1. GASTRITIS
BY JAMES NYIRENDA.

2. Definition.
•Gastritis is an inflammation of the
gastric mucosa or lining of the stomach.
• Can be classified as either acute or
chronic.

3. Pathophysiology of gastritis
•The gastric mucosa is protected from acid
autodigestion by prostaglandins. Injury occurs
when there is a break in the protective barrier.
The resulting injury is compounded by histamine
release and vagal nerve stimulation which leads to
hydrochloric acid diffusing back into the mucosa
and injure small vessels resulting in edema,

4. .
, haemorrhage, and erosion of the
stomach’s lining. As the disease
progresses, the walls and lining of the
stomach thin and atrophy decreasing
the function of the parietal cells.

5. .
•The source of intrinsic factor is also
lost and the absorption of vitamin B
12 is impaired leading to pernicious
anaemia.

6. ACUTE GASTRITIS
•Definition:
•This is an acute inflammation of the
gastric mucosa or sub mucosa with
destruction of the superficial epithelial
cells (Bloom, 2005). The condition lasts a
few hours to few days.

7. Causes
•Thermal causes: very hot fluids or food.
•Chemical Causes
•Ingestion of corrosive substances.
•Food which cause irritation such as
spiced food , alcohol.

8. .
•Drugs such as aspirin and other
nonsteroidal anti-inflammatory agents
(in large doses), cytotoxic agents,
caffeine, corticosteroids,
antimetabolites, phenylbutazone, and
indomethacin excavates the mucosa of
the stomach.

9. .
•Bacterial causes: endotoxins released from
infecting bacteria such as staphylococci,
Escherichia coli, salmonella and helicobacter
pylori.
•Conditions- uraemia, shock, prolonged
emotional tension, major burns, hepatic
diseases, renal diseases, peptic ulcers, major
surgery.

10. .
•Bile reflux: A backflow of bile into the
stomach from the bile tract (that connects to
the liver and gallbladder) irritates the mucosa
membrane of the stomach.
•Exposure to certain procedures such as nasal
gastric tube insertion and endoscopy

11. Signs and symptoms
•Sudden onset of symptoms
•Anorexia
•Nausea and vomiting
• Dyspepsia

12. .
•Epigastric pains of varying severity
•Haematemesis and maleana stool if gastric
bleeding occurs.
•Water brush syndrome – clear fluid which
comes through the mouth due to reflex
salivation in response to duodenal ulceration.

13. .
•Signs and symptoms of pernicious
anaemia (lack of cynocobalamine –
Vitamin responsible for maturation
of RBC) due to loss of intrinsic
factor.

14. .
•Colic diarrhea 2 – 4 hours following
intake of contaminated food if
gastritis is due to food poisoning.
•Fever may be present.

15. Diagnosis
•Endoscopy/ gastroscopy will show inflamed gastric
membranes
•FBC for laboratory tests will reveal low Hemoglobin
level due to concealed bleeding as occult blood will be
present in vomitus and stool. Erythrocyte
Sedimentation Rate (ESR) will also be raised due to
infection.
•Histological examination of biopsy specimen

16. .
•Serologic testing for antibodies for
Helicobacter pylori or breath test.
•Gastric acid analysis which will reveal
increased HCL secretion

17. Medical and Nursing Management
•The gastric mucosa is capable of repairing
itself after an attack of less severe gastritis.
•Patient recovers in about a day, although the
appetite may be diminished for an additional
2 or 3 days.

18. .
•Management is largely symptomatic. Oral
fluids and food are withheld while patient is
vomiting. Oral fluids and non-irritating food
should be re-introduced gradually according
to the patient’s tolerance.

19. .
•Patient will then progress to normal diet.
Intravenous fluids are administered if the
gastritis lasts longer than 12-18 hours, or if
there is evidence of dehydration and
electrolyte imbalance, in this case, the
patient will be hospitalized and will need
complete bed rest.

20. .
•The following drugs may be prescribed:
•Antiemetic such as promethazine to
relieve nausea and vomiting but avoid
when the cause is due to corrosives.

21. .
•Anticholinergic such as atropine to decrease
gastric secretions and to relax smooth
muscle.
•Cimetidine is usually given to reduce gastric
acid secretion when there is haemorrhage
associated with gastritis

22. CHRONIC GASTRITIS
• Definition
•It is a chronic degeneration of the
mucosa membranes of the stomach
which may follow prolonged dietary
indiscretion or alcohol abuse.

