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THEORETICAL BACKGROUND

OF ACUTE GASTRITIS

A. CONCEPT OF DISEASE
1. Anatomy and Physiology Overview
The stomatch is located at the top left of the abdomen just below the
diaphragm. In the empty state of the J-shaped hull, and when full, it is shaped like
a giant avocado. Anatomically the stomach is divided into fundus, body and
antrum pyloric or pylorus. The upper right side of the stomach is a small curvature
curve, and the lower left portion of the stomach is a major curvatura (Figure 1).
The normal capacity of the stomach is 1 to 2 L (Lewis, 2000). The volume of
the stomach will increase at mealtime, and decreases as the stomach fluid enters
the small intestine. When the stomach is relaxed (empty), the mucosa enters the
crease called rugae (Figure 1). Rugae is a temporary place of gastric enlargement.
When the stomach is filled the rugae narrows and when the stomach is full the
rugae disappears (Simon, 2003).

Figure 1. Stomatch structure

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The digestive and motor function of the hull is summarized in Table 1. The
motor function consists of storage, mixing, and discharging of the stomach fluid
(kimus / food mixed with gastric secretions) to the duodanum.

TABLE 1. STOMATCH PHYSIOLOGICAL SUMMARY


MOTOR FUNCTION DIGESTIVE FUNCTION
Reservoir Store food until the food is Protein The digestion of
function gradually digested and digestion proteins by pepsin and
moves in the gastrointestinal secretion and HCI
tract. begins here; digestion
Adjust the volume increase of carbohydrates and
without increasing pressure fats by amylase and
with smooth muscle small gastric deformity
receptive relaxation; lipase role
mediated by the vagus nerve
and stimulated by gastrin.
Mixing Break food into small Synthesis Synthesis and release
function particles and mix it with and of gastrin is influenced
gastric juices through release of by edible proteins,
muscle contractions that gastrin antrum stretching,
surround the stomach. The alkaline alkalinization,
peristaltic contraction is and vagal stimulation.
governed by a basic
intrinsic electrical rhythm.
Gastric It is regulated by the Secretion Intrinsic factor
emptying opening of the pyloric of secretion allows the
function sphincter affected by intrinsic absorption of vitamin
viscosity, volume, acidity, factors B2 from the distal
osmotic activity, physical intestine.
state, as well as by Secretion Mucus secretions form
emotions, drugs, and work. of mucus a shell that protects the
Gastric emptying is stomach and serves as
governed by nerve and a lubricant so that food
hormonal factors. is more easily
transported.

2. Definition

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Acute gastritis is an acute inflammation of the gastric mucosal surface with
erosive damage to the superficial. Many factors can cause acute gastritis, including
some drugs, alcohol, bacteria, viruses, fungi, acute stress, radiation, allergies or
intoxication from food and beverages, bile salts, ischemia and direct trauma.
 Drugs, such as NSAIDs / Non-steroidal anti-inflammatory drugs
(indomethacin, ibuprofen, salicylic acid), sulfonamides, steroids,
cocaine, chemotherapy agents (mitomycin, 5-fluoro-2-deoxyuridine),
salicylates and digitalis, are also involved in irritating the gastric
mucosa (Gelfand, 1999).
 Alcoholic beverages, such as whiskey, vodka, and gin (Kang, 1995).
 Bacterial infections, such as: H pylori (most frequent), H heilmanii,
Streptococci, Staphylococci, Proteus species, Clostridium species, E
coli, Tuberculosis, Secondary syphilis (Andersen, 2007).
 Viral infections by cytomegalovirus (Giannakis, 2008).
 Fungal infections, such as: Candidiasis, Histoplasmosis, and
Phycomycosis (Feldman, 1999).
 Physical stress caused by burns, sepsis, trauma, surgery, respiratory
failure, renal failure, central nervous system damage, gastrointestinal
reflux (Lewis, 2000).
 Irritant food and drinks. Seasoned food and beverages with caffeine and
alcohol content, are the causes of irritant gastric mucosa (Price, 1996).
 Bile salts occur in bile salt reflux conditions (an important component
of alkali for the activation of gastrointestinal enzymes) from the small
intestine to the gastric mucosa thus causing a mucosal inflammatory
response (Mukherjee, 2009).
 Ischemia, this is associated with a decrease in blood flow to the
stomach (Wehbi, 2009).
 Direct trauma to the stomach, associated with an aggressive balance
and defense mechanisms to maintain mucosal integrity give rise to a
combat response to the gastric mucosa (Wehbi, 2009).

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3. Pathway

4. Supporting Investigation/Diagnostic
 Endoscopy: will appear multi erosion that some are usually bloody and
scattered.
 Examination of Hispatology: will appear mucosal damage because the
erosion never passes through the muscular mucosa.
 Radiology examination.
 Laboratory examination.
 Gaster analysis: to determine the level of HCL secretion, HCL secretion
decreases in the client with chronic gastritis.
 Levels of vitamin B12 serum: Normal value 200-1000 Pg / ml, low vitamin
B12 levels is megalostatic anemia.

