lead to hemorrhage

Clinical Manifestations of Gastritis

• Acute gastritis may manifest as abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccupping
• Some patients, however, have no symptoms
• Chronic gastritis may involve anorexia, heartburn after eating, belching, a sour taste in the mouth, or nausea and vomiting
• Patients with chronic gastritis from vitamin deficiency usually have evidence of malabsorption of vitamin B12 caused by antibodies against intrinsic factor

Diagnostic Investigations for Gastritis

• Hemoglobin and hematocrit levels decrease
• Anemia (iron deficiency) occurs due to chronic, slow blood loss
• Fecal occult blood test is positive
• Helicobacter pylori test may be positive
• Upper endoscopy shows inflammation and allows for biopsy

Management of Gastritis

• Administer antacids like Maalox, Mylanta, Tums, and Gaviscon
• Administer sucralfate to protect the gastric lining
• Administer histamine 2 blockers like ranitidine, famotidine, nizatidine, cimetidine
• Administer proton pump inhibitors like omeprazole, esomeprazole, pantoprazole, rabeprazole, lansoprazole
• Eradicate Helicobacter pylori infection if present
• Implement diet modification
• Monitor hemoglobin and hematocrit levels

Nursing Diagnosis Related to Gastritis

• Imbalanced nutrition, less than body requirements, related to inadequate intake of nutrients
• Risk for imbalanced fluid volume related to insufficient fluid intake and excessive fluid loss subsequent to vomiting
• Acute pain related to irritated stomach mucosa

Nursing Interventions for Gastritis

• Monitor vital signs
• Monitor intake and output
• Monitor stool for occult blood
• Assess abdomen for bowel sounds and tenderness
• Teach the patient about diet restrictions: avoid alcohol, caffeine, and acidic foods
• Also teach patient about medications
• Emphasize the need to avoid smoking and NSAIDs

Complications of Gastritis

• Left untreated, gastritis may lead to stomach ulcers and stomach bleeding
• Rarely, some forms of chronic gastritis may increase the risk of stomach cancer

Peptic Ulcer

• An ulcer develops when there is erosion of a portion of the mucosal layer of either the stomach or duodenum
• Ulcers may occur within the stomach (gastric ulcer) or the duodenum (duodenal ulcer)
• Roughly 80% of all peptic ulcers are duodenal ulcers

Incidence of Peptic Ulcers

• Duodenal ulcers typically affect individuals aged 30–60 years
• In duodenal ulcers, the male to female ratio is approximately 2–3:1
• 80% of peptic ulcers are duodenal
• Gastric ulcers usually affect individuals aged 50 and over
• In gastric ulcers, the male to female ratio is approximately 1:1
• 15% of peptic ulcers are gastric

Risk Factors for Peptic Ulcers

• Risk factors for both duodenal and gastric ulcers include H. pylori, alcohol, smoking, or stress
• Additional duodenal ulcer risk factors: cirrhosis
• Additional gastric ulcer risk factors include gastritis, and use of NSAIDs

Peptic Ulcer Pathophysiology

• A break in the protective mucosal lining allows the acid within the stomach to make contact with the epithelial tissues
• Gastric ulcers favor the lesser curvature of the stomach
• Duodenal ulcers tend to be deeper and penetrating through the mucosa to the muscular layer
• Helicobacter pylori infection has been associated with duodenal ulcers
• Stress ulcers are associated with another acute medical condition or traumatic injury
• Ischemia develops within the stomach or duodenum when the body attempts to heal
• Ischemic areas subsequently ulcerate

Clinical Manifestation - Duodenal Ulcers

• The Duodenal variety exhibits hypersecretion of stomach acid (HCl)
• Patients may experience weight gain
• Pain typically occurs 2–3 hours after a meal, often awakening individuals between 1–2 AM
• Ingestion of food relieves pain
• Hemorrhage is less likely but melena (dark, tarry stools) is more common than hematemesis (vomiting blood)
• Duodenal ulcers are more likely to perforate than gastric ulcers

Clinical Manifestation - Gastric Ulcers

• The gastric variety exhibits normal to hyposecretion of stomach acid (HCl)
• Patients may experience weight loss
• Pain occurs 1⁄2 to 1 hour after a meal, rarely occurs at night, but may be relieved by vomiting
• Ingestion of food does not help, sometimes increases pain
• Vomiting is common
• Hemorrhage is more likely to occur, and hematemesis is more common than melena

