1. COURSE : MEDICINE AND MEDICAL NURSING
TOPIC : GASTRITIS
DATE : 4TH JUNE, 2020
PRESENTER : MS KWALEYELA M C
2. GASTRITIS
• Gastritis
• Gastritis means inflammation of the gastric or
stomach mucosa. It is the most common gastro
intestinal problem.
• Classification
• Gastritis can be acute, lasting several hours to a
few days, or chronic resulting from repeated
exposure to irritating agents or recurring episodes
of acute gastritis.
3. Gastritis cont’d
Acute gastritis
This is the most common disorder, it is generally
benign self limiting disorder associated with
infection of gastric mucosa. It causes mucosal
erosion.
Causes of acute gastritis
• Dietary discretion- the person can eat foods that
is contaminated with disease- causing.
4. Gastritis cont’d
micro organism or that is irritating or too highly
seasoned
• Overuse of aspirin and other nonsteroidal anti
inflammatory drugs (NSAIDs).
• Excessive alcohol intake
• Bile reflux
• Radiation therapy
5. Gastritis cont’d
• A severe form of acute gastritis is caused by the
ingestion of strong acid or alkaline, which may
cause the mucosa to be come gangrenous or to
perforate. Scarring may occur, resulting in
pyloric obstruction
• Gastritis may also be the first sign of systemic
infection.
6. Gastritis cont’d
Pathophysiology of acute gastritis
Acute gastritis is characterized by disruption of
the mucosal barrier by local irritant. This
disruption allows Hydrochloric acid (HCL) and
pepsin to come into contact with gastric tissue
resulting into irritation and inflammation.
However, the gastric mucosal rapidly regenerates
when the local irritant is stopped, making the
condition self limiting disorder
7. Gastritis cont’d
Clinical manifestation of acute gastritis
• Epigastric pain due reflux of HCL.
• Blood in vomitus due to erosion of the mucosa.
• Abdominal tenderness
• Nausea and vomiting
• Hiccupping
• Lassitude
• Anorexia due to pain on intake of food leading to
weight loss
• Dispepsia
• Hematemesis and meleana
8. Gastritis cont’d
Chronic gastritis- is the inflammation of the
stomach that happens for prolonged period. It is
progressively and irreversible. It is common in
the elderly due to degeneration of tissues and
also common in chronic smokers due to
stimulation of HCL acid.
9. Gastritis cont’d
Causes of chronic gastritis
• Chronic gastritis and prolonged inflammation of
the stomach may be caused by either benign or
malignant ulcers of the stomach or by bacteria
called helicobacter pylori
• Sometimes chronic gastritis is associated with
autoimmune disease such as pernicious anaemia
10. Gastritis cont’d
• . Dietary factor such as caffeine
• Use of medication especially NSAIDs
• Alcohol causes direct damage to the mucosa
• Smoking
• Reflux of intestinal contents into the stomach.
• Hot drinks and spices
• Diabetes mellituis due easy atrophy of the mucosa
lining
11. Gastritis cont’d
Pathophysiology of chronic gastritis
The disease result from progressive erosion and
inflammation and causes parietal cells changes
leading to atrophy and cellular infiltration
especially in the fundus of the stomach. The
disease destroys the glands and mucosa.
13. Medical management
Investigations
1) History taking of signs and symptoms such as
pain, vomiting of blood, smoking, alcohol
consumption, ingestion of spiced foods and hot
pepper.
2) Physical examination
Abdominal tenderness and distension
14. Investigation cont’d
Endoscopy (Gastroscopy) will reveal inflammation
and erosion of the gastric mucosa.
• You can also do a biopsy will reveal any tissue
damage and abdominal abnormalities
• Haemoglobin level estimation – which may be
below (anaemia).
• Laboratory analysis of vomitus and stool will
review occult blood.
15. Treatment
1) Eliminate the cause of gastritis e.g stop taking
hot pepper, alcohol and smoking.
2) Encourage intake of cold drinks and non fried
foods.
Pharmacological
1) Cemetidine
Dose 400mg BD (twice daily) per oral for 4-6
weeks.
16. Treatment
Action- decreases gastric acid secretion by
inhabiting action of histamine receptor site of
parietal cells.
Side effect
• Confusion
• Dizziness
• Headache
• Muscle pain
17. Treatment
cont’d
• Hallucination
Nursing consideration
• Use cautiously to avoid confusion
• Advise patient to take with food.
