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Gastritis includes a myriad of disorders that involve inflammatory changes in the gastric mucosa, including:
1. erosive gastritis caused by a noxious irritant
4. infectious gastritis
5. gastric mucosal atrophy
Acute gastritis
an acute mucosal inflammatory process, usually of a transient nature severe erosive form is an important cause of acute gastrointestinal bleeding
Pathophysiology
The mechanisms of mucosal injury in gastritis and PUD are thought to be an imbalance of aggressive factors
Pathophysiology
Erosive gastritis usually is associated with serious illness or with various drugs. Stress, ethanol, bile, and nonsteroidal antiinflammatory drugs (NSAIDs) disrupt the gastric mucosal barrier, making it vulnerable to normal gastric secretions.
Pathophysiology
NSAIDs and aspirin also interfere with the protective mucus layer by inhibiting mucosal cyclooxygenase activity, reducing levels of mucosal prostaglandins
Sex:
Male-to-female ratio
of gastritis is
approximately 1:1
Age:
An estimated 60% of Americans older than 60 years harbor H pylori. Duodenal ulcers usually occur in those aged 2575 years. Gastric ulcer incidence peaks in those aged 55-65 years.
Acute gastritis
Acute gastritis
Acute hemorrhagic gastritis Acute erosive gastritis Acute stress gastritis
Physical
Causes
H pylori (most common cause of ulceration) NSAIDs, aspirin Gastrinoma (Zollinger-Ellison syndrome) Severe stress (eg, trauma, burns), Curling ulcers Alcohol Bile reflux Pancreatic enzyme reflux Radiation Staphylococcus aureus exotoxin Bacterial or viral infection
Differential diagnosis
Acute Coronary Syndrome [Aneurysms, Abdominal] Cholangitis Cholecystitis and Biliary Colic Cholelithiasis Diverticular Disease Esophagitis Gastroenteritis Hepatitis Inflammatory Bowel Disease
Differential diagnosis
Mesenteric Ischemia
Myocardial Infarction
Pancreatitis
Pulmonary Embolism
Renal Calculi
Complications:
Malignancy
Hemorrhage
Perforation Obstruction
Patients should be warned of known or potentially injurious drugs and agents. Some examples are as follows: o NSAIDs o Aspirin o Alcohol
Chronic gastritis
Hypertrophic gastritis
circulating antibodies to parietal cells and intrinsic factor hypo- or achlorhydria a high intragastric pH and hypergastrinemia 10% of patients go on develop overt pernicious anemia associated with autoimmune disorders such as Hashimotos thyroiditis and Adisons disease
- the most common form of gastritis in all age groups - irregularly focal involvment of the antral mucosa - gradually extends deeper into the mucosa and cause mucosal atrophy
Hypertrophic gastritis
Three variants are recognized
All three types are characterized by giant cerebriform enlargement of the rugal folds of the gastric mucosa
Stress ulcers
Shock
Extensive burns
Sepsis
Trauma Brain tumors and following intracranial surgery
Mucosal ischemia
Stress ulcers
Those associated with intracranial problems are referred to as Cushings ulcers. Those associated with shock an extensive burns are referred to as Curlings ulcers.