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01.06 Gastritis

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Overview

  1. Inflammation of lining of stomach
    1. Can be Acute or Chronic
  2. Present with abdominal pain, nausea, and vomiting
  3. Treatment dependent on root cause

 

Nursing Points

General

  1. Causes
    1. H. Pylori Colonization
    2. Excessive alcohol use
    3. Overuse of NSAIDS
    4. “Trigger Foods”
    5. Viral Infection
    6. Food Poisoning
  2. Helicobacter pylori colonization
    1. Many experience no symptoms
    2. Can cause ulcers

Assessment

  1. Will present with at least 1 of 3 common symptoms
    1. Nausea
    2. Vomiting
    3. Abdominal pain
  2. Acute Gastritis
    1. Patient may not know what caused symptoms
    2. More likely to feel relief more quickly
  3. Chronic Gastritis
    1. May be related to GERD or Peptic Ulcer Disease
    2. Can lead to more serious complications
    3. Symptoms resolve more slowly

Therapeutic Management

  1. Determine Root Cause
    1. Lab Tests
      1. Complete Blood Count
      2. H. pylori
      3. Liver function panel 
      4. Lipase
    2. Patient History
      1. Ever happened before?
      2. Any known gastrointestinal disorders?
    3. Diagnostic Imaging
      1. Upper Endoscopy
      2. Abdominal Xray
      3. Abdominal/Pelvic CT
  2. Supportive Care
    1. Symptom Management
      1. Antiemetics
      2. Analgesics
    2. Fluid Resuscitation
    3. H2 Receptor Blockers – Famotidine
      1. Combat inflammatory response
      2. Decrease reflux
      3. Protect from further damage
  3. Remember: Have we treated the underlying cause?

 

Nursing Concepts

  1. Comfort
    1. Nausea and vomiting
    2. Pain management
    3. Sensation of esophageal reflux
  2. Elimination
    1. Nausea and vomiting
    2. Monitor for decreased urine output
  3. Gastrointestinal/Liver Metabolism
    1. Inflammation causes symptoms
  4. Nutrition
    1. Decreased oral intake
    2. Poor nutritional habits

Patient Education

  1. Call doctor or nurse if:
    1. Symptoms do not improve in 24-72 hours
    2. Unable to keep food or medication down
    3. Blood present in vomit or stool
  2. Take all medications as prescribed
  3. Follow up with primary care provider

Reference Links

Study Tools

Video Transcript

Hi and welcome! My name is Meg and I am going to teach you how to identify and support patients with gastritis.

So, what is gastritis? The key point to remember is that gastritis is inflammation of the stomach’s mucosal lining. Gastritis, unlike peptic ulcer disease, will only affect the top two layers of the stomach’s lining. If we look at this diagram here, only the stomach’s mucosa and sometimes the submucosa will be irritated. Gastritis is a broad diagnosis that requires process of elimination to diagnose. We don’t always know what exactly causes gastritis, but you can begin to deduce that a patient might have gastritis by checking for 3 symptoms: nausea, vomiting, and abdominal pain. The treatment will be dependent on the root cause and minimizing inflammation. Gastritis can be acute or chronic, and depending on the area you are working in, you may see one more than the other.

So what causes Gastritis? Viral infection and food poisoning are common causes of acute gastritis, but these two conditions are hard to pinpoint and diagnose. We can deduce a patient has a viral infection or food poisoning only by a process of elimination once we have ruled out other causes. You might also see episodes of acute gastritis if your patient has eaten a “Trigger food.”  These trigger foods are patient-specific- I think we can all name a food that has given us gastritis symptoms in the past. Unfortunately for me, it’s pizza! If I eat it, i know I’m going to have a bad time! Excessive alcohol and NSAID use can contribute to both acute and chronic gastritis. Pop pharmacology quiz- which two over the counter NSAIDS irritate the mucosal layer of the stomach the most? … If you guessed Ibuprofen and Aspirin, you’re right! In patients with chronic gastritis and other upper GI issues, alcohol and NSAIDS are expressly discouraged. Another common cause of chronic gastritis is H. pylori. Many of us have H. pylori in our guts, but only when it colonizes do we have symptoms. When H. pylori colonizes, these little green guys burrow into the stomach mucosa and cause the inflammation that gives our patients nausea, vomiting and abdominal pain. H. pylori also causes many peptic ulcers, so differentiating between these ulcers and gastritis is essential to getting your patient a good outcome. If a patient is treated for acute gastritis when their symptoms were actually caused by an ulcer, they aren’t going to feel better!

