GASTRITIS (English Version)

 

• Acute Gastritis
  Gastritis (inflammation of the stomach) is most often due to a dietary indiscretion. The individual eats too much or too rapidly or eats' food that is noxious because it is too highly seasoned or is infected. Other causes of acute gastritis include alcohol, aspirin. uremia, or radiotherapy. gastritis may also be the first sign of an acute systemic infection.
  
  
  • Pathophysiology and Clinical Manifestations.
    The gastric mucous membrane becomes edematous and hyperemic and undergoes superficial erosion; it secretes a paucity of gastric juice, containing very little acid but much mucus. The patient may have uncomfortable feelings in his abdomen, with headache, lassitude, nausea, and anorexia, often accompanied by omiting and hiccupping. Some patients, however, are asymptomatic.
    
    The gastric mucosa is capable of repairing itself after
    a bout of gastritis. Occasionally, hemorrhage occurs; it may be severe and may require surgical intervention. If the irritating food is not vomited. but reaches the bowel, colic and diarrhea may result. As a rule, the patient is well in about a day, although he may not have much appetite for
    the next 2 or 3 days.
    
    Nursing goals of care for patients with gastritis are to provide physical support through an acute episode, and in a patient with a chronic or more severe episode, to providefor further referral or emergency care. Later, when the acute episode has passed, the goal is to provide information that will help the patient to avoid a subsequent attack.
    
    
  • Nursing Assessment.
    A history is important to identify whether known dietary excesses or other indiscretions are associated with the current symptoms, whether others in the patient's environment have similar symptoms, whether the patient is vomiting blood, and whether any known caustic element has been swallowed. The length of time of the current symptoms and any interventions tried by the patient, and their effects, should also be identified.
    
  • Management and Nursing Intervention.
    Management consists of permitting the patient nothing by mouth until acute symptoms subside. When the patient is able to take nourishment by mouth, a bland diet, perhaps supplemented by alkalis, is offered. If the symptoms persist, parenteral administration of fluids may become necessary.
    
    
  • Evaluation of Nursing Interventions.
    When the acute episode has subsided, the nurse^-should discuss with the patient the importance of avoiding the causative agent (if known). The nurse should evaluate the patient's knowledge of drugs (e.g., antacids) to be taken in the event of future episodes. If alcohol ingestion is a factor, the nurse should provide information regarding appropriate referral, and if diet is a factor, the nurse should discuss with the patient an acceptable, nonirritating diet. Written instructions regarding drug and diet information are helpful for the patient's review after discharge or treatment.
    
    
  • Corrosive
    Gastritis. A more severe form of acute gastritis is caused by the ingestion of strong acids or alkalies (corrosive gastritis). Immediate treatment consists of diluting and neutralizing the offender.
    
    • To neutralize acids, use common antacids (milk, aluminum hydroxide, etc.); to neutralize an alkali, use lemon juice or diluted vinegar.
      
    • If corrosion is extensive and severe, avoid emetics and lavage, because of the danger of perforation.
      

    
    Therapy thereafter is supportive, including nasogastric incubation, analgesics and sedatives, antacids, intravenous fluids, and electrolytes.
    
    It may be necessary to evaluate the situation by fiberoptic endoscopy. Emergency surgery may be required to take care of gangrenous or perforated tissue. Corrosive gastritis can result in scarring and cause pyloric obstruction, which may require gastrojejunostomy or resection.
    
    

• Chronic Gastritis
  
  • Pathophysiology.
    In patients with chronic gastritis, the mucous membrane of the stomach becomes thickened and its rugae are prominent. As time passes, both the lining and the walls become thinned, and secretion lessens in quantity and in quality, eventually consisting almost entirely of mucus and water.
    
  • Causes.
    One of the important causes of chronic gastritis is chronic uremia. Among the local causes of gastritis are benign and malignant ulcers of the stomach and cirrhosis of the liver complicated by portal hypertension, the latter causing chronic congestion of the stomach wall.
    
  • Clinical Manifestations.
    Symptoms of chronic gastritis vary greatly. The appetite may be poor (anorexia) or too good (bulimia); there is usually some_. distress ("heartburn") after eating, and often there are eructations of gas. The taste in the mouth is unpleasant; there is usually considerable nausea, and perhaps some vomiting, especially early in the morning. The diagnosis is determined by gastroscopy, upper gastrointestinal x-ray series, and histologic examination.
    
  • Management.
    Treatment is similar to the medical regimen recommended for the patient with peptic ulcer. Patients with diffuse atrophic gastritis may require supplementary vitamin B12.