Gastritis: Difference between revisions
(Text replacement - "*ECG" to "*ECG") |
ClaireLewis (talk | contribs) No edit summary |
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*May lead to [[peptic ulcer disease]] | *May lead to [[peptic ulcer disease]] | ||
*Causes | *Causes | ||
**H. pylori | **[[H. pylori]] | ||
**NSAIDs | **[[NSAIDs]] | ||
**ETOH | **[[ETOH]] | ||
**Critical Illness (Cushing ulcer) | **Critical Illness (Cushing ulcer) | ||
***Increased ICP, stimulation of vagal nuclei, increased secretion of gastric acid | ***[[Increased ICP]], stimulation of vagal nuclei, increased secretion of gastric acid | ||
==Clinical Features== | ==Clinical Features== | ||
*Gnawing or burning pain | *Gnawing or burning [[epigastric pain]] | ||
*Nausea | *[[Nausea/vomiting]] | ||
*Early satiety, bloating | *Early satiety, bloating | ||
*Heartburn | *Heartburn | ||
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*[[Pyogenic liver abscess]] | *[[Pyogenic liver abscess]] | ||
*[[Fitz-Hugh-Curtis Syndrome]] | *[[Fitz-Hugh-Curtis Syndrome]] | ||
*Hepatomegaly due to [[CHF]] | *[[Hepatomegaly]] due to [[CHF]] | ||
*[[Bowel obstruction]] | *[[Bowel obstruction]] | ||
*[[Pulmonary embolism]] | *[[Pulmonary embolism]] | ||
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==Evaluation== | ==Evaluation== | ||
*CBC (to rule out anemia) | *CBC (to rule out anemia) | ||
*BMP, LFTs | *BMP, [[LFTs]] | ||
*Lipase | *Lipase | ||
*Consider: | *Consider: | ||
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**?Barium swallow (upper GI series) | **?Barium swallow (upper GI series) | ||
**endoscopy (most will be done as outpatient) | **endoscopy (most will be done as outpatient) | ||
**RUQ US | **[[RUQ US]] | ||
**[[ECG]]/troponin | **[[ECG]]/[[troponin]] | ||
==Management== | ==Management== | ||
*Cessation of NSAIDs and | *Cessation of [[NSAIDs]] and [[ETOH]] | ||
*Eradicate H. pylori if identified in symptomatic patient | *Eradicate [[H. pylori]] if identified in symptomatic patient | ||
**Triple Therapy: PPI + [[clarithromycin]] 500mg BID + [[amoxicillin]]1g BID x 10-14d | **Triple Therapy: [[PPI]] + [[clarithromycin]] 500mg BID + [[amoxicillin]]1g BID x 10-14d | ||
***[[Metronidazole]] 500mg BID can be substituted for [[amoxicillin]] in penicillin-allergic individuals | ***[[Metronidazole]] 500mg BID can be substituted for [[amoxicillin]] in penicillin-allergic individuals | ||
**Quadruple Therapy: PPI + bismuth subsalicylate 524mg QID + [[metronidazole]] 250mg QID and [[tetracycline]] 500mg QID x 10-14d. | **Quadruple Therapy: [[PPI]] + [[bismuth subsalicylate]] 524mg QID + [[metronidazole]] 250mg QID and [[tetracycline]] 500mg QID x 10-14d. | ||
***Can be used in areas of high resistance to [[clarithromycin]] or metronidazole | ***Can be used in areas of high resistance to [[clarithromycin]] or [[metronidazole]] | ||
*PPI | *[[PPI]] | ||
**Generally heal ulcers faster than H2 | **Generally heal ulcers faster than [[H2 blocker]]s | ||
**[[Omeprazole]] 20-40mg QD | **[[Omeprazole]] 20-40mg QD | ||
*H2 | *[[H2 Blocker]]s | ||
**[[Famotidine]] 20-40mg QD | **[[Famotidine]] 20-40mg QD | ||
**[[Ranitidine]] 75-150mg BID | **[[Ranitidine]] 75-150mg BID | ||
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*Unexplained weight loss | *Unexplained weight loss | ||
*Early satiety | *Early satiety | ||
*Persistent vomiting | *Persistent [[vomiting]] | ||
*Dysphagia | *[[Dysphagia]] | ||
*Anemia or GI bleeding | *[[Anemia]] or [[GI bleeding]] | ||
*Abdominal mass | *Abdominal mass | ||
*Persistent anorexia | *Persistent anorexia | ||
*Jaundice | *[[Jaundice]] | ||
==See Also== | ==See Also== | ||
Revision as of 15:15, 14 September 2019
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 epigastric pain
- 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
Evaluation
- CBC (to rule out anemia)
- BMP, LFTs
- Lipase
- Consider:
Management
- Cessation of NSAIDs and ETOH
- Eradicate H. pylori if identified in symptomatic patient
- Triple Therapy: PPI + clarithromycin 500mg BID + amoxicillin1g BID x 10-14d
- Metronidazole 500mg BID can be substituted for amoxicillin in penicillin-allergic individuals
- Quadruple Therapy: PPI + bismuth subsalicylate 524mg QID + metronidazole 250mg QID and tetracycline 500mg 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