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Gastritis (Helicobacter pylori (may predispose 傾向 to peptic ulcer (90%…
Gastritis
Helicobacter pylori
spiral; gram -ve; colonize human gastric mucosa
directly/ indirectly cause ulceration
hypochlorhydria: decrease gastric acid secretion
Urease
: enzyme products that give H. pylori protection in gastric lumen
may predispose 傾向 to peptic ulcer
90% associate with distal gastric cancer
duodenal ulcer: gastric acid hypersecretion
inflammation of gastric mucosa
acute gastritis
iatrogenic (related to drug): e.g. NSAIDs, alcohol, in critically ill pt
opportunistic gastritis
immunocompromised pt
chronic gastritis
atrophy
increase risk of gastric carcinoma
clinical manifestations
asymptomatic in most pt
s/s are related to peptic ulcer
dyspepsia消化不良 is noted in H. pylori infection
management
medication
Triple therapy
Proton Pump inhibitor
e.g. Pantoprazole (Pantoloc)
Antibiotics x2
e.g. amoxycillin (penicillin group)
Clarithromycin (MacrolideS)
antacids
Magnesium hydroxide (Triact, Mucaine)
H2 Receptor Antagonists
e.g. Famotidine (pepcidine)
monitor + manage GI bleed
nursing management
reduce anxiety
promote optimal nutrition
promote fluid balance
relieve pain
self care & ongoing assessment
surgery
Pyloroplasty 修補: widen the opening at the lower part of the stomach
Vagotomy: remove vagus nerve.
subtotal/ total gastrectomy
type
type A
autoimmune gastritis
type B
infection (most common)
bacterial: Helicobacter pylori
viral: Cytomegalovirus (CMV)
fungal: candidiasis
parasitic: hookworm