gastritisBy Group 10

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Anatomy and Physiology of Gastrointestinal

Mouth Salivary Gland

Oropharinx

Esophagus Peritoneal Cavity

Stomach

Small Intestine

Large Intestine

Gallblader

Pancreas

Mouth • Mechanical and chemical digestion begins in the mouth. The

teeth and tongue aid in mechanical breakdown, whereas the secretion of the salivary glands begins basic starch digestion and lubricate food to aid in swallowing.

Salivary GlandConsist of:o Parotid glando Submaxillary glando Sublingual glando There are some small salivary glands found in the lips, buccal mucosa, and palate.

Oropharinx • The oropharynx is the midpoint of the upper respiratory tract

and digestive tract. • The contents of the oropharynx include the soft palate, the

uvula, the tonsils and their pillars, and the base of the tongue.

Esophagus It begins in the neck at the lower border of the fifth cervical vertebra and connects the hypopharynx to the cardia of the stomach. On each side of the esophagus are the thyroid lobes and parathyroids.

Peritoneal Cavity• The parietal peritoneum is the tissue that lines the abdominal

wall. The mesentery is a double fold of parietal peritoneum that is fan shaped and encircles the jejunum and ileum attaching them to the posterior abdominal wall.

Stomach The function of stomach is to alter the consistency and the composition of ingested foods.

Small Intestine• As in outer segments of the gastrointestinal tract, the mucosa

is separated from the submucosa by the muscularismucosae. The submucosa contains the connective tissue, lymphatics, blood vessels, and nerves. Meissner’s plexus in the submucosa. The muscularis externa consists of an inner circular layer and an outer longitudinal layer. Auerbach’s (myenteric) plexus lies between the two muscle layers.

Large Intestine

Gallblader • The gallbladder is a pear-shaped sac,6 to 8 cm (3 to 4 inches)

long , and attached to the inferior surface of the liver. Its joined to the billiary tree by the cystic duct at the point where the hepatic duct becomes the common bile duct.

Pancreas Acinar cells of pancreas secrete the exocrine product , bicarbonate and pancreatic enzyme, and the endocrine secretions of insulin, glucagon , and gastrin are from the alpha , beta , and delta cells of islets of langerhans.

pathophysiology

• Gastritis refers to any diffuse lesion in the gastric mucosa that can be identified histologically as inflamed

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Acute gastritis is a short-lived inflammatory process affecting the mucosa of the stomach. It involves erosion of the mucosa. The mucosa is spotted with submucosal hemorrhages that resemble ecchymoses and may be round or linear. There may also be shallow erosions that appear as brown spots or red petechiae or small breaks in the mucosa. The hemorrhagic erosions usually involved the glandular layer, are extremely shallow, and are found anywhere in the stomach. Acute gastritis is more common in gastric ulcer than duodenal ulcer.There are a number of drugs , stimuli and

circumstance associated with acute gastritis, including aspirin, anty-inflammatory agents, alcohol, corticosteroids,major physiologis stress, and instense emotional reactions.

Acute gastritis

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• Superficial gastritis is characterized by an inflammatory infiltration of the lamina propria. Lymphocytes, plasma cells, eisonophils are found in the outer one third of the mucosa. The gastric glands are not involved.

• In athropic gastritis there is loss of fundic glands, parietal cells, and chief cells. The muscularis mucosa is split and thickened, and marked inflammation is present.

• Gastric athropy refers to marked or total glands loss with minimal inflammation. The mucosa is thinned.

• Two additional features may be seen in three types of chronic gastritis: intestinal metaplasia and pseudopyloric metaplasia.

• In type A gastritis involves the fundus, there is a marked reduction in acid secretion, hypergastrinemia, and eventually impaired vitamin B12 absorption. Type B involves the fundus and the antrum and has less reduction of acid secretions, normal gastrin levels, and only rare impairment of vitamin B12 absorption.

Chronic Gastritis

Etiology of Gastritis• Drinking alcohol• smoking nicotine• Using drugs over a long period of clinical observation such as aspirin,

Phenylbutazone, prednisone, indomethacin, ibuprofen, can cause gastric mucosal lesions, if the long-term effect on the gastric mucosa may cause chronic gastritis.