23. Causes
•Helicobacter pylori (most
cause).
•Alcohol abuse
•Thyroid disease

24. .
•Diabetes mellitus
•Radiation therapy
•Repeated attacks of acute gastritis
•Auto immune condition such as pernicious
anaemia
•Smoking

25. Signs and symptoms
•Anorexia leading to weight loss
•Nausea and vomiting (heamatemesis) which
relieves pain due to irritations of the gastric
mucosa.
•Dyspepsia due to impaired gastric function

26. •Flatulence (presence of gas) due to impaired
gastric function.
•Epigastric pain (heart burn) due to
regurgitation of gastric contents
•Abdominal pain due to erosion of the gastric
mucosa

27. .
•Melena stool due to gastric bleeding
•Constipation which is later followed by
diarrhoea caused by enteritis.
•Slow in progression

28. Diagnosis
•History from the patient will reveal recurrence of
acute gastritis.
•Barium meal will reveal inflammation of the
gastric mucosa
•Endoscopy/Gastroscocpy reveal inflammation of
the gastric mucosa
•Stool for occult blood

29. .
•FBC will reveal low HB due to
bleeding
•Gastric acid analysis which will
reveal increased HCL secretion.

30. MEDICAL MANAGEMENT.
•Antiemetic drugs are administered to
treat nausea and vomiting e.g.
promethazine 25-50mgs either IM or IV
for 3 days or Plasil 10-20mgs t.d.s by
3day.

31. .
•Antacids to relieve pain or
discomforts. such as Aluminum
hydroxide 200-400mgs t.d.s for 7days.
•Histamine receptor blockers these
drugs help to reduce production of
hydrochloric acid e.g. cimetidine 200-
400mgs t.d.s for 14days.

32. Nursing care of gastritis
•Aims
•Prevent complications
•Relieve signs and symptoms
•Help in healing process.
•Reducing anxiety.

33. Environment
•Patient is nursed in a general medical ward.
Environment should be clean , well ventilated to
promote air circulation and quite to promote rest.
•Position
•Nurse the patient in any comfortable position
preferably in a semi-fowlers position to prevent
regurgitation of gastric juice.

34. Rest
•Ensure noise free environment to promote
rest. Do nursing activities collectively to
avoid disturbances thereby promoting rest.

35. Observations
•Observe general condition of patient to see
whether improving, static or worsening. Monitor
vital signs such as temperature, pulse,
respirations and blood pressure and record the
findings. High temperature indicates presence of
infection, rapid pulse and low BP will indicate
bleeding.

36. .
•Observe stool and vomitus for colour,
consistency, amount and odor. If blood is
present in stool and vomitus, give ice drinks
to patient to constrict blood vessels thereby
arresting the bleeding. Check for abdominal
tenderness and also observe patient for any
complications such as gastric ulcers. Patient
should be weighed daily.

37. Psychological care
•Explain condition to patient and his/her
relatives in simple terms and this should
include possible causes, disease process,
treatment and why certain things are not
allowed. This is to alley anxiety and gain
cooperation.

38. .
•Allow patient to ask questions and
answer them correctly. This is to help
patient understand his/her condition.
Involve patient and relatives in the plan
of their care to avoid dependency.

39. Nutrition and fluids
•Provide nutritious balanced meals containing
proteins and vitamins to promote healing,
carbohydrates to provide energy and vitamins to
boost the immunity. Since patient may have
anorexia and vomiting, serve food in small
frequent amounts to promote appetite and
prevent vomiting.

40. .
•Avoid spiced foods for this may worsen the
condition. Give fluids either orally or
intravenously to prevent dehydration and also to
flush out toxins.
•Patients should be discouraged to consume
alcohol because it can worsen the condition

41. Elimination
•Observe intake and output. Observe stool and
vomitus for consistency, color, amount and odor
and then record and report. Observe the bowel
patterns of the patient. Give patient food rich in
roughage and encourage patient to take alot of
fluids to prevent constipations.

42. Exercises
•Initially patient may be on total bed rest
but as the condition improves,
encourage patient to do passive
exercises to prevent complications such
as deep vein thrombosis and to promote
blood circulation

43. Hygiene
•If condition is bad and patient is unable to
bath herself, do bed bath to promote
hygiene, comfort and blood circulation. Do
oral care to prevent mouth infections and
promote appetite. Do nail care also to
prevent accumulation of dirt. Change bed
linen when soiled or dirty

44. .
•Advise patient on importance of drug
compliance.
•Advice on importance of following the review
dates.
•Teach patient signs and symptoms of
complications.
•Emphasise on the need of changing life style such
as to stop drinking.

45. Complications
•Gastric ulcers
•Haemorhage
•Anaemia
•Obstruction
•Perforation
•Peritonitis
•Cancer of the stomach