Gastritis: Symptoms and Causes

Gastritis

• Inflammation of the stomach lining, known as the gastric mucosa.
• Chronic stress to the stomach lining causes gastritis like diet, pathogens, medications, stress, smoking, or staphylococcus.
• Gastritis is erosive if it causes ulcers, or it is nonerosive.
• Avoid NSAIDs, alcohol, smoking, spicy and hot foods, and caffeine

Signs and Symptoms of Acute Gastritis

• Decreased appetite and discomfort or pain such as cramping.
• Abdominal tenderness, bloating, and belching, also known as burping.
• Reflux and heartburn, also known as dyspepsia.
• Nausea, vomiting, and diarrhea are symptoms.
• GI bleeding manifests as hematemesis, which is vomiting bright red blood, or melena if there is black, tarry, sticky stools.
• Acute gastritis appears as thickened, reddened mucous membrane with prominent rugae, or folds.
• Complete recovery occurs in a few days if the stomach muscle is not involved.
• Bleeding or hemorrhage may occur if the muscle is affected.

Signs and Symptoms of Chronic Gastritis

• Few symptoms are present unless ulceration occurs.
• Patients report nausea and vomiting with upper abdominal discomfort.
• Periodic epigastric pain after a meal is common alongside a feeling of fullness after eating
• Frequent burping or hiccups occur alongside unexplained weight loss and even anorexia.
• Decreased intrinsic factor impairs vitamin B12 absorption and can result in B12 deficiency.
• Pernicious anemia is a potential result.
• Chronic gastritis appears as patchy, diffuse inflammation of the mucosal lining.
• Helicobacter pylori (H. Pylori) infection is the most common cause.

Diagnosis and Patient Teaching for Gastritis

• Dark, bloody stools such as black, tarry, sticky stools, or melena, may be present.
• Diagnostic tests include a biopsy, upper GI x-ray series, or urea breath test.
• Esophagogastroduodenoscopy (EGD) via an endoscope with biopsy is the gold standard for diagnosing gastritis.
• Tissue samples detect H. pylori via rapid urease testing, cultures, or molecular detection (PCR DNA).
• Test results are more reliable if the patient stops antacids and PPIs for at least a week before the test
• The urea breath test involves swallowing a radioactive carbon urea (13C urea) capsule, liquid, or pudding
• Bacterium presence is confirmed if exhaled air contains radioactive carbon urea after a few minutes.
• Report hematemesis (vomiting blood) or hemoptysis (coughing up blood) immediately.
• Avoid long-term use of aspirin, NSAIDs, ibuprofen, or corticosteroids.
• Avoid irritants like caffeine and limit intake of foods that cause distress or contain caffeine or high acid content like tomato products, citrus juices, bell peppers and onions.
• Stop smoking or using other forms of tobacco.

Gastritis Prevention and Medication

• Balanced diet, regular exercise, and stress-reduction serve as preventative measures
• Avoid alcohol and caffeine and only consume uncontaminated foods free from lead and nickel
• Sucralfate should be given 1 hour before and 2 hours after meals and at bedtime to avoid food interference with drug adherence to mucosa
• Refrain from giving antacids or other drugs within 30 minutes and crystalloid solution to replace blood with GI bleeding
• Stress can affect patients with gastritis and it is important to manage and prevent GI bleeding

Gastroesophageal Reflux Disease (GERD)

• Gastroesophageal reflux, or GER, occurs from regurgitation, which is backward flow of stomach contents into the esophagus.
• GERD is a chronic and serious condition from persistent GER, the most common upper gastrointestinal disorder in the United States.
• Obesity is a high risk factor because excess weight increases intra-abdominal pressure and causes reflux.
• Helicobacter pylori might contribute by causing gastritis and poor gastric emptying.