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 Levels of hemagiobi, hematocrit, platelets, leukocytes and albumin.
 Gastroscopy. To know the mucosal surface (change) identify the area of
bleeding and take tissue for biopsy.
 EGD (Esofago Gastriduo Denoscopy): Key diagnostic test for upper GI
bleeding, done to see bleeding / degree of tissue ulcers / injury.
 Angiography: GI vascularization can be seen if the endoscope can not be
inferred or can not be performed. Shows the circulation of the cholesterol and
possible contents of the bleeding.
 Serum amylase: increased with duodenal ulcer, low grade suspected gastritis
(Doengoes, 1999, p. 456)
5. Medical Management
Acute gastritis usually resolves when the causative agents are removed.
Medical interventions made when the complaint is not lost by avoiding the
causative agent are by pharmacological therapy including fluid therapy and drug
therapy (Wehbi, 2008).
a. Liquid therapy. This is given in the acute phase for excessive post-vomiting
hydration.
b. Drug therapy.

Prinsive therapy, including:

 There is no specific cure for cure except for Helicobacter pylori infection
(Santacroce, 2008).
 Provision of therapy in accordance with known factors, such as tuberculosis
then get OAT (Anti-Tuberculosis drug) which is adjusted with the protocol of
administration from the MOH RI.
 Provision of pharmacological drugs tailored to the conditions and tolerance of
clients.

Pharmacological drugs, including:

 Antacids. Used for group profiles in general. Antacids contain aluminum and
magnesium that can help decrease gastritis complaints by neutralizing stomach
acid.
 H2 Inhibitor. This agent has a mechanism as it inhibits histamine receptors.
Histamine is believed to have an important role in gastric acid secretion. H2
inhibitors will effectively suppress stomach acid expenditure and stimulate the
release of acid by food from the nervous system. Some agents of this agent
include cimetidine, ranitidine, famotidine and nizatidine. Cimetidine is very

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effective when administered intravenously while ranitidine is more effective
when used orally on an empty stomach with the effect of decreasing the
secretion of acid production, accelerating gastric emptying and balancing
hydrogen concentration.
 Proton pump inhibitors. This agent inhibits proton pumps such as enzymes,
H +, K + -ATPase, which are located within the apical membrane scretory of
gastric acid (parietal cell) stomach cells. This agent has the ability to inhibit
acid production with long duration. These agents include omeprazole (Kee,
1996).
 Antibiotics. This agent is used in gastritis of bacterial infections, such as
Helicobacter pylori. Some antibiotic agents are recommended such as oral
amoxicillin, oral tetracycline, oral metronidazole.
6. Nursing Care Plan
1. Assessment
a. Nursing history
 Main complaint
Usually clients come with pain complaints on epigastrium, nausea,
vomiting, anorexia and dizziness.
 History of current disease
In acute gastritis is usually accompanied by a history of food poisoning
drinks. Decreased awareness level, vomiting, weak pulse tachycardia,
rapid breathing and severe pain in the entire abdomen, pain in the
esophagus, tongue burns. There may also be an increase in intestinal
peristalsis, diarrhea or melena.
 History of previous disease
Includes disease-related diseases now, hospital history, and history of drug
use.
b. Physichal examination
 General situation: Looking painful on physical examination there is
tenderness in the epigastric quadrant.
 B1 (breath): Thakipnea
 B2 (blood): Tachycardia, hypotension, dysrhythmias, weak peripheral
pulse, slow peripheral fill, pale skin color.
 B3 (brain): Headache, weakness, level of consciousness can be disturbed,
disorientation, pain epi gastrum.
 B4 (bladder): Oliguria, fluid balance disorder.

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 B5 (bowel): Anemia, anorexia, nausea, vomiting, heartburn, intolerant
spicy food.
 B6 (bone): Weakness, fatigue.
c. Supporting Investigation/Diagnostic
 Endoscopy: will appear multi erosion that some are usually bloody and
scattered.
 Examination of Hispatology: will appear mucosal damage because the
erosion never passes through the muscular mucosa.
 Radiology examination.
 Laboratory examination.
 Gaster analysis: to determine the level of HCL secretion, HCL secretion
decreases in the client with chronic gastritis.
 Levels of vitamin B12 serum: Normal value 200-1000 Pg / ml, low
vitamin B12 levels is megalostatic anemia.
 Levels of hemagiobi, hematocrit, platelets, leukocytes and albumin.
 Gastroscopy. To know the mucosal surface (change) identify the area of
bleeding and take tissue for biopsy.
 EGD (Esofago Gastriduo Denoscopy): Key diagnostic test for upper GI
bleeding, done to see bleeding / degree of tissue ulcers / injury.
 Angiography: GI vascularization can be seen if the endoscope can not be
inferred or can not be performed. Shows the circulation of the cholesterol
and possible contents of the bleeding.
 Serum amylase: increased with duodenal ulcer, low grade suspected
gastritis (Doengoes, 1999, p. 456).
2. Nursing Diagnosis
Diagnosis 1: Deficient fluid volume related to active fluid volume loss.
Diagnosis 2: Imbalance nutrition: less than body requirtments related to
anorexia, nausea and vomiting.
Diagnosis 3: Impaired comfort related to epigastric pain
3. Nursing Intervention
Diagnosis 1: Deficient fluid volume related to active fluid volume loss.
Goals: After getting treatment for 3 days the fluid and electrolyte client
balance will balance again
After being given nursing care for 3x24 expected fluid and electrolyte client
balance with result’s criteria:
NOC Label>> Fluid Balance
 Turgor elastic skin (scale 5)

