Gastritis

Question 1

Acute gastritis

Answer 1

Inflammation of the stomach and presents with nausea and vomiting

Question 2

Enteritis

Answer 2

Inflammation of the intestines and presents with diarrhhoea

Question 3

Gastroenteritis

Answer 3

Inflammation all the way from the stomach to the intestines and presents with nausea, vomiting + diarrhoea

Question 4

Risk factors

Answer 4

Ingestion of undercooked food: BBQ, raw meat
Reheating meals: particularly rice
Poor sanitary conditions: no access to clean water, crowded living
Travelling to endemic areas: South Asia, Sub-Saharan Africa
Immunosuppression

Question 5

Atrophic gastritis

Answer 5

Chronic inflammation of gastric mucosa = epithelial metaplasia, mucosal atrophy, gland loss
- Chronic gastritis,
- Metaplastic gastritis,
- Gastric atrophy

Question 6

Aetiology (Atrophic gastritis)

Answer 6

NSAIDs (causes gastropathy - injury without inflammation)
Helicobacter Pylori
Alcohol, cigarettes, caffeine
Extreme stress (shock, sepsis, burns)

Question 7

Aetiology (Acute gastritis)

Answer 7

Infectious =
- Most common cause of gastroenteritis is VIRAL
- Rotavirus, Norovirus, Adenovirus (LC)
- Bacterial = E.coli, Campylobacter Jejuni, Shingella, Salmonella, Bacillus Cereus (Gram +ve rod, left over rice)
Autoimmune = most common cause in individuals without H. pylori

Question 8

Autoimmune gastritis

Answer 8

Inherited autoimmunity against intrinsic factor, H+/K+ ATPase in parietal cells = inhibition of gastric acid secretion

Question 9

Pathophysiology

Answer 9

High conc of HCl normally present however in gastric atrophy + acid blocking medications raise gastric pH + disrupt the acid barrier to bacterial overgrowth.
Under rare circumstances damage to the gastric mucosa may allow ingested bacteria to become invasive, resulting in phlegmonous gastritis

Question 10

Signs

Answer 10

Dehydration
Electrolyte imbalance
Reduced urine output
Tachycardia
Hypotension

Question 11

Symptoms

Answer 11

Vomiting
Abdominal cramps
Diarrhoea
Fever
Lethargy

Question 12

Diagnosis

Answer 12

If H. Pylori suspected:
- urea breath test (1st line)
- stool antigen test
Gold standard = endoscopy + biopsy

Question 13

Treatment

Answer 13

Addressing cause:
- H. Pylori = PPI, Clarithromycin, Amoxicillin
- Mild = encourage fluid intake, small light non-fatty meals
- Moderate/Severe =
- NSAID or Aspirin cause = PPI or H2RA
- Campylobacter = self limiting but if severe clarithromycin

Question 14

Returning back to work

Answer 14

Miss work until 48 after last diarrhoea
No swimming for 2 weeks after last diarrhoea
E.coli after 48 hours symptom free