Pathophysiology and Contributing Factors of GERD

• Transient lower esophageal sphincter relaxations, or TLESRs, is the most common cause, allowing stomach contents to reflux into the esophagus.
• Compromised lower esophageal sphincter (LES) causes gastric contents to reflux into the esophagus, causing a sour or bitter taste
• Water brash, a reflex salivary hypersecretion, also occurs in response to reflux
• Weakened/dysfunctional LES cannot maintain adequate pressure to prevent reflux.
• Poor esophageal motility prevents effective clearance of refluxed contents.
• A decreased mucosal resistance allows greater mucosal injury from refluxed gastric contents.
• Factors decreasing LES pressure are caffeine, chocolate, citrus fruits, tomatoes, alcohol, peppermint, smoking, calcium channel blockers, anticholinergic drugs, high estrogen and progesterone, and nasogastric tube placement.
• Nasogastric tubes decrease esophageal sphincter function, keeping the cardiac sphincter open.
• Increased intraabdominal and intragastric pressure, including pregnancy, wearing tight belts or abdominal binders, bending over, and ascites.
• Frequent GERD episodes occur with obstructive sleep apnea and supine position at night causes prolonged esophageal acid with no back flow with gravity.

Signs, Symptoms, and Complications of GERD

• Dyspepsia (indigestion) and regurgitation.
• Severe GERD symptoms occur after each meal and last for 20 minutes to 2 hours.
• Abdominal discomfort, feeling uncontrollably full, nausea, flatulence (gas), eructation (belching), and bloating are other symptoms.
• Symptoms are typically worse when bending over, straining, or lying down.
• Severe indigestion may produce pain in the chest that radiates to the neck, jaw, or back, mimicking cardiac pain.
• Other symptoms include: Water brash (hypersalivation), dental caries, dysphagia, odynophagia (painful swallowing), globus, pharyngitis, wheezing, chest pain, pyrosis (heartburn), epigastric pain, belching, flatulence and nausea Older adults signs and symptoms of GERD include: dysphagia, vomiting, anorexia, anemia, cough, and respiratory issues.
• Barrett’s epithelium occurs when columnar epithelium substitutions for normal squamous cells during healing in the lower esophagus, it is premalignant and cancerous
• Esophageal stricture forms from fibrosis and scarring
• Uncontrolled esophageal reflux increases the risk for asthma, laryngitis (inflammation of the larynx), dental decay, cardiac disease, hemorrhage, and aspiration pneumonia.

GERD Prevention and Diagnostic Tests

• Consume small, frequent meals and limit fried, fatty, spicy foods, and caffeine.
• Avoid foods like peppermint, chocolate, carbonated beverages and acidic foods and patients need to sit up 90 degrees for 30minutes-1hr after meals and no meals at least 3 hours before bed.
• Patients may come to the emergency department fearing myocardial infarction, but they are diagnosed off symptoms and history based on visualizing the stomach and gastric acid as GERD does not have a definitive diagnosis
• Patients with atypical GERD symptoms get an upper endoscopy, or EGD, to see abnormalities and take a biopsy while an endoscope (flexible tube with light and lens) is inserted down the throat.
• Ambulatory esophageal pH monitoring is the most accurate method of diagnosing GERD.
• A transnasally placed catheter or wireless, capsule-like device assesses and records patient activity by pH monitoring and a symptom diary over 24 to 48 hours
• The patient keeps an activity and symptom diary over 24 to 48 hours by recording when acidic levels are monitored

