chronic gastritis

Question 1

definition

Answer 1

Definition
Chronic inflamn of gastric mucosa, changing mucous secretion, charac. of gastric juice, structural alteration of glandular compartments. Atrophy and metaplasia of mucosa wall and development of secretory, evacuatory, motility and metabolic insufficiency.

Question 2

type A - etiology, pathogenesis, clinical pciture

Answer 2

Atrophic gastritis, Diffuse corporal atrophic gastritis, Pernicious anemia gastritis, Metaplastic atrophic gastritis, Atrophic pan gastritis

Etio: Autoimmune

Patho: associated with Hashimoto‘s thyroidits, Hyperthyroidism, Hypothyroidism.
- Non-bacterial. Involvemt of autoIM response (↑incidence pernicious anemia in relatives )
- atypical changes of mucosa as a result of protein struc changes affecting body of stomach & severely impairs acid secretion
- gastric secretion ↓ (hyposecretion)
- older ppl ( 50-55y.o)
- erosion & ulceration rare, dev B12 def anemia
- absent malignization

Clinical pic:
- Pain not typical. Dullness,heaviness, hardness in epigastric w/o irradiation
- discomfort after meal
- gastric dyspepsia : vomiting with bile, nausea (not specific)
- intestinal dyspepsia : diarrhea
- Loos of appetite, loss of weight
- Dev symptoms of pernicious anemia(weakness, changes of hair,skin,red tongue)
- severe weakness
- during palpation can reveal pain in pyloric region, dull, no radiation, no tenderness

Question 3

type b

Answer 3

Non-atrophic gastritis, superficial gastritis, Diffuse antral gastritis with H.pylori, Interstitial-follicular non-atrophic gastritis Etio: Helicobacter pylori, Camphylobacter

Patho:
H.pylori infects 1‘ the antrum & adheres to gastric epithelial cells→it produces proteases, phospholipase, urease→ inflamn →host response includes addition of inflammatory infiltrate (T&B cells, lymphocytes) in the lamina propria & epithelium
- gastric secretion ↑(hypersecretion)
- affect younger ppl ( 25-55y.o)
- obvious erosion & ulceration
- dev Ferum deficient anemia
- present malignization

Clinical pic:
- Pain in epigastric aft eating. Food ↓pain but ↑aft ½ hr.Wit or w/o irradiation.> intensive
- Gastric dyspepsia : heartburn( ↑acid), nausea, vomiting, eructation wit acid taste
- Intestinal dyspepsia : Constipation
- ↑ appetite at early onset of disease, aft prolongation : ↑ weakness & heartburn
- White tongue
- local pain in epigastric on palpation

Question 4

syndrome

Answer 4

syndrome Type A Type B
I. asthenic
Vertigo, weakness, inactive Vertigo, weakness, inactive

II. pain
- Low secretin level -discomfort in epigastric region -loosing of appetite -dull pain
- As in gastroduodenitis -same clinical pictures in peptic ulcer -spastic pain

III. dyspeptic
- Stomach: spoiled egg smell Intestininal: diarrhoea
- Stomach: burning, acidic, nausea & vomiting with acidic taste Intestinal: constipation

IV. secretin level
- Stomach: low Serum: high
- Stomach: high Serum: low

Question 5

investigation

Answer 5

1. Blood analysis : anemia (type A), ↓ albumin & cell count
   - vitamin B & iron deficiency anemia (↓ RBC, ↓ Hb, ↓ CI -<0.85, microspehrocyte)
2. fibrogastroduedenoscopy –presence of bile refluxes
3. x-ray –thickening of fold of stomach
4. biopsy -see changes in stomach mucosa
5. gastroscopy –hyperproduction of gastric juice

Question 6

Role of x-ray, gastroscopy & biopsy in diagnostic of chronic gastritis

Answer 6

Role of x-ray, gastroscopy & biopsy in diagnostic of chronic gastritis
X-ray:
- Enlargement of fluid vol (↑secretion)
- examination of motor disorder ( ↓peristalsis, disorder of motor func)
- shape,size,position& mobility of stomach
- direction& shape of mucosa folds,thickness,continuity( A-folds ↓, B-folds ↑)

Fibrogastroduodenoscopy :
- Location,size,shape
- condition of gastric mucosa( Δ in colour,surface,growths)
- presence of bile in gastric juice ( if reflux present)
- height,width,density of folds
- reveal tumor/ulcers
- A- thin mucosa,diffuse paleness; B- hyperemia,erosions,hypertrophy

Biopsy.
- Removal of polyps
- A - atrophic B- dystrophic
- Gastroscopy & biopsy: true diagnosis of gastritis
- Inflammatory changes must be found in minimum 3, maximum 7 parts of stomach mucosa in order to put diagnosis

Question 7

Evaluation of stomach secretary function

Answer 7

Evaluation of stomach secretary function

acid secretion is ↓ in Type A & ↑ in Type B

Hyposecretion :
- Gastric juice excreted ,30ml/hr on fasting stomach
- Achlorhydria ( absent HCl)
- Achylia ( absent pepsin )
- pH metry : 3.0-5.0 ( norm 2.5 )

Hypersecretion :
- Gastric juice excreted >60ml/hr on fasting stomach
- pH metry : 0.9-1.3 ( norm 2.5 )
serum gastrin level r elevated substantially in patient with pernicious anemia

Substances for stimulation secretion: pepsin, gastrin, pentagastrin
- high secretion: high initial secretin
- low secretion: increase secretin level, causes stomach to secrete more secreatin (compesative mechanism)
- In atrophic: no effect on stimulation

Question 8

Treatment: diet, medicaments

Answer 8

Diet:
- diet no 1
- min 4-6x daily food ( freq wit small proportion)
- avoid gas containing, very hot,very cold,fatty,acidic food

Medications:
- Antibiotics: Metranidazole, penicillin (Amoxicillin), cephalosporine, Macrolides ( Clarithromycin )
- antacid
a. non water soluble: almagen, phospogen
b. water soluble: sodium bicarbonate, calcium bicarbonate, magnesium hydroxide
- H2 histamine blocker: nizatidine, Famotidine,Ranitidine,Cimetidine
- Proton pump inhibitors ( Omeprazole, Lansoprazole)
- Mucosal protective: Bismuth, De-nol
- in case of reflux: cerucol, metachlorpromide (to improve motoric function of GIT)
- specific treatment for pernicious anemia
- vitamin b12 administration
- Pain syndrome : Spasmolytics- Atropine,Perenzipine (↓gastic secretion)
- symptomatic: spasmolytic: baralgin, plantaglycin, papaverin
- sodium carbinosolium- ↑ b.flow in stomach mucosa
- calcium channel blokers -decrease production of hcl acid
- cholinergic receptor blocker, perezipine
- sodium carboxalon