Diagnostic Investigations for Peptic Ulcers

• Upper GI tract X-rays show abnormalities in the mucosa
• Gastric secretory studies show hyperchlorhydria
• Upper GI endoscopy confirms the presence of an ulcer
• Serologic or breath urea test shows the presence of H. pylori
• Biopsy rules out cancer
• Stool may test positive for occult blood

Management of Peptic Ulcers

• Administer antacids
• Administer histamine-2 blockers: famotidine, ranitidine, nizatidine
• Administer proton pump inhibitors: omeprazole, lansoprazole, rabeprazole, esomeprazole, and pantoprazole
• Administer mucosal barrier fortifiers, such as sucralfate
• Administer prostaglandin analogue: misoprostol
• Adjust diet
• Treat H. pylori infection if present with combination therapy, such as a proton pump inhibitor plus clarithromycin plus amoxicillin or a proton pump inhibitor plus metronidazole plus clarithromycin, or bismuth subsalicylate plus metronidazole plus tetracycline

Nursing Diagnosis for Peptic Ulcers

• Acute pain related to the effect of gastric acid secretion on damaged tissue
• Anxiety related to coping with an acute disease
• Imbalanced nutrition related to changes in diet

Nursing Intervention for Peptic Ulcers

• Monitor vital signs
• Monitor intake and output
• Assess abdomen for bowel sounds, tenderness, rigidity, rebound pain, and guarding
• Monitor stool for change in color, consistency, and blood
• Instruct the patient on home care
• Counsel patient on diet modification to avoid acidic foods, caffeine, peppermint, and alcohol
• Encourage patient to eat more frequent, small meals
• Remind patient to avoid nonsteroidal anti-inflammatory medication
• Stop smoking

Complications of Peptic Ulcers

• Perforation and penetration
• Risk of malignancy is rare in duodenal ulcers and occasional in gastric ulcers

Inflammatory Bowel Disease

• Ulcerative Colitis and Crohn’s disease are two inflammatory conditions, characterized by:
• Unknown, autoimmune-related causes
• Primarily affecting young adults
• Chronic and recurrent patterns
• Diarrhea as the primary symptom
• Association with extra-intestinal manifestations like arthritis

Ulcerative Colitis

• It is an inflammatory disease of the large intestine that affects the mucosal layer beginning in the rectum and colon
• It may also spread into the adjacent tissue
• The exact cause is unknown
• Higher incidence observed in individuals of northern European, North American, or Ashkenazi Jewish origins
• Peak incidence is from the mid-teens to the mid-twenties and from the mid-fifties to mid- sixties

Ulcerative Colitis Aetiology

• Conditions believed to be risk factors for ulceratic colitis include: family history and bacterial infection
• Allergic reactions may also be risk factors, particularly to food and milk
• Overproduction of enzymes has been identified as a risk factor, along with emotional stress
• Patients with autoimmune disorders such as rheumatoid arthritis, hemolytic anemia, erythema nodosum, and uveitis are at greater risk

Ulcerative Colitis Pathophysiology

• Ulcerative colitis primarily damages the large intestine's mucosal and submucosal layers
• The disease generally originates in the rectum and lower colon, then spreads to the entire colon
• The mucosa experiences diffuse ulceration accompanied by hemorrhage
• The mucosa is also prone to congestion, edema, and exudative inflammation
• Unlike Crohn's disease, ulcerations are continuous

Ulcerative Colitis Progression

• Abscesses can form in the mucosa, draining purulent pus, which leads to necrosis and ulceration
• Sloughing occurs, resulting in bloody, mucus-filled stools
• Disease starts in the rectum and extends throughout the colon
• Eventually, the bowel narrows, shortens, and thickens because of muscular hypertrophy and fat deposits

Clinical Manifestation of Ulcerative Colitis

• Its predominant symptoms are diarrhea, lower left quadrant abdominal pain, intermittent tenesmus, and rectal bleeding
• Potential symptoms for patients include anorexia, weight loss, fever, and vomiting
• Dehydration, cramping, the feeling of needing to defecate urgently, and 10 to 20 liquid stools each day are also symptoms
• Other potential complications are hypocalcemia and anemia
• Rebound tenderness may develop in the right lower quadrant
• Extraintestinal side effects include skin lesions (eg, erythema nodosum)
• There are also eye lesions (eg, uveitis), joint abnormalities (eg, arthritis), and liver disease

