Gastritis Flashcards
what is the definition of gastritis?
Gastritis is defined as the histological presence of gastric mucosal inflammation.
what is the aetiology of gastritis?
Mucosal ischaemia - mucin barrier damaged as less blood to cells, acid gets in, kills cells
Stress = increased acid productive, critically ill patients
Helicobacter = increased acid production, lives in mucin layer, release chemicals that cause acute inflammation in stomach via neutrophils, acute non-erosive, can become CHRONIC ( intestinal metaplasia)
NSAID = e.g. aspirin, acute erosive gastritis
Bile reflux = erosive gastritis
Strongly alcohol alcohol = straight spirits
what are the risk factors for gastrits?
Helicobacter pylori infection NSAIDs Alcohol use Previous gastric surgery Critically ill patient Autoimmune disease
what is the pathophysiology of gastritis?
Helicobacter pylori infection induces a severe inflammatory response with gastric mucin degradation and increased mucosal permeability, followed by gastric epithelial cytotoxicity.
Non-steroidal anti-inflammatory drugs (NSAIDs) and alcohol decrease gastric mucosal blood flow with loss of the mucosal protective barrier. NSAIDs inhibit prostaglandin production, whereas alcohol promotes depletion of sulfhydryl compounds in gastric mucosa.
In autoimmune atrophic gastritis, antiparietal cell antibodies stimulate a chronic inflammatory, mononuclear, and lymphocytic infiltrate involving the oxyntic mucosa, leading to the loss of parietal and chief cells in the gastric corpus
what are the key presentations of gastritis?
Presence of risk factors
Dyspepsia
Epigastric discomfort
what are the signs of gastritis?
Glossitis - swollen tongue
Coexisting autoimmune disease
Risk factors
what are the symptoms of gastritis?
Pain after/ before eating Worse when stressed Nausea Vomiting Severe emesis Acute abdo pain Fever Cognitive impairment
what are the first line and gold standard investigations for gastritis?
Helicobacter pylori (urea) breath test - pos H pylori faecal antigen test - pos FBC - reduced haem and hematocrit, increased MCV in autoimmune, leukocytosis in phlegmonous
what are the differential diagnoses for gastritis?
PUD
GORD
Non-ulcer dyspepsia
how is gastritis managed?
Acute H pylori: H pylori eradication therapy Acute erosive: Proton pump inhibitor/ H2 blocker , Enteric coated aspirin = does not dissolve in stomach so no irritation Acute bile reflux: Rabeprazole or sucralfate, surgery Acute phlegmonous: ICY admission, empiric broad spectrum antibiotics, gastrectomy
how is gastritis monitored?
Test for eradicate H pylori
Endoscopy and biopsy for NSAIDs or alcohol induced
what are the complications of gastritis?
Pancreatitis
Gastric carcinoma
Gastric carcinoid
Gastric lymphoma
what is the prognosis fo gastritis?
Rarely progress - due to availability of ant-acids etc.
Erosive : improve with discontinued use of irritant
H pylori: cure rates can be low, can be good
Autoimmune: good with cyanocobalamin
Phlegmonous: 50% mortality for medical treated, 20% for surgical
