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Gastritis

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22 views29 pages

Gastritis

Uploaded by

Juma John
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
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UPPER NILE UNIVERSITY

COLLAGE OF MEDICINE &


HEALTH SCIENCE
DEPERTMENT OF SURGERY

Topic : Gastritis
Presented by :Lam Machungo Abraham
Supervised by : Leftery George
Consultant General Surgery
Upper Nile University
OBJECTIVE OUTLINE
 Introduction
 Epidemiology

 Causes

 Classification

 Signs & symptoms

 Pathophysiology

 Investigations & diagnosis

 Management

 Complication

 Prognosis
GASTRITIS
• Gastritis is inflammation of the lining of
the stomach
• May affect part or entire stomach
EPIDEMIOLOGY

 The incidence of gastritis is highest in the fifth


and sixth decades of life man are more frequently
affected then women. The incidence is greater in
clients who are heavy drinkers and smokers
 in developing countries, the overall prevalence of
H. pylori varies depending on geographical region
and socioeconomic conditions. It is approximately
69% in Africa, 78% in South America, and 51% in
Asia.
 Autoimmune gastritis is more common in women
and older people. The prevalence is estimated to
be approximately 2% to 5%. However, available
data do not have high reliability.

CAUSES
 Infection (helicobacter pylori)
 Alcohol
 Smoking
 Medication( ASAID, iron,…)
 Gastroesophgeal reflux disease
 Ischemia
PATHOPHYSIOLOGY
 Destructive processes outweigh protective
mechanism in the gastric mucosa
 H.pylori-associated gastritis transmission is

via the faecal-oral route. H. pylori possess


several virulence factors which facilitate cell
adhesion, cell damage and disruption of
tight junctions, and evasion from the immune
response.
 NSAIDs cause gastritis through inhibition of

prostaglandin synthesis. Prostaglandins are


responsible for the maintenance of protective
mechanisms of gastric mucosa from injuries
caused by hydrochloric acid.
SIGNS & SYMPTOMS
May be asymtomatic
 Abdominal pain

 Epigastric pain

 Pain may improve or worsen with eating

 May be sever and acute in case of

phlegmonous gastritis

 Nausea & vomiting


 due to inflammation of the stomach
CONTIN……
 Reduced appetite
 Abdominal fullness

 After eating

 Often within the epigastric area

 Bloating

 Belching

 Fever& chills
CONTIN….
 Hiccups
 Stomach inflammation my trigger hiccup reflex
 Persistent , long- lasting hiccups
 Bleeding
 May be due to bleeding erosion or ulcer

 occult bleeding

 Hematochezia
 Bright red blood in stool
 Melena
CONTIN…..
 Dark , black terry stool
 Hematemesis
 May be red color

 Streak in mucus

 May be coffee-ground emesis


TYPE

 1. Type A gastritis.
 2. Type B gastritis.
 3. Reflux gastritis.
 4. Erosive gastritis.
 5. Others: Stress gastritis, lymphocytic gastritis,
granulomatous
 gastritis, phlegmonous gastritis.
 Type A Gastritis
 x Autoimmune disease.
 x There is formation of antiparietal cell antibodies.
 x Parietal cell dysfunction occurs causing
achlorhydria and vitamin
 B12 deficiency.
 x Antrum is not affected.
 x ‘G’ cell hyperplasia occurs with raised serum
gastrin level.
 x There is formation of microadenoma of
enterochromaffin like
 cells (ECL cells) with predisposition to gastric
carcinoma.
 Type B Gastritis
 x Occurs due to Helicobacter pylori infection.

 x Antrum is affected.

 x Peptic ulcer is common.

 x Helicobacter related pangastritis commonly

occurs which may


 turn into gastric cancer.
 Reflux Gastritis
 x Usually occurs after gastric surgeries.

