Gastritis-1.pptx,medical-surgery in Edna Adan University

Gastritis is infection.....

1. MEDICAL-SURGICAL ONE COURSE. GASTRO-INTESTINAL DISORDERS

2. GASTRITIS DEFINITIONS Gastritis is defined as the inflammation of the stomach lining, characterized by swelling or irritation of the gastric mucosa. It can be acute, appearing suddenly and severely, or chronic, developing slowly and persisting for a prolonged period. Gastritis is often confused with other gastrointestinal conditions like gastroenteritis, which involves inflammation of both the stomach and intestines and is usually caused by viruses or bacteria. It is also distinct from peptic ulcers, which are sores that develop on the stomach lining due to erosion rather than just inflammation.

3. Pathophysiology The gastric mucosal barrier is a Defense mechanism that protects the stomach lining from the acidic gastric juice it produces for digestion. This barrier consists of a mucus layer, bicarbonate secretion, tight epithelial cell junctions, and regenerative capabilities of the epithelium. Disruption of this barrier through direct damage to the mucus layer or disruption of the bicarbonate production can lead to gastritis. Common disruptors include excessive alcohol consumption, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), and infection with Helicobacter pylori.

4. Pathophysiology--- Acid production in the stomach is primarily through the secretion of hydrochloric acid by parietal cells. This acid is essential for digestion but can be damaging to the stomach lining if the protective mechanisms fail. The stomach also has protective mechanisms such as the secretion of mucus and bicarbonate, which neutralize the acid, and the tight junctions between epithelial cells that prevent acid from penetrating the deeper layers of the stomach lining. When these mechanisms are impaired, the acid can cause inflammation and damage to the stomach cells, leading to gastritis.

5. Signs & Symptoms Common Symptoms: Abdominal pain : Often described as a gnawing or burning sensation in the upper abdomen. It may be aggravated or relieved by eating. Nausea and vomiting: Frequent in acute cases; vomiting may occasionally include blood if the stomach lining is significantly irritated. Bloating: A feeling of fullness or swelling in the abdomen, often after eating. Indigestion : Also known as dyspepsia, includes burping, stomach fullness, and heartburn.

6. Signs & Symptoms´--- Less Common Symptoms: Hematemesis : Vomiting of blood, which may appear as bright red blood or dark coffee grounds, indicating bleeding in the stomach. Melena : Black, tarry stools that indicate the presence of digested blood in the gastrointestinal tract, usually from bleeding in the stomach. Unintentional weight loss : This can occur due to decreased appetite or avoiding food because of pain.

7. Causes Common Causes H. pylori infection: The most common infectious cause of chronic gastritis, leading to ulcers and, in some cases, stomach cancer if untreated. - Long-term use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): These drugs can weaken the stomach's defensive mucus barrier, making the mucosa more susceptible to acid damage. Alcohol consumption: High alcohol intake can irritate and erode the stomach lining, increasing acid production and inflammation. Stress : Especially severe or chronic stress, can exacerbate or lead to the development of gastritis through mechanisms that impair the stomach lining’s defenses.

8. Causes--- Less Frequent Causes: Autoimmune disorders : Where the body's immune system mistakenly attacks the stomach lining, as seen in autoimmune gastritis. Bile reflux: This can cause gastritis when bile, a digestive fluid produced in the liver, backs up into the stomach rather than moving into the small intestine. Infections other than H. pylori: Such as those caused by viruses, fungi, or parasites, particularly in individuals with weakened immune systems.

9. Types Acute vs. Chronic Gastritis Acute Gastritis occurs suddenly and usually has a short duration. It often results from dietary indiscretions, excessive alcohol consumption, or acute stress (such as from severe illness or surgery). The gastric mucosa becomes red and swollen, and symptoms can be severe but typically resolve quickly with treatment.

10. Types--- Acute vs. Chronic Gastritis--- Chronic Gastritis develops gradually and persists for a long duration. It may be asymptomatic or cause chronic digestive problems. Chronic gastritis can be caused by persistent infections like H. pylori, autoimmune diseases, or chronic bile reflux. It often leads to changes in the stomach lining over time and increases the risk of gastric atrophy and gastric cancer.

11. Types--- Special Types of Gastritis: Erosive Gastritis (Reactive gastritis): Characterized by significant erosion of the stomach lining due to acidic damage, leading to ulcers and bleeding. Commonly associated with NSAID use or excessive alcohol intake. Atrophic Gastritis: Involves thinning and loss of the gastric mucosa. It may be associated with long-term H. pylori infection or autoimmune conditions targeting stomach cells. This type increases the risk of stomach cancer. Other Types : Including hypertrophic gastritis (where the stomach lining thickens) and lymphocytic gastritis (characterized by an increase in lymphocytes).

12. DIAGNOSIS History Taking and Physical Examination: A thorough medical history is crucial to understand the potential causes of gastritis, including dietary habits, medication use, alcohol consumption, and previous medical conditions. Physical examination may reveal tenderness in the upper abdomen or other signs of acute or chronic gastritis.

13. DIAGNOSIS Diagnostic Tests: Endoscopy : The primary diagnostic tool for gastritis, allowing direct visualization of the stomach lining and the ability to perform a biopsy. Biopsy : Samples taken during endoscopy can confirm inflammation, the presence of H. pylori, or changes like atrophy.

