Gastritis

Gastritis is a condition in which the stomach lining—known as the mucosa—is inflamed. The stomach lining contains special cells that produce acid and enzymes, which help break down food for digestion, and mucus, which protects the stomach lining from acid. When the stomach lining is inflamed, it produces less acid, enzymes, and mucus.

 

Gastritis may be acute or chronic. Sudden, severe inflammation of the stomach lining is called acute gastritis. Inflammation that lasts for a long time is called chronic gastritis. If chronic gastritis is not treated, it may last for years or even a lifetime.

Erosive gastritis is a type of gastritis that often does not cause significant inflammation but can wear away the stomach lining. Erosive gastritis can cause bleeding, erosions, or ulcers. Erosive gastritis may be acute or chronic.

The relationship between gastritis and symptoms is not clear. The term gastritis refers specifically to abnormal inflammation in the stomach lining. People who have gastritis may experience pain or discomfort in the upper abdomen, but many people with gastritis do not have any symptoms.

Causes

• Helicobacter pylori (H. pylori) infection causes most cases of chronic nonerosive gastritis. H. pylori are bacteria that infect the stomach lining. H. pylori are primarily transmitted from person to person. In areas with poor sanitation, H. pylori may be transmitted through contaminated food or water.
• In industrialized countries like the United States, 20 to 50 percent of the population may be infected with H. pylori.¹ Rates of H. pylori infection are higher in areas with poor sanitation and higher population density. Infection rates may be higher than 80 percent in some developing countries.¹
• The most common cause of erosive gastritis—acute and chronic—is prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. Other agents that can cause erosive gastritis include alcohol, cocaine, and radiation.
• Traumatic injuries, critical illness, severe burns, and major surgery can also cause acute erosive gastritis. This type of gastritis is called stress gastritis.
• Less common causes of erosive and nonerosive gastritis include autoimmune disorders in which the immune system attacks healthy cells in the stomach lining
• some digestive diseases and disorders, such as Crohn’s disease and pernicious anemia
• viruses, parasites, fungi, and bacteria other than H. pylori

Symptoms

The following symptoms can be a result of gastritis or can be related to the underlying cause:

• Upper abdominal pain or discomfort
• Gastric hemorrhage
• Hyperchlorhydria
• Appetite loss
• Belching
• Nausea
• Vomiting
• Fever
• Lethargy

Diagnosis

The most common diagnostic test for gastritis is endoscopy with a biopsy of the stomach. The doctor will usually give the patient medicine to reduce discomfort and anxiety before beginning the endoscopy procedure. The doctor then inserts an endoscope, a thin tube with a tiny camera on the end, through the patient’s mouth or nose and into the stomach. The doctor uses the endoscope to examine the lining of the esophagus, stomach, and first portion of the small intestine. If necessary, the doctor will use the endoscope to perform a biopsy, which involves collecting tiny samples of tissue for examination with a microscope.
Other tests used to identify the cause of gastritis or any complications include the following: 

• Upper gastrointestinal (GI) series. The patient swallows barium, a liquid contrast material that makes the digestive tract visible in an x ray. X-ray images may show changes in the stomach lining, such as erosions or ulcers.
• Blood test. The doctor may check for anemia, a condition in which the blood’s iron-rich substance, hemoglobin, is diminished. Anemia may be a sign of chronic bleeding in the stomach. 
• Stool test. This test checks for the presence of blood in the stool, another sign of bleeding in the stomach. 
• Tests for H. pylori infection. The doctor may test a patient’s breath, blood, or stool for signs of infection. H. pylori infection can also be confirmed with biopsies taken from the stomach during endoscopy.

Treatment

Treatment for gastritis usually consists of removing the irritant or the infection. In cases of infection, a doctor will most often prescribe antimicrobial drugs. Helicobacter infection typically responds well to the triple therapy protocol (consisting of two antibiotics, and a proton pump inhibitor). Regimens that work well include PCA or PCM triple therapy (PPI, Clarithromycin, Amoxicillin) or (PPI, Clarithromycin, Metronidazole). Quadruple therapy has a >90% success rate and includes PPIs, Bismuth subsalicylates, Metronidazole, and Tetracycline.

 

Nursing considerations

Acute Pain may be related to irritation/inflammation of gastric mucosa, possibly evidenced by verbal reports, guarding/distraction behaviors, and autonomic responses (changes in vital signs).

Risk for deficient Fluid Volume [isotonis]: risk factors may include excessive losses through vomiting and diarrhea, continued bleeding, reluctance to ingest/restrictions of oral intake.

Risk for imbalanced Nutrition: less than body requirements: risk factors may include inability to ingest adequate nutrients (prolonged nausea/vomiting, anorexia, epigastric pain).*

Deficient Knowledge [Learning Need] regarding pathophysiology, psychologic factors, therapy needs, and potential complications may be related to lack of information/misinterpretation, possibly evidenced by verbalization of concerns, questions, misconceptions, and continuation of problem.

Key outcomes Nursing Care Plans For Gastritis

The patient express feelings of comfort.
The patient express an understanding of the disorder and treatment regimen.
The patient maintain weight.
The patient express concerns about his current condition.
The patient maintain normal fluid volume

Interventions Nursing Care Plans For Gastritis

Provide physical and emotional support.
Provide  e antiemetics and replace I.V. fluids as ordered. Monitor fluid intake and output and electrolyte levels.
Monitor the patient for returning symptoms as food is reintroduced after he has received nothing by mouth. At this time, provide a bland diet that takes into account his food preferences.
small, frequent meals to reduce the amount of irritating gastric secretions.
Patient teaching Nursing Care Plans For Gastritis
Teach the patient about gastritis
Reinforce the physician's explanation of the procedure and provide preoperative teaching.
Provide the patient list of foods to avoid

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