Interventions and Treatment for GERD

• Lifestyle modifications include nonrestrictive clothing and avoiding heavy lifting and straining
• Drugs causing reflux include oral contraceptives, anticholinergic agents, sedatives, NSAIDs, nitrates and calcium channel Instruct patients to eliminate foods that decrease LES pressure and irritate inflamed tissues like peppermint, chocolate, fatty fried foods, spicy and acidic foods, caffeine, and carbonated beverages.
• Instruct patients to avoid eating at least 3 hours before bed.
• Aspiration risks increase if regurgitation occurs when lying down, so patient sleep propped up to promote gas exchange.
• Treatment for GERD includes antacids (TUMS), histamine blockers, and proton pump inhibitors (PPIs) such as Pantoprazole/Protonix and Omeprazole/Prilosec; they inhibit gastric acid secretion and mucosa, while accelerating gastric emptying to decrease pain
• Tums (calcium carbonate) side effects are constipation, acid rebound, kidney stones, milk-alkali, hypercalcemia; it only provides temporary relief
• Proton pump inhibitors reduce stomach acid such as omeprazole; but cause electrolyte imbalances such as hypomagnesemia, hypocalcemia, and hypokalemia, as well as hip fractures in older adults
• Reglan (Metoclopramide, dopamine receptor antagonists) increases gastric pressure; but the side effects include fatigue, dry mouth, seizures, and breast cancer
• Endoscopy, or EGD, helps check for esophageal inflammation, ulcers, strictures, or other complications from chronic acid reflux with therapeutic interventions being performed
• Nurses monitor respiratory depression and provide chest rubs is respiration drops.
• Nurses monitor for bleeding or perforation and aspiration with a NPO until gag reflex returns

Post-Op EGD

• Patients consume a soft food diet as progressed from post op precautions and clear liquids
• Surgical complications are control pain while monitoring airways and infection symptoms such as fever, chills, increased pain or tenderness, difficulty swallowing, nausea/vomiting, abdominal pain or bloating, and general malaise
• Frequent injury and inflammation cause strictures, which is scarring and narrowing (stricture formation) of the esophagus, requiring procedure
• Stretta Procedures replace GERD surgery when all else fails by decreasing vagus nerve activity and applying radiofrequency (RF) energy through the endoscope, and the patients require clear liquids for first 24 hours and soft foods for the next few days
• Do not allow nasogastric tubes due to potential perforation and report chest pain and shortness of breath because the esophagus is able to be perforated

Important GI Terms

• Dyspepsia—indigestion
• Dysphagia—difficulty swallowing,
• Esophageal stricture—an abnormal narrowing or tightening of the esophagus that can make it difficult for food and liquids to pass through to the stomach.
• Odynophagia—painful swallowing.

Bowel Obstruction

• Obstipation refers to a severe, intractable form of constipation with impacted and difficult-to-pass fecal matter, requiring enemas or manual disimpaction,
• Small bowel obstructions are more common because of the smaller lumen and are often caused by adhesions, hernias, or tumors and include colicky, pain, nausea, vomiting, distention and hyperactive bowel sounds
• Large bowel obstructions are less common but present with abdominal distention, dehydration, constipation, and dull pain due to tumors or inflammatory conditions like diverticulitis with vomiting being a late sign
• Paralytic ileus is s paralytic ileus with distention, nausea , and emesis, and requires monitoring vitals, administering IV fluids, and providing analgesics, while the diet should be a low-residue one

Non-surgical Interventions for Bowel Obstruction

• Nasogastric decompression removes the fluid and gas buildup
• IV fluids to compensate dehydration and electrolyte imbalances
• Anti-emetics for nausea/emesis controls
• Enemas or disimpaction of colon
• Neostigmine to stimulate motility

Additional Bowel Obstruction Information

• Borborygmi are higher pitched bowel sounds made by the movement of fluids and gas in intestines
• Mechanical obstructions are caused by physical blockages such as hernia and volvulus
• Non-mechanical obstructions are functional-they impair neural signaling with paralytic ileus
• pseudo-obstruction may cause sepsis, ileus, or inflammation

Blood in Stool and Incomplete Obstructions

• Blood in stool is tested with FOBT or FIT, and more testing may be required if either comes back positive
• Partial or incomplete obstructions mean there is still some passage available Hypoactive bowel sounds may signify paralytic ileus

Hemorrhoids and Dietary Changes

• dietitians recommend patients who had exploratory laparotomy get clear fluids to encourage peristalsis
• swelling and prolapse can cause bleeding and irritation from inner tissues
• colorectal cancer, or narrowing due to the tumor, may also cause obstructions, preventing the absorption of fluids and electrolytes

Urinary Calculi/Urolithiasis (urinary stones)

