causing various symptoms Acute Gastritis.pptx

causing various symptoms Acute Gastritis.pptx

1. Gastritis is inflammation of the stomach lining, causing various symptoms. Here's a comprehensive overview: Types of Gastritis: Acute Gastritis: Sudden onset, usually caused by infection, medication, or food poisoning. 2. Chronic Gastritis: Long-term inflammation, often caused by Helicobacter pylori (H. pylori) bacteria or autoimmune disorders. 3. Erosive Gastritis: Severe inflammation causing stomach lining erosion. 4. Atrophic Gastritis: Chronic inflammation leading to stomach lining thinning.

2. Causes: H. pylori bacteria Nonsteroidal anti-inflammatory drugs (NSAIDs) Excessive alcohol consumption Stress Viral or bacterial infections Food poisoning Autoimmune disorders Allergies

3. Symptoms: Abdominal pain or discomfort Nausea and vomiting Bloating and gas Loss of appetite Weight loss6. Heartburn Black, tarry stools (indicating bleeding)

4. Diagnosis: 1. Endoscopy 2. Upper GI series (barium swallow) 3. Blood tests (infection, anemia) 4. Stool tests (infection) 5. Biopsy (tissue sample)

5. Treatment: Antibiotics (H. pylori) Antacids and acid reducers Histamine-2 (H2) blockers Proton pump inhibitors (PPIs) Lifestyle changes (diet, stress management) Avoid trigger foods and substances

6. Stomach has five layers: Mucosa Sub mucosa Smooth muscle layer Sub serosa Serosa

7. Stomach cancer begins when cancer cells form in the inner lining of stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.

8. Causes

9. Clinical Presentation Common clinical Presentation: 3A”s: 1.Anaemia(due to bleeding from tumour) 2.Asthenia(septic absorption from the tumour) 3.Anorexia onset of early satiety, dyspepsia, epigastric discomfort

10. Specific symptoms depending on the site of tumour. Pyloric region - gastric outlet obstruction. Proximal region - dysphagia, hamaetemesis. Body of stomach - mass per abdomen(silent variety). Metastatic disease - jaundice, ascites

11. Sign Grossly Anemic, Cachexia, Epigastric mass, Virchows node Sister mary joseph node Krukenberg tumor Irish node

12. Stages of gastric cancer

13. Staging of Gastric Cancer T 1 - lamina propria & sub - mucosa T 2 - muscularis & sub - serosa T 3 - serosa T 4 - Adjacent organs N - no lymph node N 1 - Epigastric node N 2 - main arterial trunk M o - distal metastasis M 1 - distal metastasis

14. Spread of Gastric Cancer Direct Spread Blood-borne metastasis Lymphatic spread Transperitoneal spread

15. INVESTIGATIONS Full blood count LFT, RFT Stool examination for occult blood CXR Serum tumor markers (CA 72-4,CEA,CA19- 9)

16. Diagnostic study of choice - USG, CT, biopsy UGI endoscopy with biopsy, CT, MRI & USG Laparoscopy Upper gastro intestinal endoscopy - Diagnostic accuracy is 98% if upto 7 biopsies is taken. Laparoscopy: Help in assessment of wall thickness, metastases (peritoneum ,liver & LNs) Help in assessment of wall thickness, metastases (peritoneum ,liver & LNs) Detection of peritoneal metastases

17. Management

18. Initial treatment 1.Improve nutrition if needed by parentral or enteral feeding. 2.Correct fluid &electrolyte & anemia if they are present.

19. Approaches Though some superficial cancers can be treated endoscopically, gastrectomy is the most widely used approach Total gastrectomy - usually performed for lesions in the upper third (proximal) stomach Distal subtotal gastrectomy - performed for tumors in the distal (lower two-thirds) of the stomach

20. RADICAL GASTRECTOMY Remove the stomach +distal part of esophagus+ proximal part of duodenum + greater & lesser omentum + Lymph Nodes Oesophagojejunostomy with roux-en-y gastric bypass surgery

21. SUBTOTAL GASTRECTOMY Similar to total one except that the PROXIMAL PART of the stomach is preserved Followed by reconstruction & creating anastomosis ( by gastrojejunostomy, billroth II )

22. Billroth - II

23. PALLIATIVE SURGERY For pts with advanced (inoperable) disease & suffering significant symptoms e.g. obstruction, bleeding. Palliative gastrectomy not necessarily to be radical, remove resectable masses & reconstruct (anastomosis/intubation/stenting/ recanalisation)

24. POSTOPERATIVE ORDERS Admit to PACU Detailed nutritional advise (small frequent meals)

25. Post-Operative Complications Leakage from duodenal stump. Secondary hemorrhage. Nutritional deficiency in long term.

26. Chemotherapy Responds well, but there is no effect on survival. Marsden Regimen - Epirubicin, cisplatin &5-flurouracil (3 wks) 6 cycles Response rate : 40% .

27. Radiotherapy Postperative-radiotherpy: may decrease the recurrence.

28. Nursing Diagnosis Acute Pain Altered Nutrition: Less Than Body Requirements Risk for Fluid Volume Deficit Fatigue Risk for Infection Risk for Altered Oral Mucous Membranes Risk for Impaired Skin Integrity

29. Anticipatory Grieving Situational Low Self-Esteem Risk for Altered Sexuality Patterns Risk for Altered Family Process Fear/Anxiety Risk for Constipation/Diarrhea

30. Nursing Management Monitor nutritional intake and weigh patient regularly. Monitor CBC and serum vitamin B12 levels to detect anemia, and monitor albumin and prealbumin levels to determine if protein supplementation is needed. Provide comfort measures and administer analgesics as ordered. Frequently turn the patient and encourage deep breathing to prevent pulmonary complications, to protect skin, and to promote comfort. Maintain nasogastric suction to remove fluids and gas in the stomach and prevent painful distention.

31. Provide oral care to prevent dryness and ulceration. Keep the patient nothing by mouth as directed to promote gastric wound healing. Administer parenteral nutrition, if ordered. When nasogastric drainage has decreased and bowel sounds have returned, begin oral fluids and progress slowly. Avoid giving the patient high-carbohydrate foods and fluids with meals, which may trigger dumping syndrome because of excessively rapid emptying of gastric contents. Administer protein and vitamin supplements to foster wound repair and tissue building.

32. Eat small, frequent meals rather than three large meals. Reduce fluids with meals, but take them between meals. Stress the importance of long term vitamin B12 injections after gastrectomy to prevent surgically induced pernicious anemia. Encourage follow-up visits with the health care provider and routine blood studies and other testing to detect complications or recurrence .