Download 12_Main symptoms and syndromes in diseases of a stomach

Main symptoms and syndromes in
diseases of a stomach and intestine
Methods of clinical, laboratory and
instrumental examinations in acute and
chtonic gastritis, peptic stomach and
duodenal ulcers, enteritis and colitis.
Khabarova N.A.
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Gastritis is an
inflammation of the
lining of the
stomach.
There are many
possible causes of
this disorder
including an
infection, an irritant,
an autoimmune
disorder, or a backup
of bile into the
stomach.
CLASSIFICATION OF CHRONIC GASTRITIS
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ADOPTED AT THE 9TH INTERNATIONAL CONGRESS OF
GASTROENTEROLOGISTS
( SYDNEY 1990) , MODIFICATED IN HOUSTON IN 1994
1. CHRONIC NONATROPHIC ( CHRONIC HELICOBACTERIC
GASTRITIS , CHRONIC ANTRIAL , TYPE «B») , WHICH REPRESENTS
ALMOST 70 % OF ALL GASTRITS TYPES.
2. CHRONIC ATROPHIC GASTRITIS ( AUTOIMMUNE , DIFFUSE
GASTRITIS OF STOMACH CORPUS , ASSOCIATED WITH
PERNICIOUS ANEMIA , ATROPHIC , TYPE A ) , PRESENT IN 15 – 18
% CASES OF CHRONIC GASTRITIES ; CHRONIC MULTIFOCAL
GASTRITIS.
3. SPECIAL FORMS OF CHRONIC GASTRITIS :
CHEMICAL ( REACTIVE CHRONIC GASTRITIS , WHICH OCCURS IN
CASE OF BILE REFLUX ( ABOUT 15 % ) , AFTER NSAID THERAPY (
ABOUT 10 % ) ;
GRANULOMATOUS ( IN CASE OF CROHN’S DISEASE ,
SARKOIDOSIS , TUBERCULOSIS ) ;
EOZINOPHILIC ( IN CASE OF BRONCHIAL ASTHMA , FOOD
ALLERGY ) ;
LYMPHOCYTIC ( WITH MANIFESTED LYMPHOCYTIC
INFILTRATION OF EPITHELIUM ) ;
GIGANT HYPERTROPHIC GASTRITIS ( MENETRIER’S DISEASE ) ;
RADIATION GASTRITIS
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Type B (Chronic
antral gastritis)
It principally affects
the antrum and is
associated with the
presence of
Helicobacter pylori on
the surface
epithelium. If
organism is not
present serological
tests show antibodies
against Helicobacter
pylori.
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Type A
(autoimmune
gastritis)
It is an autoimmune
disorder involving
the fundic glands of
stomach that
secretes both the
intrinsic factor and
acid. The antibodies
destroy the parietal
cells with loss of
acid and intrinsic
factor.
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Signs and Symptoms
The most common
symptoms of gastritis
are stomach upset and
pain. The following are
other symptoms of
gastritis.
Indigestion (also called
dyspepsia)
Heartburn
Abdominal pain
Hiccups
Loss of appetite
Nausea
Vomiting
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Diagnosis
There are several tests that may be
done to make a diagnosis.
These include endoscopy of the
stomach.
The laboratory tests may need
will depend on the specific cause
of gastritis.
A stool test may be used to check
for the presence of blood
A biopsy may be taken of the
tissues of stomach to determine
the cause of discomfort.
A breath test may detect H. pylori,
or samples from stomach may be
taken to look for this organism.
Normal mucous coat of
stomach
Acute gastritis
Type B (Chronic antral
gastritis)
Type A (autoimmune gastritis)
Chronic gastritis Type B
A breath test
H. Pylori
H. Pylori
pH-metry
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Treatment
Medications are often necessary to relieve
symptoms, eradicate an infection such as H.
pylori, and prevent or treat complications from
gastritis such as an ulcer.
Helicobactor pylori infestation, a common
bacterial cause of gastritis and ulcers, is
typically treated with a combination of drugs.
The typical combination includes antibiotics, a
bismuth compound, and a proton pump
inhibitor.
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Antacids such as calcium carbonate and magnesium hydroxide
with aluminum salts
H2 blockers such as ranitidine, cimetidine, nizatidine, and
famotidine
Proton pump inhibitors such as omeprazole and lansoprazole
Drugs that reduce stomach acid secretion help protect against
or treat ulcers. Other drugs used for ulcers include:
Misoprostol – protects against the major intestinal toxicity of
NSAIDS, and can reduce the formation of ulcers
Sucralfate – helps to heal ulcers in the stomach
In case of atrophic gastritis, either stimulating or replacement
therapy is administered. Stimulating therapy includes
metabolic drugs, replacement therapy includes gastric juice or
acidin pepsin.
Peptic Ulcer
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Peptic ulcer is a general
chronic and relapsing
disease characterized by
seasonal exacerbations
with ulceration of the
stomach wall or the
duodenum.