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• Flank pain is associated with retroperitoneal structures, kidney stones, urinary tract, and muscles, radiating toward the groin or abdomen.
• Lithotripsy is a non-invasive medical procedure that requires monitoring vital signs and urine output to pass stones and prevent complications while managing pain
• Increasing fluid and limiting purines/animal protein is recommended to dilute and protect urinary stones

Urinary Issues

• Dietary modifications include sodium restrictions, avoiding high-oxlate foods, and adequate calcium
• Increasing citrus is also recommended

Ulcer and Crohn's

• Ulcer colitis is consisits of 10–20 liquid, bloody stools per day
• Crohns disease consists of 5–6 soft, loose stools per day, nonbloody

Ulcerative Colitis and Testing

• Ulcerative Colitis entails abdominal pain, cramping, urgency, flares, and tenesmus
• Triggers include stress, infection, and certain food or illness or poor sleep
• CRP tests for inflammation.
• Hypokalemia is also common with severe diarrhea due to loss of fluids

Post-Op Colectomy and Wound Dehiscence

• Low bowel sounds are common
• After Dr assessment of incision, nurses monitor for infection
• Dehiscence should be evaluated and bandaged to prevent full burst of wound, caused by high adipose or diabetes.

Benign Prostate Hypertrophy (BPH)

• Increase in cell production
• nocturia/incomplete bladder are common symptoms of BPH, with dilation of kidneys as a possible complication (hydronephrosis)

Tests for BPH

• Prostate-specific antigen (PSA)
• Urinalysis, Digital rectal exam (DRE)
• Uroflowmetry
• Cystoscopy
• Imaging with ultrasound or CT scan

BPH Treatments and Teaching

• Transurethral Resection of the Prostate (TURP) surgical resection of prostate and catheterization to prevent regrowth with monitoring
• Medications include Flomax and finasteride
• Pre and Post Op teaching by doctors and nurses to discuss incision, catheter and impotence while monitoring catheter placement, diet and voiding practices

Dietary Recommendations after TURP

• Avoid alcohol, caffeine, and sweetners

Additional Medications

• shower don’t bathe, walk gently and kegels

Urethral Stricture

• Obstruction
• Infection in bladder
• Swelling backup into kidneys
• Pain and burning caused by trauma
• Watch for low output and infection

Medications for Urethral Strictures

• Monitor flomax, dizziness

Anorexia

• Eating disorders in the body and affect psychological and eating habits
• Includes binging, cachexia, bulimia which waste and deteriorate the body with decreased calorie intake and energy use
• Malnutrition occurs with these conditions due to deficiencies
• Refeeding is a potentially dangerous outcome due to changes in fluid and electrolytes

Diet and Support for Anorexia

• Diets need to be more protein and calories
• Provide care that encompasses team functions
• Patients feeding should be less than 4 weeks so that patient is feeding orally
• Obesity affects social psychological, and physical health
• Bariatric is also a solution to combat problems, but can result in high fat of foods in stomach

Bariatric Potential complications and Dumping Syndrome

• Infection, bleeding, clots, dumping
• Restricting diet to reduce absorption; therefore needs lifelong follow up
• Dumping syndrome is a side effect causing weakness and hyperglycemia
• Bulb should be compressed.
• NO REPOSITIONING NGT, nurses need to assess
• WBC decline after 24hrs
• TPN bag for more than 24 hrs increase contamination, use clean technique

Dietary Teaching for TPN

• TPN contains K, NA, and CA electrolytes
• Teach to drink fluids and caution constipation
• Empty stomach
• Sit upright
• Softeners
• Know BMI; high, fatty acids increased risk for heart disease; maintain open airway

Common Medications for Anorexia/GI Support/BPH

• Semaglutide or Ozempic—increase diabetes to lower glucose and lose weight
• Pantoprazole or Protonix—Proton pump inhibitor to stop acid production
• Omeprazole or Prilosec—Hinder to stop acid production
• Calcium Carbonate or Tums—Antacid neutralizes acid
• Metoclopramide or Reglan - Stimulate motility
• Finasteride - Shring prostate, but limit alcohol and increase fluid
• Tamsulosin (Flomax) - relax fluid and lower bp