SAINT MICHAEL’S COLLEGE OF

LAGUNA
Old National Highway, Platero, Biñan Laguna.

School of Nursing and Midwifery

A Partial Fulfillment in Related Learning

Experience III

A CASE STUDY
of
Chronic Gastritis

Submitted by:

Angelique A. Malabo
BSN 3B
Group 8

Submitted to:

Ma’am Aimee Agorilla

16January2009

INTRODUCTION
Gastritis is a term used to describe a group of conditions characterized
by inflammation of the lining of your stomach. Commonly, the
inflammation of gastritis results from infection with the same
bacterium that causes most stomach ulcers. Yet other factors —
including traumatic injury and regular use of certain pain relievers —
also can contribute to gastritis.

Gastritis may occur suddenly (acute gastritis), or it can occur slowly

over time (chronic gastritis). In spite of the many conditions associated
with gastritis, the signs and symptoms of the disease are very similar:
a burning pain in your upper abdomen and, occasionally, bloating,
belching, nausea or vomiting.

In some cases, gastritis can lead to ulcers and an increased risk of

stomach cancer. For most people, however, gastritis isn't serious and
improves quickly with treatment.

Chronic gastritis is a chronic gastric lesion, pathologically characterized

by nonspecific chronic inflammation of the gastric mucosa. Chronic
gastritis can be divided into two categories, primary and secondary.
The former is further categorized into superficial, atrophic and
hypertrophic types; the latter often complicates gastroduodenal ulcer
and gastric cancer.

It develops gradually and is more likely to cause a dull pain and a

feeling of fullness or loss of appetite after a few bites of food. For many
people, though, chronic gastritis causes no signs or symptoms at all.

Chronic gastritis may be caused by prolonged irritation from the use of

nonsteroidal anti-inflammatory drugs (NSAIDs), infection with the
bacteria Helicobacter pylori, pernicious anemia (an autoimmune
disorder), degeneration of the lining of the stomach from age, or
chronic bile reflux.Many people with chronic gastritis have no
symptoms of the condition.

An estimated 50% of the world population is infected with H pylori;

therefore, chronic gastritis is extremely frequent. H pylori infection is
highly prevalent in Asia and in developing countries, and multifocal
atrophic gastritis and gastric adenocarcinomas are more prevalent in
these areas.

The treatment depends on the cause of the gastritis. Antibiotic therapy

will treat chronic gastritis caused by infection with Helicobacter pylori.

Antacids or other medications, such as cimetidine (to decrease or

neutralize gastric acid in the stomach) or proton pump inhibitors such
as Prilosec, will usually eliminate the symptoms and promote healing.
Medications known to cause gastritis should be discontinued. Gastritis
caused by pernicious anemia is treated with vitamin B12.

Doctors use several regimens to treat H. Pylori infection. Most use a

combination of two antibiotics and a proton pump inhibitor. Sometimes
bismuth (Pepto-Bismol) is added to the mix. The antibiotics help
destroy the bacteria, and the proton pump inhibitor relieves pain and
nausea, heals inflammation and may increase the antibiotics'
effectiveness.
To ensure that H. pylori has been eliminated, your doctor may test you
again after treatment.

PATIENT’S PROFILE

Name: Jaime M. Gonzales

Address: 3rd St. Hi-way Homes Platero Biñan, Laguna

Age: 64

Gender: Male

Nationality: Filipino

Religion: Roman Catholic

Birth Date: May 03, 1944

Birth Place: Manila

Spouse: Alice Gonzales

Attending Physician: Dr. Marquez

Admitting Physician: Dr. Pagdanganan

Date of Admission: January 05, 2009

Time of Admission: 08:40 pm

Chief Complain: epigastric pain

Admission Diagnosis: Chronic Gastritis

History of Past Illness:

Two days prior to admission, the patient started to experience

epigastric pain not associated with fever or nausea. Then after a day,

the patient still complained with episodes of epigastric pain. And few

hours prior to admission, epigastric pain was accompanied by

vomiting. This prompted consult in Biñan Hospital where he was

advised to be confined after undergoing a series of examinations.

Results of the examinations showed that he has chronic gastritis.

 ANATOMY and PHYSIOLOGY

The human digestive system is a complex series of organs and glands

that processes food. In order to use the food we eat, our body has to
break the food down into smaller molecules that it can process; it also
has to excrete waste.

