GASTRITIS

GASTRITIS - inflammation of the mucous membrane (sometimes even deeper layers) of the stomach wall.

Acute gastritis develops as a result of the influence of the following factors: bacterial infection - food toxic infections ; Nutritional factors - excessive overeating, especially when you use a large number of unusual sharp, coarse foods, as well as alcohol; Exposure to chemicals (strong alkalis, acids) and drugs (especially anti-inflammatory drugs); Exposure to allergens - food products (strawberries, eggs, etc.).

The most common is a simple gastritis . Suddenly, 4-8 hours after eating poor-quality foods, too much food, excessive intake of alcohol, there is nausea , combined with a feeling of faintness and sharp weakness. Soon, and sometimes at the same time, a feeling of bursting, a dull pain in the epigastric region, profuse vomiting , which brings some relief. Vomit first contain recently eaten foods. Repeated vomiting is accompanied by the release of mucus, sometimes bile. The urge to vomit can be very frequent and painful, combined with cramping pains in the epigastric region. There is a complete aversion to food. After vomiting, the patient experiences severe weakness, often becomes covered with a cold sweat. Sometimes a violation of the digestive function of the stomach is accompanied by diarrhea; Repeated vomiting and diarrhea can lead to significant dehydration of the body. At inspection the skin is pale, the tongue is dry, usually densely covered with a grayish-white coating. Sometimes a swelling in the epigastric region and a splash in the stomach are determined. Palpation of the epigastric region is moderately painful, but the stomach always remains soft.

Signs of intoxication are a moderate increase in body temperature, tachycardia , a decrease in blood pressure, neutrophilic leukocytosis can be detected in the blood.

Diagnosis of acute gastritis usually does not cause difficulties, but you should always bear in mind that many diseases can also occur with nausea, vomiting, pain in the epigastric region. Acute gastritis must be differentiated with acute appendicitis, acute cholecystitis, myocardial infarction. Vomiting is often observed in infectious diseases (influenza, meningitis, hepatitis) and acute disorders of cerebral circulation. A differential diagnosis with salmonellosis and other intestinal infections is mandatory.

In acute appendicitis, in contrast to gastritis, the maximum pain in palpation is determined in the right iliac region, in the same place - the tension of the abdominal muscles and symptoms of irritation of the peritoneum. Acute cholecystitis begins with an attack of hepatic colic, in the picture of the disease in the initial stages of pain predominates with characteristic irradiation, later pain is associated with palpation and tension of the abdominal muscles in the right upper quadrant of the abdomen; Fretting on the right costal arch is very painful. Sometimes it is possible to palpate a sharply painful enlarged gallbladder, later jaundice appears.

When meningitis, nausea and vomiting are combined with persistent severe headache, high fever. Objective research reveals symptoms of affecting the meninges.

Myocardial infarction is usually preceded by a period of increased episodes of angina pectoris, a heart attack begins with pain, cruel, painful. Even with gastralgic form of myocardial infarction and primary localization of pain in the epigastric region, the pain usually extends beyond the sternum, radiating to the scapula, arm. The development of an infarct is often accompanied by an early appearance of symptoms of left ventricular heart failure. The electrocardiographic study plays a decisive role in the diagnosis.

Emergency care in case of an established diagnosis of acute gastroenteritis should begin with gastric lavage with a 2% solution of sodium hydrogen carbonate (1 tablespoon per 1 liter of water) and alkaline water (Borzhomi, Essentuki No. 20). Washing is best done with a thick probe - until the stomach is completely cleansed of the rest of the food, that is, to clean water. In those cases where it is impossible to insert a probe, the patient is allowed to drink glasses of water followed by mechanical irritation with the fingers of the throat until vomiting occurs. After vomiting should be given a salt laxative (20 - 30 grams of magnesium sulfate in 400 - 500 ml of water). The patient should be put in bed, put on the stomach warmer. For severe pain, spasmolytic agents are used (atropine 0.5-1 ml 0.1% solution or platifillin 1 ml 2% solution subcutaneously). The combination of symptoms of intoxication, dehydration with arterial hypotension requires mandatory intravenous drip of fluids (isotonic sodium chloride solution with 5% glucose solution). In cases of severe gastroenterocolitis, with severe intoxication, signs of dehydration, hypotension after emergency treatment, the patient should be referred to a hospital - infectious or therapeutic department (depending on the preliminary diagnosis).

The prognosis with timely treatment is favorable, usually the duration of the disease does not exceed 1-4 days.

Corrosive gastritis develops when concentrated acids, alkalis enter the stomach and develop the necrosis of the stomach wall. The clinical picture depends on the nature of the damaging factor (alkalis often damages the esophagus, acid-stomach), its resorptive action, and also the degree of damage to the gastric mucosa. There are severe pains and burning sensations in the mouth, behind the breastbone and in the epigastric region, multiple painful vomiting with an admixture of mucus, blood, sometimes with scraps of the mucous membrane. Complications can be a collapse , bleeding and perforation of hollow organs, in case of secondary infection - peritonitis and mediastinitis , then - scarring of the esophagus, stomach, the formation of stenosis of the gatekeeper.

The diagnosis is based on the history and the clinical picture, when looking at the patient, they pay attention to the burn marks on the lips, the mucous membrane of the mouth (gray-white spots appear in case of burns with hydrochloric and sulfuric acids, yellow, greenish scabs - nitric acid, brownish-red - chromic acid) .