Let’s talk more about the differences between acute and chronic gastritis. Cases of acute gastritis will often resolve more quickly and respond more readily to treatment. Patients with chronic gastritis are more likely to have ongoing symptoms related to GERD or peptic ulcer disease. For more information on those two disorders, you should check out the lessons in the Med/Surg course. Treatment of acute and chronic gastritis will be similar, but chronic treatment will continue after symptoms resolve. For example, a patient with acute gastritis may receive a prescription for Famotidine for 1-2 weeks, while chronic gastritis patients are likely to remain on treatment indefinitely.

So we have talked about the causes and different types of gastritis, and now it’s time to talk about how patients with gastritis will look. The thing to remember about any process involving irritation and inflammation is that without treatment, the inflammation is likely to worsen. The irritation of the stomach’s lining will lead the stomach to expel its contents by vomiting, but uncontrolled vomiting will further irritate the stomach’s lining.This is why we commonly see patients with gastritis exhibit intractable vomiting, or vomiting that is not responsive to first line treatments.  It’s really a vicious cycle, and for the patient to feel better we have to stop it. The other assessment piece to remember is the location of the abdominal pain. Gastritis causes upper-to-middle abdominal pain or LUQ pain. Nausea and vomiting with pain in other areas of the abdomen is probably something different, like appendicitis.

Now that you’re pretty sure your patient has gastritis, we need to figure out what is causing it! Determining the root cause is essential to getting your patient feeling better. When attempting to rule out potential causes of any symptoms, remember to use your best resource- the patient! Ask your patient questions like, “Has this ever happened before?,” and “Do you have any known GI issues?” This may help guide the diagnostic process and get you an answer and the patient some relief more quickly! Lab tests will also help narrow down possible causes. If your patient has abdominal pain, you can pretty much always expect the provider to order a chemistry and complete blood count (CBC). The patient’s CBC will give us the white blood cell count- this helps to assess for infection. We will also get a hemoglobin on the CBC, which will help to identify any bleeding as a cause. The provider is also probably going to add a liver function panel and lipase level to the chemistry, which will help to identify liver failure and pancreatitis, respectively. With other more serious causes ruled out, you can start to deduce that the patient’s symptoms are from gastritis. And lastly, patients with underlying gastrointestinal issues might need further diagnostic imaging like an upper endoscopy, xray, or CT scan.

So now we are sure our patient has gastritis, let’s get them feeling better! Managing acute gastritis will involve supportive care, replacing fluids, and treating the inflammation. Patients will receive antiemetics like ondansetron or promethazine to stop their vomiting.The patient may receive pain medication for their abdominal pain, but remember- NSAIDS can cause irritation in the stomach- so if the provider orders ibuprofen or acetaminophen, it is important to verify that is the plan of care! I have seen the amount of pain medicine given for gastritis decrease a lot due to the opioid crisis- now we know if we treat the underlying cause, the patient’s pain will decrease without a narcotic. While we are giving our patient nausea meds, we are also replacing fluids lost to vomiting. IV fluids will not only re-hydrate your patient, it also helps to relieve symptoms of dehydration like headache and nausea. And remember- gastritis is inflammation, so we need to address it! H2 receptor blockers like famotidine are just as important as the nausea medications, even though they do not work as quickly. H2 receptor blockers prevent the release of histamine to the lining of the stomach. Remember- the inflammatory response is driven by histamines, so if we block histamine from reaching the inflamed area, we are supporting the healing and soothing of that area!

Now you have assessed your patient, and you have gotten them feeling better. Do not forget to ask yourself if you can name the root cause of the symptoms. If you can’t, how can you know it’s gastritis? And if it’s not gastritis, have we treated the patient correctly?
Let’s go over the 3 big nursing concepts really quickly. No one likes throwing up, so of course gastritis causes a lot of discomfort! We can make the patient feel better if we treat the underlying cause. Next, gastrointestinal system is the largest player in gastritis. It is important to rule out more serious GI issues when diagnosing a patient with gastritis. Not only can repeated vomiting impair the patient’s nutrition, poor overall nutrition can cause gastritis as well. Assessing the patient’s diet may help to pinpoint the cause of the patient’s symptoms.

So what do you need to remember? Our key takeaways are inflammation, symptom management, and treating the root cause. To support and treat a patient with  gastritis, remember that inflammation is the culprit. Managing the inflammation will help you to manage the patient’s symptoms. They might require other supportive treatment like nausea medication and IV fluids as well. You can feel confident that you have treated the patient’s gastritis if you can name the cause and the steps you have taken to address them.

Ok that’s it for our lesson on gastritis, don’t forget the key component- you’ve got to treat the root cause! Check out all the resources attached to this lesson to get a bigger picture of caring for this patient. Now, go out and be your best self today. And, as always, happy nursing!

 

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