GASTRITIS MEDICAL MANAGEMENT
• Gastritis is an inflammation of the gastric mucosa.
• Gastritis may be acute, lasting several hours to a few
days, or chronic, resulting from repeated exposure to irritating agents or
recurring episodes of acute gastritis
• Acute gastritis maybe classified as erosive or non-erosive.
• The erosive form of acute gastritis is often caused by local irritants
such as aspirin and other NSAIDS; alcohol consumption; and gastric
radiation therapy.
• The non-erosive form is often caused by an infection
with Helicobacter or H.pylori.
A more severe form of acute gastritis is caused by the ingestion of strong
acid or alkali, which may cause the mucosa to become gangrenous or to
perforate.
Stress-related gastritis may also develop in acute illnesses, especially
when the patient has had major traumatic injuries; burns; severe
infection ; hepatic, kidney, or respiratory failure; or major surgery.
PATHOPHYSIOLOGY
Gastritis is characterized by a disruption of the mucosal barrier that
normally protects the stomach tissue from digestive juices (e.g. HCl and
pepsin). The impaired mucosal barrier allows corrosive HCl, pepsin, and
other irritating agents (e.g., NSAIDS and H.pylori) to come in contact with
the gastric mucosa, resulting in inflammation. Inflammation causes the
gastric mucosa to become edematous,and hyperemic (congested with fluid
and blood) and to undergo superficial erosion.
CLINICAL MANIFESTATIONS
• Epigastric pain or discomfort
• Dyspepsia (Indigestion)
• Anorexia
• Hiccups
Nausea and Vomiting
• In erosive gastritis, bleeding may manifest as blood
in vomit or as melena (black tarry stools) or hematochezia
(bright red, bloody stools).
The patient with chronic gastritis may complain of fatigue,
pyrosis (a burning sensation in the stomach and esophagus
that moves up to the mouth; heartburn) after eating,
belching, a sour taste in the mouth, early satiety, anorexia,or
nausea and vomiting.
DIAGNOSIS
• Endoscopy with biopsy
• CBC
• Stool examination for occult blood
Gastric analysis
• 1. Elimination of causative factor (especially if
perpetuated by dietary of lifestyle based actions)
• 2. Antiemetics for nausea and vomiting
3. Antacid, H2 acid blockers, proton pump inhibitors to
decrease gastric acid production and lower acidity in the
gastic area to lessen mucosal injury and decrease pain.
• 4. Treatment iof H. pylori with antibiotics plus gastic
acid - redgulating drugs.
Surgical Intervention (optional only if medical intervention
fails or hemorrhage occurs.)
NURSING INTERVENTION
• Goal No.1: To decrease gastric irritation
• a. Nothing by mouth (NPO) initially, with IV fluid and
electrolyte replacement.
• b. Administer medications as prescribed.
c. Advise bed rest
• d. Begin clear liquids when symptoms subside
Goal No. 2: To Assist client to identify and avoid precipitating
causes
Malabsorption Syndrome
Definition:
-It is a state arising from abnormality in absorption of food
nutrients across the gastrointestinal tract (GIT).
-Impairment can be of single or multiple nutrients depending
on the abnormality.
-This may lead to malnutrition and a variety of anaemias.
Malabsorption constitutes the pathological interference with
the normal physiological sequence of body such as:
 Digestion (intraluminal process),
Absorption (mucosal process) and
 Transport (postmucosal events) of nutrients.
Causes of malabsorption:
Intestinal malabsorption can be due to:
1. digestive failure caused by enzyme deficiencies
2. structural defects
3. mucosal abnormality
4. infective agents
5. systemic diseases affecting GIT Symptoms can be

1. Extraintestinal

1. Due to digestive failure: 2. Intraintestinal

• Pancreatic insufficiencies: Diarrhoea, often steatorrhoea is the most common feature.