Emergency care includes rinsing the stomach with a large amount of cold water through a thin soft rubber probe, previously oiled, parenteral administration of antispasmodics (1 ml of 0.1% atropine solution, 2 ml of a 2% solution of papaverine or no-shpa), narcotic analgesics (morphine, promedola , Fentanyl), transfusion of isotonic sodium chloride solution and 5% glucose solution during collapse. A full-fledged treatment is possible only in a hospital, where the patient must be hospitalized immediately after first aid.

Phlegmonous gastritis develops with infection of the stomach wall with bacteria (usually streptococci) against a background of severe infection (sepsis, typhoid fever), ulcers or stomach cancer, gastric trauma by foreign body (including gastroscopy), stomach injury, poisoning with strong acids and alkalis.

Clinically characterized by acute onset with fever, intense pain in the epigastric region, nausea, vomiting, the appearance of peritonitis, toxic changes in peripheral blood (neutrophilic leukocytosis , increased ESR).

Differential diagnosis is carried out with acute pancreatitis accompanied by shingles in the abdomen, multiple painful vomiting, collapse, increased serum amylase levels; With a perforated ulcer of the stomach, which is characterized by the sudden appearance of daggerache in the abdomen, a dense strain of the muscles of the anterior abdominal wall and the involuntary immobile position of the patient.

With reflammatory gastritis, in addition to therapy with broad-spectrum antibiotics, surgical treatment is necessary - resection or drainage of the stomach, so a patient with suspected phlegmonous gastritis should be immediately hospitalized.

Chronic gastritis is a common disease that occurs as a result of the formation of antibodies to the gastric lining cells (autoimmune fundal gastritis is more common in the elderly and adulthood), due to infection of the gastric mucosa, more often Helicobacter pylori (bacterial antral gastritis occurs more often in young patients) In the stomach of duodenal contents (for example, after operations on the stomach and duodenum - reflux gastritis), and also for unknown reasons (idiopathic gastritis). Predisposing factors are long-term systematic violation of the regime and the nature of nutrition, alcohol abuse, smoking , use of medicines (primarily non-narcotic analgesics), chronic infections and diseases of the digestive system (cholecystitis, enterocolitis), metabolic disorders in diabetes, gout, etc. In the pathogenesis of the disease, the role of the secretory and motor function of the stomach plays a role, further inflammatory and dystrophic changes, atrophy of the gastric glands.

Often gastritis is asymptomatic. With normal or increased secretory function (in patients with infectious gastritis), heartburn, acidic eructation, sometimes vomiting , a feeling of rasporia, or pain in the epigastric region after eating can be observed; With exacerbation of gastritis may reveal a slight soreness in the epigastric region. With the growth of atrophy of the mucous membrane and a decrease in the secretory function of patients, unpleasant taste in the mouth, nausea , salivation, belching of the air are more often disturbed; Pain syndrome is not expressed. With severe atrophy of the gastric glands, the internal factor of Castle is not produced. This can lead to the development of B12-deficiency anemia , manifested by pallor, glossitis, neurological disorders, etc. Violation of the secretory and motor function of the stomach comes to the appearance of symptoms of intestinal dyspepsia, manifested by flatulence, unstable stools; On the background of chronic gastritis may also be remembered signs of asthenoneurotic syndrome (weakness, irritability, etc.).

The diagnosis of chronic gastritis can be established only with gastroscopy and morphological examination of biopsies with evaluation of the severity of inflammation (superficial, deep gastritis), the degree of gland atrophy (absent, partial, complete), metaplasia - transformation of the gastric mucosa; With the help of special tests in biopsy specimens the presence of Helicobacter pylori is determined.

In uncomplicated course of chronic gastritis, in most cases, treatment is not required; When Helicobacter pylori is detected, ampicillin , trichopolum or de-nol are prescribed ; With pronounced signs of inflammation - sucralfate (venter); Hospitalization is only indicated if there is a marked exacerbation of the disease and, if necessary, differential diagnosis of chronic gastritis and stomach cancer.

The prognosis is favorable (chronic gastritis in itself practically does not affect the duration and quality of life), however gastritis with pronounced signs of atrophy and metaplasia of the mucosa is considered as a precancerous condition.

Erosive gastritis - a common cause of bleeding from the upper parts of the digestive tract - can also be acute and chronic. Acute erosive gastritis occurs against a background of extensive trauma, head lesions, extensive burns, hemorrhage, shock, sepsis, renal or hepatic insufficiency. Usually the patient is in a serious condition, and it is not possible to detect any dyspeptic manifestations; The first sign of acute erosive gastritis is bloody vomiting (hematemesis) or tarry stool (melena). Diagnosis is established endoscopically, during the manipulation immediately carry out electrocoagulation of erosion. Further treatment includes antacid agents and H2-histamine receptor blockers (cimetidine, ranitidine).

Chronic erosive gastritis often develops when non-steroidal anti-inflammatory drugs are taken, as well as against Crohn's disease or a viral infection or without a visible cause (idiopathic erosive gastritis). Symptoms may be absent. Sometimes patients notice nausea, discomfort in the epigastrium; Most often patients seek medical help when symptoms of gastrointestinal bleeding occur.

Diagnosis is established with gastroscopy; Treatment includes antacid agents, blockers of H2-histamine receptors. With gastritis, which arose against the background of therapy with anti-inflammatory drugs (suppressing the production of prostaglandin E in the stomach), it is advisable to use misoprostol, a synthetic analogue of prostaglandin E, which has cytoprotective properties.