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Causes
Helicobacter pylori (H. pylori), a bacterial organism, is
responsible for most ulcers. This organism weakens the
protective coating of the stomach and duodenum and allows
the damaging digestive juices to irritate the sensitive lining
below.
Non-steroidal anti-inflammatory drugs (NSAIDs) – ongoing
use of this class of medications is the second most common
cause of ulcers.
Zollinger–Ellison syndrome.
Other causes of ulcers are conditions that can result in direct
damage to the wall of the stomach or duodenum such as heavy
use of alcohol, radiation therapy, burns, and physical injury
Signs and Symptoms
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Abdominal pain with a
burning or gnawing
sensation
Heartburn
Indigestion (dyspepsia)
Belching
Nausea
Vomiting
Poor appetite
Weight loss
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PAIN
Site: Epigastrium
Character: Burning in character
Radiation:
Pain is localized and patient is
able to point it with his one finger
"pointing sign".
Time of pain:
Soon after eating within 15-30
minutes in gastric ulcer while 2-3
hours after eating in duodenal
ulcer that frequently awakens the
patient at night.
Relation with food:
Patient with gastric ulcer are
afraid to eat because it causes pain
due to release of acid in response
to food. Patients with duodenal
ulcer feel pain in empty stomach
and get relief after taking food
which causes partial
neutralization of acid.
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Aggravating factors:
Smoking
Excessive intake of coffee and tea
Alcohol
Eating precipitates pain in gastric ulcer while
missing a meal in duodenal ulcer.
Relieving factors:
• Antacids and milk
•. Vomiting relieves pain in gastric ulcer
• Intake of food relieves pain in duodenal ulcer
Periodicity:
Pain comes and goes in a 2-3 month cycle in gastric ulcer
In duodenal ulcer episode occurs with 4-6 month cycle,
often worse in spring and autumn.
Duration of attack:
A few weeks in gastric ulcer
A month or two in duodenal ulcer
•COMPLICATIONS:
Hemorrhage
melena
Penetration
Perforation
Malignization
malignant [neoplastic] transformation
Pyloric obstruction
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Investigation
One of two tests will be performed to try to identify
an ulcer:
Endoscopy
Upper gastrointestinal (GI) series
DIAGNOSIS OF H.PYLORI
Histology
Rapid urease activity test
Other tests that may be performed to look for H.
pylori include a blood test checking for antibodies to
this organism, a breath test after drinking a substance
called urea, and a stool test looking for the organism
in the feces.
Lumen of the duodenum of a healthy human male. White
spots are reflections of the light source.
Endoscopy
Endoscopy
X-ray Study
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Treatment
The main goals for treating a peptic ulcer include
eliminating the underlying cause (particularly H.
pylori infection or use of NSAIDs), preventing
further damage and complications, and reducing
the risk of recurrence. Medication is almost
always needed to alleviate symptoms and must be
used to eradicate H. pylori. Surgery is required for
certain serious or life-threatening complications
of peptic ulcers and may be considered if
medications are not working. Even with
medications, many lifestyle factors, including
making changes in diet, are important.
Medications
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"Triple therapy" (including a proton pump inhibitor [for
example, omeprazole] to reduce acid production and two
antibiotics to get rid of the organism) is commonly used to
treat H. pylori-related ulcers. Instead of one of the antibiotics,
bismuth salicylate may be the third medication recommended.
Some of the same drugs are used for non-H. pylori ulcers as
well as for symptoms (like indigestion) due to ulcers of any
cause:
Antacids, available over the counter, may relieve heartburn or
indigestion but will not treat an ulcer
H2 blockers, such as cimetidine, ranitidine, nizatidine, and
famotidine, reduce gastric acid secretion.
Misoprostol
Proton-pump inhibitors, including esomeprazole, lansoprazole,
omeprazole, pantoprazole, and rabeprazole, decrease gastric
acid production.
Sucralfate
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Enteritis is an inflammation of the small intestine caused by a
bacterial or viral infection.
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Types of enteritis include:
Food poisoning
Salmonella enteritis
Shigella enteritis
Staph aureus food poisoning
Campylobacter enteritis
E. coli enteritis
Bacterial gastroenteritis
Radiation enteritis
Crohn's disease and regional enteritis
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Campylobacter jejuni Enteritis
Colitis is an inflammation of the large
intestine that can be caused by many different
disease processes.
 These processes include acute and chronic
infections, inflammatory disorders (ulcerative
colitis, Crohn's colitis, lymphocytic and
collagenous colitis), lack of blood flow
(ischemic colitis), and history of radiation to
the large bowel.
Procedures
Sigmoidoscopy - May be diagnostic in ulcerative colitis
• Colonoscopy - Helps by ruling out more serious
disorders.(Tissue biopsy and further studies may help in
diagnosis.)
Other studies that can identify colitis include:
 Barium enema
 Abdominal CT scan
 Abdominal MRI
 Abdominal x-ray
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