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 Intake and balanced fluid output (scale 5)
 Moist mucus membrane (scale 5)

NOC label >> Vital sign

Vital signs of clients in normal range (BP: 120/80 mmHg, RR: 15-20
x/minutes, HR: 60-100 x/minutes, client temperature 36.5-37,5o C)

INTERVENTION RATIONALE
NIC Label >> Electrolyte Monitoring 1. Know the cause to determine the
1. Identify possible causes of electrolyte settlement intervention
imbalance 2. Know the general state of the client
2. Monitor for fluid and electrolyte loss 3. Reduce the risk of voume fluid
3. Monitor the presence of nausea, deficiency is increasing
vomiting and diarrhea
NIC Label >> Fluid Management 1. Know the progress of rehydration
1. Monitor hydration status (mucous 2. Evaluation of interventions
membrane, orthostatic pressure, pulse 3. Know the general state of the client
strength) 4. Optimal rehydration
2. Monitor the accuracy of intake and
fluid output
3. Monitor vital signs
4. Monitor IV therapy
NIC Label >> Vital Signs Monitoring To know the client’s vital sign
Monitor client’s vital sign

Diagnosis 2: Imbalance nutrition: less than body requirtments related to


anorexia, nausea and vomiting.

Goals: After getting treatment for 3 days the nutrition will balance again.
After done nursing care for 3 × 24 hours expected fulfillment of client
requirement fulfilled with result’s criteria:
NOC Label >> Nutritionl status
 Sufficient nutrition intake.
 Adequate food and fluid intake
NOC Labels >> Nausea and vomiting severity
 Decreased intensity of nausea vomiting
 Decreased frequency of nausea and vomiting.
NOC Labels >> Weight: Body mass

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Clients experience weight loss

INTERVENTION RATIONAL
NOC Label >> Nutritionl status 1. An important assessment is conducted
1. Determine client’s nutritional status to determine the nutritional status of
and ability to meet nutrition needs the client so as to determine the
2. Instruct client about nutritional needs intervention given.
(i.e., discuss dietary guidelines and 2. To help meet the nutritional needs of
food pyramids) the client.
3. Assist client in determining guidelines 3. The information provided can
or food pyramids (e.g, vegetarian food motivate the client to improve the
pyramid, food guide pyramid, and nutritional intake.
food pyramid for seniors over 70)
most suited in meeting nutritional
needs and preferences

NOC Labels >> Nausea and vomiting 1. It is important to know the


severity characteristics of nausea and the
1. Perform complete assessment of factors that cause nausea. If the
nausea, including frequency, duration, characteristics of nausea and causing
severity, and precipitating factors, factors of nausea are known then it
using such tools as self-care journal, can determine the intervention given.
visual analog scales, duke descriptive 2. Eating little by little can increase the
scales, and rhodes index of nausea nutritional intake.
and vomiting (INV) form 2
2. Encourage eating small amounts of
food that are appealing to the
nauseated person
NOC Labels >> Weight: Body mass 1. Helps to choose an adequate nutrition
1. Discuss with individual the fulfillment option.
relationship between food intake, 2. Weighing can monitor the
exercise, weight gain and weight loss improvement and nutritional status.
2. Encourage individual to chart weekly
weights, as appropriate

Diagnosis 3: Impaired comfort related to epigastric pain.

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Goals: After getting treatment for 3 days the problem of pain relief pain is
overcome

After getting treatment for 3x24 hours, pain relief problem can be overcome
with result’s criteria:

NOC Label >> Pain Level

 The frequency of client pain decreases


 The client does not seem to wince

NOC Tags >> Comfor Status: Physical

 Client can control the symptoms


 Relaxation of the client muscle
INTERVENTION RATIONAL
NIC label: Pain Management 1. Reduce the scale of pain felt by the client
1. Ensure that clients get the analgesic 2. Prevent client pain getting worse
appropriately 3. Provide techniques to deal with pain in the
2. Exploring factors that can aggravate client
clients' pain
3. Teach the principles in managing pain
NIC label: Environmental Management 1. Provide a comfortable temperature for the
Comfort client more relaxed
1. Set the room temperature at a comfortable 2. Prevent the emergence or worsen the bad
temperature for the client feeling of discomfort to the client
2. Reduce the things that can interfere with
the client's convenience

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