• Control diet, or overeating, or eating something too cool or too hot, or frequently eat certain spicy food (such as chili, bamboo shoots, rice, apple, plum, peach, etc)

• Other diseases such as pulmonary heart disease, liver cirrhosis, portal hypertension, could make long-term mucosal congestion, blocked circulation, nutrition, produced the gastric mucosal barrier causing chronic inflammation; oral cavity, nasopharynx or nasal cavity of chronic inflammation of the bacteria or toxin into the stomach to stimulate gastric so inflammatory, chronic gastritis can occur.

• Autonomic dysfunction caused by various reasons, long-term mental stimulation, depression, fatigue, etc

• Bile reflux in normal human liver

Clinical Appearances of GastritisAcute gastritisStomach•Asymptomatic; or vague complaints of postprandial distress after a large meal; or vague ulcerlike distress, particularly relieved by food•Massive gastrointestinal hemorrhage•History of aspirin or alcohol intake•History of hematemesis or melena•Nasogastric aspirate or stool heme positive for blood (in hospitalized patient)

Chronic gastritisStomach•Often asymptomatic•Diffuse, epigastric burning or pain that increase after eating large amounts; relieved by a small amount of antacidVomiting•Pernicious anemia•May be first clinical sign of chronic gastritis•Weakness, numbness and tingling in extremities; fever; pallor; anorexia; weight loss•Smooth or beefy red tongue

Diagnostic Assessment of GastritisAcuted Gastritis• Nasogastric aspiration• Endoscopy : Erosions, superficial ulcerations,

and diffuse oozing of blood when procedure is done during acute phase; after 3 days, lesions will begin to heal

• Angiographic visualization : To detect and treat lesions with infusion of vasopressin

• Double-contrast barium study : Superficial gastric erosion. Can not be used to detect bleeding lesions

Chronic Gastritis• Serum gastrin• Serum parietal cell antibodies• Pentagastrin stimulation • Serum pepsinogen I levels • Schilling test : Assessment of vitamin B12 absorption by measuring urinary

excretion of an oraldose of radiolabeled vitamin B12

• Barium swallow with double contrast : Appearance of a “bald fundus” and thinning of gastric ruage

• Endoscopy with biopsy and cytology : Biopsy necessary to obtain a definitive diagnosis. Cytology of multiple biopsy sites through the stomach is used to rule out gastric carcinomas

• Differential diagnosis : Rule out Zollinger-Ellision syndrome vs. chronic gastritis. High serum gastrin and high serum pepsinogen levels are andicative of Zollinger-Ellision syndrome; may also indicative multiple poorly healed ulcers.

Theraphy for Gastritis PatientsAcute gastritisSurgical : Partial gastrectomy, pyloroplasty, vagotomy, or total gastrectomy may be

indicated for managing patient with major bleeding from erosive gastritisChemotherapeutic• Histamine receptor • Antacids : Antacids recommended to help maintain alkaline pH• Fluid volume replacement : Intravenous fluid replacement during bleeding

episode to maintain volume. Blood replacement may required when gastrointestinal hemorrhage is associated with acute gastritis

• Pituitary hormone• Electromechnical : Ice water or saline lavage used in patient with

gastrointestinal bleeding. Laser therapy with direct coagulation of bleeding spots through an endoscopic approach may be utilized.

• Supportive : Removal of causative agents (alcohol, aspirin, non-steroidal anti-inflammatory agents). Withholding of food and fluids until vomiting and inflammation subside; then bland diet of medium temperature in acute gastritis without bleeding will assist healing process.

Chronic gastritis • Chemotherapeutic• Antacids to reduce or alleviate symptoms• Vitamins : Vitamin C (ascorbic acid) to facilitate iron

absorption in the patient with achlorhydria70. Vitamin B12 injections (cyanocobalamin, 1 mg/ml 100μg)

• Electromechanical : Routine endoscopy to asses formation of gastric polyps and gastric carcinomas in patients diagnosed with atrophic gastritis and gastric atrophy. Routine Schilling test or serum vitamin B12 levels to evaluated intrinsic factor deficiency

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