It is due to impaired water, carbohydrate and electrolyte
• cystic fibrosis
absorption.
• chronic pancreatitis
Other symptoms include:
• carcinoma of pancreas
- Weight loss
• Bile salt insufficiency:
-Growth retardation
• obstructive jaundice
-Swelling or edema
• bacterial overgrowth
-Anaemias
2. Due to structural defects:
-Muscle cramps and bleeding tendencies.
•Inflammatory bowel diseases commonly: Crohn's Disease

• Gastrectomy and gastro-jejunostomy

Specific Disease Entities causing malabsorption
• Fistulae, diverticulae and strictures.
1. Celiac sprue
• Infiltrative conditions such as amyloidosis, lymphoma.
- common cause of malabsorption
•Short bowel syndrome.
- Age: ranging from first year of life
•Eosinophilic gastroenteropathy etc.
through the eighth decade.
3. Due to mucosal abnormality:
Etiology: not known.
-Coeliac disease

4. Due to enzyme deficiencies:

But three factors can contribute:
-Lactase deficiency inducing lactose intolerance
1. environmental.
- Disaccharidase deficiency
2. immunologic.
- Enteropeptidase deficiency
3. genetic factors.
5. Due to infective agents:

-Whipple's disease
1. Environmental factor:
-Intestinal tuberculosis
- There is association of the disease with gliadin, a
-Tropical sprue component of gluten that is present in wheat.

-Parasites e.g. Giardia lamblia. 2. Immunologic factor:

6. Due to other systemic diseases affecting GI tract: - Serum antibodies are detected such as antigliadin.

-Hypothyroidism and hyperthyroidism 3. Genetic factor:

-Diabetes mellitus - Almost all patients express the HLA-DQ2 allele

-Hyperparathyroidism and Hypoparathyroidism

-Carcinoid syndrome Diagnosis:

-Malnutrition. - A small-intestinal biopsy should be done for suspected

patients.

- The hallmark of celiac sprue is the presence of an abnormal

Symptoms of malabsorption small-intestinal biopsy.
 Chronic multisystem disease associated with diarrhea,
steatorrhea, weight loss, arthralgia, and central nervous
2. Tropical Sprue
system (CNS) and cardiac problems .
- Caused by infectious agents including Giardia lamblia,
Diagnosis:
Yersinia enterocolitica, Clostridum difficile.
- identification of T. whipplei by polymerase chain reaction
-it tends to involve the distal small bowel.
(PCR).
-total villous atrophy is uncommon.
- PAS-positive macrophages in the small intestine and other
organs with evidence of disease.

3. Crohn’s Disease

It is an inflammatory bowel disease * Management of malabsorption syndrome:

 Marked by patchy areas of inflammation anywhere in GIT Replacement of nutrients, electrolytes and fluid may be
from mouth to anus . necessary.

Body’s immune system attacks GIT leading to chronic In severe deficiency, hospital admission may be required
inflammation. for parenteral administration.

Pancreatic enzymes are supplemented orally in pancreatic

4. Short Bowel Syndrome
-Following resection, diarrhea and/or steatorrhea can appear
due to decrease in the area of the absorptive surface area.
insufficiency.
Dietary modification is important in some conditions:
Gluten-free diet in coeliac disease.

-Other symptoms include cramping, bloating and heartburn. Lactose avoidance in lactose intolerance.

Antibiotic therapy will treat Small Bowel Bacterial

overgrowth.
5. Bacterial Overgrowth Syndrome

- There is proliferation of colonic-type bacteria within the

small intestine.

- Due to stasis caused by impaired peristalsis. This lead to

diarrhea and malabsorption.

Pathophysiology:

* Bacterial over growth leads to:

1. Metabolize bile salt resulting in deconjugation of bile salts;

→ ↓ Bile Salt and malabsorption of fat.

2. Damage of the intestinal villi by:

• Bacterial invasion

• Toxin/.

• Metabolic products

→ Damaged villi → cause total villous atrophy.

6. Whipple's Disease

Cause: by the bacteria Tropheryma whipplei.

Effect: