KNOW YOUR Health

WHAT IS GASTRITIS?
This is defined as the inflammation of the mucosa lining of the stomach which may be acute or chronic.

TYPES AND CAUSES

1. Acute gastritis:

Causes
👉 Highly seasoned food
👉 Over use of aspirin/NSAIDs
👉 Excessive intake of alcohol 👉 Bile reflux
👉Intake of strong acidic substances
👉 Burns and severe infection

2. Chronic Gastritis: This type last longer than the acute and has dull sensation.

Causes
👉Benign or malignant ulcers of the stomach
👉Bacteria Helicbacter pylori

PATHOPHYSIOLOGY

This is defined as the inflammation of the mucosa lining of the stomach which may be acute or chronic that may be caused by alcohol and over use of aspirin etc.
👉When there is inflammation of the mucosa lining of the stomach, it leads to inflammatory response thus resulting in swelling and tenderness of the wall.
👉When this occurs, nerves ending are compressed bringing about epigastric pain which is first felt as heartburn after eating, belching, a sour taste in the mouth and anorexia
👉Following the inflammatory process of the mucosa lining, the sub mucosa layer may become eroded by the effects of the hydrochloric acid thus leading to damage of the structure within it (blood vessles, lymph vessels and nerves).
👉Damage to blood vessles result in hemorrhage which when digested with food could be defecated as malaena (blood stained stool) or could be vomited as haemetemesis (vomiting of blood).
👉Due to vomiting and epigastric pain, there could be loss of appetite which leads to weight loss.

SIGNS & SYMPTOMS
 Chest pain
 Vomiting
 Anorexia
 Malaena
 Weight loss
 Haemetemesis
 Abdominal discomfort
 Heartburn

DIAGNOSTIC EVALUATION
 History taking and documentation.
 Complete blood count (CBC) to check for anaemia or low blood count.
 Examination of the stomach with an endoscope
esophagogastroduodenoscopy or EGD) with biopsy of stomach lining.
 H. pylori tests (breath test or stool test).
 Stool test to check for small amounts of blood in the stools, which may be a sign of bleeding in the stomach.

MANAGEMENT

👉 Chemotherapy:
 Analgesics: These are given to relieve the pain felt by the patient. Aspirin should be avoided since it may lead to bleeding.
 Antacid: This is given to reduce the acid level within the stomach e.g Aluminium hydroxide, magnesium oxide.
 H2 antagonists: famotidine (Pepsid), cimetidine (Tagamet) are given to reduce the effects of the acid.
 Antibiotics: This is administered following the diagnostic investigation.
 Proton Pump Inhibitors (PPIs): omeprazole (Prilosec). They are given to reduce the acid production.
👉 Fluid therapy: This is encouraged to prevent dehydration and also to know the functional level of the kidney.
 If gastritis is caused by ingestion of strong acids or alkalis, treatment consists of diluting and neutralizing the offending agent. To neutralize acids, common antacids (eg, aluminum hydroxide) are used; to neutralize an alkali, diluted lemon juice or diluted vinegar is used. If corrosion is extensive or severe, emetics and lavage are avoided because of the danger of perforation and damage to the esophagus.

NURSING MANAGEMENT

👉 Admission: Patient should be admitted in comfortable bed and allowed to rest.
👉 Rest/observation: Patient should be encouraged to rest. He should be observed from head to toe. His vital sign should also be observed.
👉 Fluid therapy: Administer fluid to prevent dehydration. Input and output chart should be monitored to prevent over dehydration.
👉 Drug therapy: Prescribed drugs should be administered and side effects should be watched out for.
👉Health education: Patient should be health educated on the following:
👉Stress management as this is a major factor that could lead to increased level of hydrochloric acid.
👉Dietary instructions: Encourage healthy diet. The nurse and patient review foods and other substances to be avoided (eg, spicy, irritating, or highly seasoned foods; caffeine; ni****ne)
 Alcohol consumption. Alcohol should be stopped.
 Taking of medications. Patient should be encouraged on the need to avoid self prescription of NSAID drugs.
 The nurse emphasizes the importance of keeping follow-up appointments with health care providers.

SAVE HER

Gone are the days when we used to cook fried rice with chicken to celebrate Independence Day.

The days when the streets were painted with green and white.

The days when clothing stores are packed with green and white shirts ready to be sold...

The days when people were itching to hear the 7 o clock speech from our president

Gone are the days when we see great match past from our children, our youths, our military, our civil servants.

What has happened to her?
Is she sick?
Can she be revived?
Is she dead?

So many questions with simple answers but complicated solutions.

The doctors handling her are not capable but won't let go.

They threaten to kill you if you want to save her.

They keep all her breast milk to themselves and allow her seed to die of starvation.

They throw drops of milk to silent the few grown ups who can talk and lock up the ones who refuse the epileptic offer.

They continually give her wrong dosage of her medicine.

They leave her in a dark ward where the noise of generators worsen her case.

They use the police to prevent her from being saved.

They only come to her seed when they want to rotate the leadership of the hospital.

No wonder the great Chinua Achebe said "There was a country"

Oh But...

Can we save her?
Who will save her?
How are we going to save her?

I don't have the answers, I don't have the finance to save her, I don't have the voice to save her but with the power of all her seeds, we can save her.

It is an Independence Day but not a Happy independence day

SAVE NIGERIA

Happy New Month

CASE STUDY: TYPHOID

“Slow rising, non localising, fever for a few days or a few weeks and without Rigors is likely enteric or brucellosis”.

1: Typhoid may start as sore throat which doesn’t respond to treatment for sore throat and fever keeps progressing (Salmonella Typhi proliferates in lymphoid tissue of oropharynx and then ileum).

2; Slow rising temperature due to slowly increasing bacteremia. With passing time, fever severity increases. So it’s more on day two, goes even higher on day 3 and so on.
Patient will not have Rigors due to slow onset bacteremia.

3: Non localising Fever. As it’s a bacteremia infection, it doesn’t give any localising symptoms or signs in first week. Localising symptoms may happen later in late second or third week if bacteria is not controlled and it starts settling in body organs. But localising symptoms in first week is not Typhoid. So by third week, either infection will be controlled by immune system etc or it may start complicating.

4: Ileal features are not seen in first week. Ileum is site of proliferation not the site of actual infection (Ileum is like a cantonment area for the bacteria, not the border area to fight). In late second or third week, Ileum may be attacked by immune system if infection is still going on. So ileal symptoms are seen late, not in first week. Presence of ileal symptoms in first week is not Typhoid but it can be other bugs infecting ileum such as compylobacter or yersinia or E.Coli etc. So Diarrhea, abdominal pain or constipation are not seen in first week. Even when Ileum is involved, subacute obstruction or perforation is more common than Diarrhea.

5: Blood culture is investigation of choice in first week. Bone marrow culture is also very rewarding but often not needed as it’s invasive test.

6: Serology such as Widal test may be positive in second week onward. So negative widal especially in first week doesn’t exclude enteric. However people living in endemic areas often have positive seology and only rising antibody titre is useful than single one time test.

Positive widal test doesn’t mean it’s Typhoid unless we document it with rising titre of antibodies in febrile patient OR it’s positive in proper clinical context of non localising fever in a person who isn’t living in endemic area. If a patient is afebrile, widal has no significance. If clinical picture isn’t suggestive of typhoid, widal has no significance. If it’s not rising titre of antibodies on repeating the test with an interval of 2-3 days, it’s not significant for patients living in endemic areas. Please don’t treat the widal test, treat the clinical picture.

Practically it’s more of a useless test than a useful test as by the time we document rising titre, it takes 4-5 days, false negative and false positive results and lack of specificity in endemic area where Typhoid actually exist.

7: Urine, f***l or bile culture may also be positive when bacteria starts seeding kidneys or bile in late second or third week.

8: Unlike TB etc Typhoid is an acute infection, doesn’t last for months. Also weight loss is either not there or not significant.

9: Being a gram negative bacteria, endotoxins mediated marrow suppression, myocardial suppression etc may be evident. Hence neutrophilia etc may not be seen or even patient may have leucopenia etc.

10: Skin rash is rare but classic one is rose pink macules mainly on abdominal wall, which may be easily missed in non-white population.

11: Complicated Typhoid Fever, seen after late second week or third week, can cause organ infections by bacterial seeding. These may be pneumonia, brain infection, bone and joint infections, kidney infection such as pyelonephritis, cholecystitis, hepatitis etc. Abscess formation is also possible.

12: Typhoid means “up in the clouds” so altered sensorium out of proportion to severity of infection may be seen and doesn’t necessarily means meningitis or encephalitis.

However focal neurological signs does indicate brain tissue involvement.

Ivf Ciproflox 200mg 12 hrly x 3/7 then, Tab Cipro 500mg.

NURSE KENT
_Working to make a Difference_