2) Anti ulcer called sucrulfate
Dose: 1g orally QID before meals
Action: protect the ulcer surface by forming a
barrier.
18. Gastritis cont’d
Side effects: Dizziness, diarrhoea, headache,
insomnia
Nursing consideration
• Advise pt to take drug before meals
• Advise rest after taking drug
• Advise the patient to report any diarrhoea.
3) Antiacid
Aluminium Hydroxide (magnesium tricilllicate)
19. Treatment cont’d
Action: neutralizes the acid and strengthen the
gastric mucosal barrier
Dosage: 300mg chewed before swallowing 5
times daily.
Side effects
Diarrhoea, constipation, and encephalopathy(
inflammation of the brain tissue).
20. Treatment cont’d
Nursing consideration
• Manage constipation with laxatives
• Advise pt not to prolong use
4) Analgesics
Paracetamol( panadol)
Action: it blocks pain receptors/inhibits
stimulation of pain receptor
Dosage: 500mg- 1000mg T.D.S (three times daily)
for 3 days
21. Treatment cont’d
Side effect
• Severe liver damage
Nursing consideration
• Limit use
• Take with plenty of water.
Triple therapy- For chronic gastritis, give
combination therapy consisting two antibiotic +
one histamine antagonistic ( amoxicillin+
metronidazole+ cimetidine).
22. Nursing care
Aim
• To reduce pain and promote comfort
• To prevent complications
• To allay anxiety
• To impart knowledge
Environment
The patient will be complaining of abdominal pains and
discomfort therefore ensure that the environment is
quiet to promote rest. - The environment should be
clean and well ventilated to prevent further infection
and promote free air circulation.
23. Nursing care cont’d
- Ensure that there is an emesis bow within reach in
case the patient vomits.
Comfort and pain relief
- Instruct the patient to take position of their
preference for the comfort.
- Instruct patient to avoid foods and drinks that may be
irritating to the gastric mucosa e.g spiced foods.
Patient should be on a bland diet.
- Offer diversional therapy such as listen to a radio,
reading magazine or newspaper to divert the mind
from pain.
24. Nursing care cont’d
Psychological care
-Assess level of anxiety of the patient to determine the
level of psychological care to provide,
- Explain the disease process, signs and symptoms, as the
patient will be anxious about the pain, bleeding and
vomiting. This will help patient to cope with the
disease.
- Allow patient to verbalize their fears and concerns so as
to allay anxiety and this will help to create nurse patient
relationship ( A problem shared is a problem solved).
25. Nursing care cont’d
- Allow patient to ask questions and answer them
appropriately in the honest and simple manner. This is
because a well informed patient copes well.
- Allow the patient to participate in their own care to
promote co-operation and gain confidence.
- Involve significant others in the care and encourage them
to visit the patient to promote sense of security.
Nutrition
- Fluids and foods not permitted for some days until the
symptoms subsides as these may cause irritation.
26. Gastritis cont’d
- When symptom clear, ice chips followed by clear
water is offered to soothe the pain.
- Small frequent bland meals are introduced as soon
as possible to provide nutrition and minimise
irritation to the gastric mucosa.
- Intake of caffeinated foods is discouraged as
caffeine is a central nervous system stimulant- it is
increases gastric activity and pepsin secretion.
27. Gastritis cont’d
Observation
-observe for pain intensity and provide appropriate care.
- Observe and monitor vital signs for any signs of
hypovolamic shocks such as hypotension and any sign
of infections such as high temperature.
- Ensure close monitoring of vomitus and stool for any
bleeding.
-IV therapy may be necessary and should be monitored.
Monitor and record intake and output to avoid fluid
overload.
28. Gastritis cont’d
Information education and communication(I.E.C)
1. Diet
- Avoid spiced food and caffeinated foods/drinks, hot
drinks as these irritate the gastric mucosa.
- Encourage the patient to be taking bland food.
2. Life style
-Advise patient to stop smoking and drinking alcohol.
This is because the nicotine in cigarettes, increase
gastric activity, alcohol also stimulates the gastric
mucosa.
29. Gastritis cont’d
3. Medication
- Teach the patient about prescribed drugs their
dosage and S/E, also encourage them to complete
their course so as possible to prevent drug
resistance.
4. Complications
Teach the patient about the signs and symptoms of
the possible complications such as fever in
peritonitis, weakness and hypotension in shock. This
is to help them report to the hospital should there
be any sign.
30. Gastritis cont`d
5. Review dates
Teach them about the importance of review
dates. This helps patient to be seen and
medication reinforced.
