Gastroenterology SubdivisionCase Report

CHRONIC GASTRITIS Department of Child Health, Medical School Hasanuddin University dr. Wahidin Sudirohusodo General Hospital, Makassar

INTRODUCTIONGastritis dyspepsia which inflammation signs and hipersalivation in the stomach.Acute gastritis suddenly and lasts briefly. Chronic gastritis longer lasting or recurrent.

Symptoms of gastritis include:Stomach painIndigestionBurpingHiccupingLoss of appetiteNausea and vomitingBloody or black vomitDark black, tarry stools

CASE REPORTA, a girl, 13 years old, admitted to the dr. Wahidin Sudirohusodo General Hospital, on 2 nd July 2006 with vomiting.

HISTORY TAKING A girl consulted to gastroenterologi subdivision by respirology subdivision because of : -Vomiting 1 day ago, > 5 x/day, no projectile. - Her appetite - She complain in stomach pain

Fever 1 day ago, no continue- Cough with mucous, but no dyspneu.Bowel movement and micturation were normal.There was history of stomach pain about 1 year.

PHYSICAL EXAMINATION- Physical examination : a moderately ill.BT : 38,8 CPain of the suprapubic and epigastric

LABORATORY EXAMINATION- Routine Blood : WBC 12.900/mm- Blood Electrolyte : Natrium 135 (136-145) mmol/l Kalium 2,8 ( 3,5 - 5,1 ) mmol/l , Chlorida 103 ( 97- 111 ) mmol/l.- Routine urine : Sediment : WBC 10- 15 / HPF,RBC 4- 6 /HPF.

WORKING DIAGNOSIS :DyspepsiaTHERAPY :IVFD KAEN 3 B : 44 drops/min.Vitamin B Complex 2 x 1 tab

FOLLOW UPThird day :- General condition was weakBT : 38,1CStomach pain (+)Therapy : IVFD KAEN 3 B 44 drops/min Semisolid food Ranitidine 2 x 150 mg/oral/day.

Urine : WBC +25/ul, sediment 10-13/HPF.Fifth day : Stomach pain Therapy continueAbdominal USG : Normal limit

Sixth day :- BT : 38 CNausea (+), vomiting (+), headache (+)Suprapubic pain (+)Stomach pain (+)Therapy continue

Nineth day :- BT : 38,3 CSuprapubic pain (-)Stomach pain (-)Therapy :Advise from supervisor gastroenterology subdivision : Antacid 3 x 500 mg/oral/day, Ranitidine 2 x 150 mg/oral/day, Amoxicillin 3 x 500 mg/oral/day, Tetracyclin 4 x 500 mg/oral/day.

MDO Examination :- Chronic gastritis with hypersecretion signs.

Tenth day :- BT : 38 CHer appetite was goodTherapy continueParents of patient was discharged.

DEFINITIVE DIAGNOSE :Chronic Gastritis

PROGNOSIS : Qua ad vitam : bonam Qua ad sanationen : dubia

DISCUSSION :Gastritides can be classified based on the underlying etiologic agent : - Helicobacter pylori, - bile reflux, - nonsteroidal anti-inflammatory drugs [NSAIDs], - autoimmunity, - allergic response - alcohol,

- severe stress - viral infection - fungal infection - injury - radiation treatment and the histopathological pattern: H pyloriassociated multifocal atrophic gastritis. endoscopic appearance of the gastric mucosa : varioliform gastritis.

H.Pylori main cause of true gastritis H. Pylori Spiral, S 0,5 x 0,3 m, Gr (-) rods, highly motile because of multiple unipolar flagella ( 3-5 ), potent producers of the enzyme urease, catalase,and oksidase. .

For this case :Helicobacter gastritis because of :- Gastritis H.pylori main cause of gastritis.There wasnt hystory of drink drugs or other causes.Chronic gastritis because of :There was histrory stomach pain about 1 year.X ray contrast.

Diagnosis Helicobacter gastritis :Urea Breath Test : (NH) 13-14 CO + H2O + 2H+ 13-14CO2 + 2 NH4 EndoscopyBiopsy

Therapy :Dual Therapy : Proton pump inhibitor + AbTriple Therapy : between Ab or bismuth subsalicylate.Combination of triple therapy + anti secretory drugs.

SUMMARY A case of chronic gastritis in a 13 years old girl is reported. The diagnosis was established on the basis of clinical features and conrast x ray . The prognosis qua ad vitam : bonam and qua ad sanationem : dubia.

Picture 1. Helicobacter pyloricaused chronic active gastritis. Genta stain (20X). Multiple organisms (brown) are visibly adherent to gastric surface epithelial cells.

Picture 2. Chronic gastritis associated with Helicobacter pylori infection. Numerous plasma cells in the lamina propria.

Picture 6. Chronic gastritis. Chemical gastropathy. Courtesy of Sydney Finkelstein, MD, PhD, University of Pittsburgh.

Picture 4. Chronic gastritis. Mycobacterium avium-intracellulare in gastric lamina propria macrophages. Courtesy of Sydney Finkelstein, MD, PhD, University of Pittsburgh.