Difference between revisions of "Gastritis"

(Text replacement - "*ECG" to "*ECG")
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==Background==
 
==Background==
 +
[[File:Gray1046.png|thumb|Stomach anatomy]]
 +
[[File:Illu stomach2.jpg|thumb|Stomach wall anatomy]]
 
*Inflammation of the stomach lining
 
*Inflammation of the stomach lining
 
*May occur acutely or chronically
 
*May occur acutely or chronically
 
*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 in epigastric area
+
*Gnawing or burning [[epigastric pain]]
*Nausea, vomiting
+
*[[Nausea/vomiting]]
 
*Early satiety, bloating
 
*Early satiety, bloating
 
*Heartburn
 
*Heartburn
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
===[[Epigastric pain|Epigastric Pain]]===
+
{{Abdominal Pain DDX Epigastric}}
*[[GERD]]
 
*[[Peptic ulcer disease]] with or without perforation
 
*[[Gastritis]]
 
*[[Pancreatitis]]
 
*[[Gallbladder Disease (Main)|Gallbladder disease]]
 
**[[Acute cholecystitis]]
 
**[[Cholangitis]]
 
**[[Symptomatic cholelithiasis]]
 
**[[Acalculous cholecystitis]]
 
*[[Myocardial Ischemia]]
 
*[[Splenic Infarction]]enlargement/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==
 
==Evaluation==
 +
[[File:PMC5316417 10120 2016 680 Fig4 HTML.png|thumb|Conventional white-light endoscopic findings for the gastric body. (a) Normal (b) Gastric mucosa with chronic atrophic gastritis associated with HP infection. Visible vessels and an absence of folds in the gastric body mucosa are characteristic of chronic atrophic gastritis.]]
 
*CBC (to rule out anemia)
 
*CBC (to rule out anemia)
*BMP, LFTs
+
*BMP, [[LFTs]]
 
*Lipase
 
*Lipase
 
*Consider:  
 
*Consider:  
**Acute abdominal series
+
**[[Acute abdominal series]]
 
**?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 Etoh
+
*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 blockers
+
**Generally heal ulcers faster than [[H2 blocker]]s
 
**[[Omeprazole]] 20-40mg QD
 
**[[Omeprazole]] 20-40mg QD
*H2 Blockers
+
*[[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==
[[PUD]]
+
*[[PUD]]
  
 
==References==
 
==References==

Latest revision as of 13:34, 2 May 2020

Background

Stomach anatomy
Stomach wall anatomy

Clinical Features

Differential Diagnosis

Epigastric Pain

Evaluation

Conventional white-light endoscopic findings for the gastric body. (a) Normal (b) Gastric mucosa with chronic atrophic gastritis associated with HP infection. Visible vessels and an absence of folds in the gastric body mucosa are characteristic of chronic atrophic gastritis.

Management

Disposition

  • Normally outpatient management, unless complication (see below)

Red Flags

Any of the following suggest need for endoscopy referral:

See Also

References