Most of the digestive organs (like the stomach and intestines) are tube-
like and contain the food as it makes its way through the body. The
digestive system is essentially a long, twisting tube that runs from the
mouth to the anus, plus a few other organs (like the liver and
pancreas) that produce or store digestive chemicals.

The digestive system is made up of the alimentary canal (also called

the digestive tract) and the other abdominal organs that play a part
in digestion, such as the liver and pancreas. The alimentary canal is
the long tube of organs — including the esophagus, stomach, and
intestines — that runs from the mouth to the anus. An adult's digestive
tract is about 30 feet (about 9 meters) long.

Digestion begins in the mouth, well before food reaches the stomach.
When we see, smell, taste, or even imagine a tasty meal, our salivary
glands, which are located under the tongue and near the lower jaw,
begin producing saliva. This flow of saliva is set in motion by a brain
reflex that's triggered when we sense food or think about eating. In
response to this sensory stimulation, the brain sends impulses through
the nerves that control the salivary glands, telling them to prepare for
a meal.

As the teeth tear and chop the food, saliva moistens it for easy
swallowing. A digestive enzyme called amylase, which is found in
saliva, starts to break down some of the carbohydrates (starches and
sugars) in the food even before it leaves the mouth.

Swallowing, which is accomplished by muscle movements in the

tongue and mouth, moves the food into the throat, or pharynx. The
pharynx, a passageway for food and air, is about 5 inches (12.7
centimeters) long. A flexible flap of tissue called the epiglottis
reflexively closes over the windpipe when we swallow to prevent
choking.

From the throat, food travels down a muscular tube in the chest called
the esophagus. Waves of muscle contractions called peristalsis force
food down through the esophagus to the stomach. A person normally
isn't aware of the movements of the esophagus, stomach, and
intestine that take place as food passes through the digestive tract.

At the end of the esophagus, a muscular ring or valve called a

sphincter allows food to enter the stomach and then squeezes shut to
keep food or fluid from flowing back up into the esophagus. The
stomach muscles churn and mix the food with acids and enzymes,
breaking it into much smaller, digestible pieces. An acidic environment
is needed for the digestion that takes place in the stomach. Glands in
the stomach lining produce about 3 quarts (2.8 liters) of these
digestive juices each day.

Most substances in the food we eat need further digestion and must
travel into the intestine before being absorbed. When it's empty, an
adult's stomach has a volume of one fifth of a cup (1.6 fluid ounces),
but it can expand to hold more than 8 cups (64 fluid ounces) of food
after a large meal.

By the time food is ready to leave the stomach, it has been processed
into a thick liquid called chyme. A walnut-sized muscular valve at the
outlet of the stomach called the pylorus keeps chyme in the stomach
until it reaches the right consistency to pass into the small intestine.
Chyme is then squirted down into the small intestine, where digestion
of food continues so the body can absorb the nutrients into the
bloodstream.

The inner wall of the small intestine is covered with millions of

microscopic, finger-like projections called villi. The villi are the vehicles
through which nutrients can be absorbed into the body.

The liver (located under the rib cage in the right upper part of the
abdomen), the gallbladder (hidden just below the liver), and the
pancreas (beneath the stomach) are not part of the alimentary canal,
but these organs are essential to digestion.

The liver produces bile, which helps the body absorb fat. Bile is stored
in the gallbladder until it is needed. The pancreas produces enzymes
that help digest proteins, fats, and carbohydrates. It also makes a
substance that neutralizes stomach acid. These enzymes and bile
travel through special channels (called ducts) directly into the small
intestine, where they help to break down food. The liver also plays a
major role in the handling and processing of nutrients, which are
carried to the liver in the blood from the small intestine.

From the small intestine, undigested food (and some water) travels to
the large intestine through a muscular ring or valve that prevents
food from returning to the small intestine. By the time food reaches the
large intestine, the work of absorbing nutrients is nearly finished. The
large intestine's main function is to remove water from the undigested
matter and form solid waste that can be excreted.

Hormone Regulators

The major hormones that control the functions of the digestive system
are produced and released by cells in the mucosa of the stomach and
small intestine. These hormones are released into the blood of the
digestive tract, travel back to the heart and through the arteries, and
return to the digestive system where they stimulate digestive juices
and cause organ movement.