Ulcerative Colitis Diagnosis

• Anemia, characterized by decreased hemoglobin and hematocrit concentrations caused by blood loss and ongoing ailments
• Elevated erythrocyte sedimentation rate
• Presence of electrolyte imbalances due to diarrhea and/or poor nutrient absorption
• Double-contrast barium enema showing inflammation and ulceration
• Sigmoidoscopy or colonoscopy showing ulcerations and hemorrhaging

Crohn’s Disease

• Known as regional enteritis is a chronic, relapsing inflammatory disorder of the GI tract
• It is known as regional enteritis or granulomatous colitis
• Commonly occurs in adolescents or young adults, but can appear at any time
• More prevalent in women and frequently observed in older individuals aged 50 to 80
• Can affect anywhere along the GI tract
• Common areas are the distal ileum and colon
• The incidence of Crohn’s has risen sharply over the past 30 years

Crohn’s Disease Pathophysiology

• The disease begins with edema and thickening of the mucosa
• Ulcers begin to appear on the mucosa affected by inflammation
• The Crohn’s lesions aren't in contact with one another
• Lesions are separated by normal tissue
• Fistulas, fissures, and abscesses form as the inflammation extends into the peritoneum

Crohn’s Disease Clinical Manifestations

• Clinical Manifestations include steady, colicky pain in the right lower quadrant
• Cramping and tenderness
• Flatulence and nausea
• Fever and diarrhea
• Bloody stool may also occur
• Diarrhea stools (four to six stools a day)
• Steatorrhoea
• Marked weight loss
• Abdominal pain in the right lower quadrant
• Weakness and fatigue
• Symptoms may extend beyond the GI tract and commonly include joint involvement (eg, arthritis)
• Skin lesions (eg, erythema nodosum)
• Ocular disorders (eg, conjunctivitis)
• Oral ulcers

Crohn’s Disease Diagnosis

• Diagnosis requires: Sigmoidoscopy, colonoscopy, and biopsy
• WBC count will show as increased
• Elevated ESR
• Hemoglobin(Hb) estimation shows as decreased
• Calcium, sodium, and magnesium level estimation

Regional Enteritis Complications

• Possible complications resulting from regional enteritis consist of intestinal obstruction or stricture formation, along with perianal ailments, and fluid and electrolyte imbalances
• Malnutrition from malabsorption may also occur
• Fistula and/or abscess formation can also create problems

IBD Management

• Treatment of regional enteritis and ulcerative colitis focus on:
• Reducing inflammation and suppressing inappropriate immune responses
• Providing a break for a diseased bowel in order to encourage healing
• Improving quality of life
• Minimizing complications
• Administer antidiarrheal medications: loperamide, diphenoxylate hydrochloride and atropine

IBD Management - Medication

• Administer Salicylate medications to reduce inflammation in the intestinal mucosa
• Administer sulfasalazine, mesalamine, olsalazine, and balsalazide
• Administer corticosteroids during exacerbations in order to reduce inflammation
• Commonly administered corticosteroids: prednisone, hydrocortisone
• Bowel rest during exacerbations is acheived NPO
• Administer anticholinergics to reduce abdominal cramping and discomfort
• Dicyclomine

IBD Management - Diet

• Oral fluids, low-residue, high-protein, high-calorie diet plan along with supplemental vitamins and iron replacement, are implemented address nutritional requirements
• This strategy allows to lower swelling, manage discomfort, and combat diarrhea
• Doctors may suggest surgery if nonsurgical methods aren't efficient in alleviating symptoms

IBD Nursing Management

• Based on the assessment information, probable nursing diagnoses consist of:
• Diarrhea pertaining to the inflammatory process
• Acute discomfort resulting from elevated intestinal activity with inflammation of GI tract

IBD Nursing Management - Deficiencies

• Deficient fluid volume shortage associated to anorexia, discomfort, and diarrhea.
• Also, imbalanced nutrition (less than body's expectations), associated with dietary restrictions and malabsorption
• Activity intolerance related to fatigue
• Anxiety associated with coming surgery
• Ineffective coping brought on by repetitive instances of diarrhea
• Probability of undermined skin due to improper nutrition and diarrhea
• Risk for ineffectiveness in therapeutic therapy due to diminished knowledge in relation to the procedure

IBD Nursing Management - Monitors

• Check the look and uniformity of stool
• Monitor the amount of bowel emptying
• Examine the perineal location for tenderness
• Keep precise monitoring of consumption and removal
• Document vital indicators every four hours
• Assess weight on a daily basis
• Focus on dietary intake
• Recommend nutrition that can be digested easily
• Sitz bath
• Track hemoglobin and number of red blood cells
• Help customers talk about their feelings