14. DIAGNOSIS Diagnostic Tests--- Urea Breath Test: A non-invasive test that detects H. pylori infection by measuring the breakdown of urea in the breath after swallowing a urea-containing substance. Stool Antigen Test: Used to diagnose H. pylori infection by detecting antigens in the stool. Blood Tests : Can assess for anemia, which may indicate chronic bleeding, and check for markers of H. pylori infection.

15. Risk Factors Understanding the risk factors for gastritis helps in identifying susceptible individuals and tailoring preventive strategies. Key risk factors include: Age : Older adults are more susceptible due to decreased stomach lining protection and increased likelihood of chronic H. pylori infection. Dietary Habits : Spicy foods, acidic foods, and excessive caffeine or alcohol can irritate the stomach lining and exacerbate symptoms.

16. Risk Factors Medications : Regular use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) can weaken the stomach's mucosal barrier, leading to gastritis. Corticosteroids and other medications may also increase susceptibility. Medical Conditions: Chronic conditions such as Crohn’s disease can affect the stomach lining and contribute to the development of gastritis. Stress from surgery, critical illnesses, or severe burns (stress gastritis) also increases risk.

17. Medical Management Effective management of gastritis involves a combination of pharmacological treatment and lifestyle modifications: Pharmacological Treatments: Antacids : Help neutralize stomach acid and provide quick relief from symptoms. Proton Pump Inhibitors (PPIs): Reduce acid production more significantly than H2-receptor antagonists, helping heal the stomach lining. H2-Receptor Antagonists: Decrease acid production by blocking histamine receptors on gastric parietal cells. Antibiotics : Used specifically for treating H. pylori-related gastritis, typically in a combination therapy to ensure eradication of the bacteria.

18. Medical Management--- Dietary and Lifestyle Modifications: Diet Adjustments : Avoid irritants such as spicy foods, alcohol, and caffeine. Incorporate bland, non-acidic foods that are easier on the stomach. Smoking Cessation: Smoking can exacerbate gastritis and delay healing of the stomach lining. Stress Management: Techniques such as meditation, adequate rest, and counseling can help manage stress, which may contribute to the exacerbation of gastritis symptoms.

19. Surgical Management Surgical intervention for gastritis is rare and usually considered only in severe cases or when complications arise. Key points include: Indications for Surgery: Complications from gastritis such as bleeding that cannot be controlled with medical treatment. Suspected malignancy in the gastric tissue that needs to be removed and analyzed. Perforations in the stomach wall.

20. Surgical Management Types of Surgeries: Partial Gastrectomy: Removal of part of the stomach, typically used when there is severe damage or malignancy. Vagotomy: Cutting of the vagus nerve to reduce acid secretion, historically used for ulcer treatment but rarely for gastritis unless other complications are present.

21. Nursing Management Effective nursing management of gastritis focuses on alleviating symptoms, preventing complications, and promoting optimal gastrointestinal health: Monitoring Symptoms and Medication Side Effects: Regular assessment of abdominal pain, nausea, vomiting, and overall gastrointestinal health. Monitoring for adverse effects from medications such as antacids, proton pump inhibitors, and antibiotics, and adjusting doses as necessary.

22. Nursing Management--- Educating Patients About Diet and Lifestyle Adjustments: Guidance on avoiding dietary irritants (spicy foods, alcohol, caffeine). Recommendations for small, frequent meals instead of large meals to reduce stomach distension. Pain Management and Emotional Support: Administering prescribed medications to manage pain and discomfort. Providing support and counseling, especially for patients stressed or anxious about their health, which can exacerbate symptoms.

23. NURSING DIAGNOSIS Nursing diagnoses focus on the current health issues the patient is facing due to gastritis and planning appropriate interventions: Example Diagnoses: Acute Pain Related to Inflammation of Gastric Mucosa: Addressed by pharmacological pain relief and dietary adjustments. Risk for Deficient Fluid Volume Related to Vomiting and Nausea: Managed by monitoring fluid intake and output, encouraging oral fluid intake when possible, and administering IV fluids if necessary.

24. NURSING DIAGNOSIS Care Planning and Interventions: Develop a care plan that includes scheduled medication administration, dietary consultations, and regular monitoring of vital signs and symptoms. Implement interventions such as patient education on lifestyle modifications, stress management techniques, and the importance of following the prescribed treatment regimen.

25. COMPLICATIONS Potential Complications: Gastric Ulcers: Prolonged inflammation can lead to the development of ulcers in the stomach lining, which are painful and may bleed. Gastric Cancer: Chronic gastritis, especially due to H. pylori infection or atrophic gastritis, increases the risk of developing gastric cancer over time. Gastrointestinal Bleeding: This can occur from erosive gastritis or ulceration, leading to significant blood loss and requiring urgent medical intervention.

26. COMPLICATIONS Prevention and Early Detection Strategies: Regular Screening: For individuals at high risk, such as those with chronic H. pylori infection or familial history of gastric cancer. Proactive Management: Immediate treatment of H. pylori infections and regular monitoring to prevent the progression of chronic gastritis. Lifestyle Modifications: Including dietary changes and smoking cessation to reduce the risk of gastritis and its complications.

27. Further Reading and Resources Recommended Textbooks: " Medical-Surgical Nursing: Assessment and Management of Clinical Problems" by Lewis et al. - Comprehensive coverage on the management of gastritis and other medical conditions. " Gastrointestinal Pathophysiology" by Lippincott Williams & Wilkins- Offers insights into the pathophysiological aspects of gastrointestinal diseases, including gastritis.