Gastritis: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Treatment==" to "==Management==") |
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*Inflammation of the stomach lining | *Inflammation of the stomach lining | ||
*May occur acutely or chronically | *May occur acutely or chronically | ||
*May lead to [[ | *May lead to [[peptic ulcer disease]] | ||
*Causes | *Causes | ||
**H. pylori | **H. pylori | ||
**NSAIDs | **NSAIDs | ||
** | **ETOH | ||
**Critical Illness (Cushing ulcer) | **Critical Illness (Cushing ulcer) | ||
*** | ***Increased ICP, stimulation of vagal nuclei, increased secretion of gastric acid | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 21:06, 12 July 2016
Background
- Inflammation of the stomach lining
- May occur acutely or chronically
- May lead to peptic ulcer disease
- Causes
- H. pylori
- NSAIDs
- ETOH
- Critical Illness (Cushing ulcer)
- Increased ICP, stimulation of vagal nuclei, increased secretion of gastric acid
Clinical Features
- Gnawing or burning pain in epigastric area
- Nausea, vomiting
- Early satiety, bloating
- Heartburn
Differential Diagnosis
Epigastric Pain
- GERD
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic Dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- Pulmonary embolism
Diagnosis
- CBC (r/o anemia)
- BMP, LFTs
- Lipase
- ?Acute abd series
- ?Barium swallow aka upper GI series
- ?EGD, most will be outpt
- ?RUQ US
- ?ECG and Troponin
Management
- Cessation of NSAIDs and Etoh
- Eradicate H. pylori if identified in symptomatic pt
- Triple Therapy: PPI + clarithromycin 500mg BID + amoxicillin1g BID x 10-14d
- Metronidazole 500 mg BID can be substituted for amoxicillin in penicillin-allergic individuals
- Quadruple Therapy: PPI + bismuth subsalicylate 524 mg QID + metronidazole 250 mg QID and tetracycline 500 mg QID x 10-14d.
- Can be used in areas of high resistance to clarithromycin or metronidazole
- Triple Therapy: PPI + clarithromycin 500mg BID + amoxicillin1g BID x 10-14d
- PPI
- Generally heal ulcers faster than H2 blockers
- Omeprazole 20-40mg QD
- H2 Blockers
- Famotidine 20-40mg QD
- Ranitidine 75-150mg BID
Disposition
- Normally outpatient management, unless complication (see below)
Red Flags
Any of the following suggest need for endoscopy referral:
- Age >55yr
- Unexplained weight loss
- Early satiety
- Persistent vomiting
- Dysphagia
- Anemia or GI bleeding
- Abdominal mass
- Persistent anorexia
- Jaundice