 x Prokinetic drugs are useful—

metochlopramide, domperidone,
 cisapride, mozapride.
 Stress Gastritis
 This is a common sequel of serious illness or

injury and is characterised by a reduction in


the blood supply to superficial mucosa of the
stomach.
 Lymphocytic Gastritis
 It is characterised by the infiltration of the

gastric mucosa by T cells and is probably


associated with H. pylori infection.
 Granulomatous Gastritis
 It is seen in Crohn’s disease and tuberculosis
 Phlegmonous Gastritis
 It is due to severe bacterial infection of

stomach. It is rare but


 dangerous
INVESTIGATIONS & DIAGNOSIS
 Diagnosis is based on
 detailed history( e.g food intake , medication

taken, and any disorder related to gastritis)


 physical examination plus the following test

 Endoscopy

 Blood test

 Stool test

 Upper gastrointestinal series ( barium study)

barium study, or barium meal, is a series of


radiographs used to examine the
gastrointestinal tract for abnormalities
DIFFERENTIAL DIAGNOSIS

 Peptic ulcer disease


 Gastric cancer

 Cholecystitis

 Zollinger-Ellison syndrome
CONTIN….
 Dyspepsia

 Gallstone disease

 Pancreatitis

 Autoimmune gastritis

 Myocardial ischemia

 Gastric involvement with inflammatory bowel disease, particularly Crohn


disease

 Menetrier disease

 Lymphoma

 Celiac disease

 Multiple endocrine neoplasias


TREATMENT / MANAGEMENT
 Treatment regimens differ from antibiotics (in H.
pylori gastritis) to vitamin supplementation (in
autoimmune metaplastic atrophic gastritis) to
immunomodulatory therapy (in autoimmune enteropathy)
to dietary modifications (in eosinophilic gastritis).

 H. pylori-associated gastritis: A triple-therapy of


clarithromycin/proton-pump inhibitor/amoxicillin for 14 to
21 days is considered the first line of treatment.
Clarithromycin is preferred over metronidazole because
the recurrence rates with clarithromycin are far less
compared to a triple-therapy using metronidazole.
However, in areas where clarithromycin resistance is
known, metronidazole is the option of choice. Quadruple
bismuth containing therapy would be of benefit,
particularly if using metronidazole.[25]
CONTIN…

 Other forms of treatment in gastritis include


cessation of alcohol, smoking, anti-
inflammatory drugs, spicy food, as well as
managing stress, immunomodulatory
therapy in autoimmune enteropathy, and
dietary modification in eosinophilic gastritis.
COMPLICATION
 Peptic ulcer
 Chronic atrophic gastritis (loss of appropriate glands
resulting mainly from long-standing H. pylori infection)
 Gastric metaplasia/dysplasia
 Gastric cancer (adenocarcinoma)
 Iron-deficiency anemia (chronic gastritis and early stages
of gastric autoimmunity)
 Vitamin B12 deficiency (autoimmune gastritis)
 Gastric bleeding
 Achlorhydria (autoimmune gastritis, chronic gastritis)
 Gastric perforation
 Mucosa-associated lymphoid tissue (MALT) lymphoma
 Neuroendocrine tumors (NET) (previously referred to as
gastric carcinoid; complicates autoimmune gastritis)



CONTIN…

 Autoimmune gastritis predisposes to the development of


both gastric adenocarcinoma and gastric type 1 NET

 The development of NET in these patients is related to


mucosal atrophy and hyperplasia of immature mucus neck
cells

 The enhanced differentiation of immature precursor neck


cells into histamine-producing enterochromaffin-like (ECL)
cells secondary to hypergastrinemia is the process

 Vitamin C, vitamin D, folic acid, zinc, magnesium, and


calcium deficiency (atrophic autoimmune gastritis)


PROGNOSIS
 The prognosis depends on the cause. For
most people who undertake treatment, the
symptoms do decrease but recurrences are
common. Patients with H.pylori induced
gastritis also have a small risk of developing
gastric cancer in future.
REFERENCE'S
 SRB,s manual of surgery 5the edition
 Bailey and love`s short practice of surgery

25the edition
 Gastritis by Azer SA Akhndi h

 Wiki med offline medical wikipedia

 http:// www. YouTube .com /jj medicin


THANK YOU

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