The main hormones that control digestion are gastrin, secretin, and
cholecystokinin (CCK):

• Gastrin causes the stomach to produce an acid for dissolving

and digesting some foods. Gastrin is also necessary for normal
cell growth in the lining of the stomach, small intestine, and
colon.
• Secretin causes the pancreas to send out a digestive juice that
is rich in bicarbonate. The bicarbonate helps neutralize the acidic
stomach contents as they enter the small intestine. Secretin also
stimulates the stomach to produce pepsin, an enzyme that
digests protein, and stimulates the liver to produce bile.
• CCK causes the pancreas to produce the enzymes of pancreatic
juice, and causes the gallbladder to empty. It also promotes
normal cell growth of the pancreas.

Additional hormones in the digestive system regulate appetite:

• Ghrelin is produced in the stomach and upper intestine in the

absence of food in the digestive system and stimulates appetite.
• Peptide YY is produced in the digestive tract in response to a
meal in the system and inhibits appetite.

Both of these hormones work on the brain to help regulate the intake
of food for energy.

Nerve Regulators

Two types of nerves help control the action of the digestive system.

Extrinsic, or outside, nerves come to the digestive organs from the

brain or the spinal cord. They release two chemicals, acetylcholine and
adrenaline. Acetylcholine causes the muscle layer of the digestive
organs to squeeze with more force and increase the “push” of food and
juice through the digestive tract. It also causes the stomach and
pancreas to produce more digestive juice. Adrenaline has the opposite
effect. It relaxes the muscle of the stomach and intestine and
decreases the flow of blood to these organs, slowing or stopping
digestion.

The intrinsic, or inside, nerves make up a very dense network

embedded in the walls of the esophagus, stomach, small intestine, and
colon. The intrinsic nerves are triggered to act when the walls of the
hollow organs are stretched by food. They release many different
substances that speed up or delay the movement of food and the
production of juices by the digestive organs.

DIAGNOSTIC EXAMINATION

Name: Jaime Gonzales

Address: 3rd St. Hi-way Homes Platero Biñan, Laguna
Exam: Whole Abdomen Ultrasound
CC: Epigastric Pain
Referred by: Dr. Marquez

Sonological Report:

The liver is not enlarged. The ducts are not dilated. No focal
mass lesion is seen.
The gallbladder is not enlarged. The wall is thickened. A high
level echo with a diameter of 1.13 cm is seen within the gallbladder.
The pancreas and the spleen are unremarkable.
The kidneys, ureters and the urinary bladder are unremarkable.
The prostate gland measures about 5.0 cm in length x 4.56 cm in
width x 3.69 cm in thickness. The echo pattern is non-homogeneous.
Calcifications are seen.

Impression:
Cholecystitis, Cholelithiasis
Negative liver, pancreas, and spleen
Negative KUB
Prostatic enlargement, Prostatic Calcifications
 BIBLIOGRAPHY

• www.wikipedia.com

• http://www.medicinenet.com

• http://doh.gov.ph

• http://kidshealth.org

• Anatomy and Physiology by Gerard Tortora

• Fundamentals of Nursing

• Medical and Surgical Book

• PPD Drug Handbook

• Handbook for Nursing Diagnosis

• Nursing Care Plan Book

• Webster’s Medical Dictionary

• http://digestive.niddk.nih.gov/ddiseases/pubs/yrdd/

• http://www.umm.edu/ency/article/000232.htm

• http://www.mayoclinic.com/health/gastritis

• http://kidshealth.org/parent/general/body_basics/digestive.html

• http://www1.us.elsevierhealth.com

• http://www.rncentral.com
 PATHOPHYSIOLOGY

Risk factors:
• eating raw / uncooked foods
• improper food handling
• alcohol abuse
• parasitic infection
• liver failure
• kidney failure

Causes:
• Ingestion of food
contaminated by H. pylori
• Most common type – B
(Chronic gastritis)
fxvc

Inflammation of the mucosal

lining of the stomach

Manifestations of the ff.

signs and symptoms:
• Nausea and vomiting
• Upper abdominal discomfort
• Epigastric pain
• Ulcer-like distress (relieved
by ingestion of foods but
exacerbated by spicy foods)

● Diet therapy – limit spices

Complications may
● Drug therapy
develop such as:
- Magnesium
If treated: hydroxide If untreated:
c aluminum hydroxide • hemorrhage
(Maalox) • formation of ulcer
- Aluminum hydroxide
(Ampojel)
- H2 antagonists Improper functioning of
- Nizatidine the Gastrointestinal
- Famotidine system
● Stress reduction
techniques Improper disposal of
- relaxation body wastes
- guided imagery
● Partial gastrectomy
● Pyroplasty Sepsis
Good
RECOVERY DEATH
● Vagotomy